What just happened in Congress
On June 25, the House Energy and Commerce Health Subcommittee voted to advance H.R. 3514, the Improving Seniors' Timely Access to Care Act, sending it toward the full House. The House Ways and Means Committee has also advanced the measure. The bill, backed by the American Medical Association and the Society of Interventional Radiology, aims to streamline what has been described as the "often cumbersome and time-consuming" task of approving requests for medical imaging and other services.
The legislation is among the most widely supported health bills in Congress, with roughly 380 cosponsors across the House and Senate and endorsements from more than 500 organizations. AMA CEO John Whyte framed the stakes bluntly, saying the bill "would eliminate unnecessary administrative red tape in Medicare Advantage to ensure that critical, lifesaving care is no longer delayed by an overused prior authorization process," as reported by Radiology Business.
In practice, the bill would require Medicare Advantage plans to implement electronic prior authorization, clarify HHS authority to set decision timeframes — including real-time decisions for items and services that are routinely approved — and require plans to report their approval and denial rates to CMS. The direction is unambiguous: fewer barriers, faster answers.
How big is the prior authorization problem in imaging?
The scale is substantial. Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, of which about 4.1 million — 7.7% — were denied, according to KFF. That denial rate was up from 6.4% in 2023. Notably, only 11.5% of denials were appealed, yet 80.7% of appealed denials were partially or fully overturned, suggesting a large share of denied requests were valid in the first place.
Advanced imaging sits squarely in the crosshairs. A 2022 HHS Office of Inspector General report found that Medicare Advantage plans sometimes denied medically necessary advanced imaging — such as MRI — by applying clinical criteria stricter than Medicare's own coverage rules, for example requiring an X-ray before approving more advanced imaging.
The clinical cost lands on patients and physicians alike. In the AMA's 2024 prior authorization survey, 94% of physicians said prior authorization delays access to necessary care, 78% reported that patients abandon treatment because of authorization challenges, and 24% said prior authorization had led to a serious adverse event for a patient in their care.
What reform actually changes: the volume math
Prior authorization functions as an upstream valve on imaging demand. Every request that is denied, delayed, or abandoned is a scan that never reaches the scanner — or reaches it weeks late. Reform loosens that valve. Real-time approvals for routinely authorized studies and electronic processing both reduce the friction between an ordering physician and an approved study.
This layers on top of a regulatory shift already in motion. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), finalized in January 2024, already requires impacted payers — including Medicare Advantage — to return prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard ones, with operational provisions phasing in from 2026. Legislation and regulation are pushing in the same direction.
The predictable result: more approved CT and MRI studies flowing into the reading room, sooner. That is good for patients. It also relocates the operational constraint. When approvals stop being the bottleneck, the next binding constraint becomes reporting turnaround — the interval between a completed scan and a signed, actionable report.
Where the constraint moves next
Radiology already operates under a persistent supply-demand imbalance: imaging volumes rise while the radiologist workforce grows slowly. Removing an approval barrier without adding reading capacity simply pushes the queue from the payer's inbox to the radiologist's worklist. Faster approvals do not create faster reads.
That is where reporting workflow becomes the lever. Three implications follow for imaging centers, teleradiology providers, and hospital imaging departments planning for a higher-throughput environment:
Approvals speed up; reads must keep pace
If more studies clear prior authorization, turnaround becomes the metric referrers and patients feel. Capacity planning has to account for the read, not just the scan — otherwise reform trades an approval backlog for a reporting backlog.
Draft-first reporting absorbs added volume
AI that produces a structured, comprehensive report draft lets a radiologist start from a working document rather than a blank template. That shifts the radiologist from transcription to review and judgment, where their expertise is most valuable — a practical way to handle more studies without extending turnaround.
A radiologist stays accountable for every read
Higher volume must not mean lower oversight. A radiologist-in-the-loop model — where AI drafts and a physician reviews and signs every report — keeps accountability intact even as throughput climbs.
Upstream vs downstream: where the bottleneck sits
The table below traces how the constraint on imaging throughput moves as prior authorization reform takes hold.
| Stage | Before reform | After reform |
|---|---|---|
| Approval | Manual, days-to-weeks; frequent denials and appeals | Electronic, real-time for routine studies; fewer barriers |
| Scan volume reaching the reading room | Suppressed by delayed and abandoned requests | Higher — more approved CT and MRI studies, sooner |
| Binding constraint | Payer prior authorization | Reporting turnaround and reading capacity |
| Lever that helps | Policy and appeals | Draft-first AI reporting with in-house review and final sign-off by the reading radiologist |
Where this fits with AI CT reporting
Policy that increases imaging volume raises a question every imaging operation will face: can turnaround hold as more studies arrive? AI CT reporting is built for exactly this pressure. A foundation-model approach produces a structured, comprehensive report draft across findings rather than flagging a single pathology, and a radiologist reviews and signs every report before it reaches the chart. When prior authorization reform pushes more scans downstream, ready-to-sign drafts are how a reading room absorbs the volume without letting turnaround slip — and without removing the radiologist from the loop.
Frequently asked questions
What is the Improving Seniors' Timely Access to Care Act?
It is bipartisan legislation (H.R. 3514 in the House, S. 1816 in the Senate) that would reform prior authorization in Medicare Advantage. It requires plans to implement electronic prior authorization, clarifies HHS authority to set decision timeframes including real-time decisions for routinely approved items, and requires plans to report approval and denial rates to CMS. On June 25, 2026, the House Energy and Commerce Health Subcommittee voted to advance H.R. 3514; the House Ways and Means Committee has also advanced the measure.
How does prior authorization slow down radiology imaging?
Advanced imaging such as MRI and CT is frequently subject to prior authorization in Medicare Advantage, and approvals can be time-consuming. In a 2024 AMA survey, 94% of physicians said prior authorization delays access to necessary care and 78% reported that patients abandon treatment because of authorization challenges. A federal watchdog found Medicare Advantage plans sometimes denied medically necessary advanced imaging using rules stricter than Medicare's own coverage criteria.
How many prior authorization requests do Medicare Advantage plans handle?
Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, of which about 4.1 million (7.7%) were denied, according to KFF. Only 11.5% of denials were appealed, but 80.7% of appealed denials were partially or fully overturned — evidence that many denied requests were ultimately valid.
Why does prior authorization reform matter for radiology reporting turnaround?
If fewer scans are blocked or delayed at the approval stage, more imaging studies reach the reading room. The constraint on throughput then shifts downstream to reporting turnaround — how quickly radiologists can read and sign studies. AI that produces a structured, comprehensive report draft for a radiologist to review and sign helps absorb that added volume without extending turnaround times.
Sources: House committee action and AMA CEO quote as reported by Radiology Business; bill text and status via Congress.gov (H.R. 3514) and Sen. Marshall's office; prior authorization volume and denial data from KFF and the HHS OIG; physician burden from the AMA 2024 survey; decision-timeframe rule from CMS. Figures are rounded as reported.