How prior authorization affects revenue at Pinnacle GI Partners centers


Pinnacle GI Partners said it hasn't seen major effects from prior authorization at its ASCs, but the paperwork approvals have affected more than one-third of the platform's overall revenue.

Partha Nandi, MD, president and CMO of Pinnacle GI Partners, told Becker's ASC Review how prior authorizations affect finances for the company and its ASCs.

Question: How much do you estimate prior authorization to affect revenue at your center?

Dr. Partha Nandi: For the total practice, at least 35 to 40 percent of revenue is affected overall, due to the fact that a majority of infusions require prior authorization, and at least a third of upper endoscopies and anesthesia now require authorizations.

For just the ASC facility charge, it would be considerably less, as it is just about one-third of upper endoscopies and very few colonoscopy procedures. I would estimate about 15 to 20 percent of revenue is affected in the ASC.


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