Prior Authorization Reform Is Overdue. DME Providers Have Known That for Years.
A new bipartisan bill would cap Medicare Advantage prior auth response times at 72 hours. For DME providers who've absorbed these delays for years, it's welcome news — but the industry pressure doesn't stop there.
If you've spent any time running a DME operation, you already know the drill. You submit a prior authorization request. You wait. You follow up. You wait some more. Meanwhile, a patient who needs a power wheelchair, oxygen concentrator, or CPAP device is sitting at home without it.
That wait isn't just frustrating, but it has real consequences for patients and for your business.
So when AAHomecare formally endorsed the Medicare Advantage Improvement Act of 2026 on June 18th, it was the kind of news the HME industry has been pushing for for years. The bipartisan bill (H.R. 8375 & S. 4384) would require Medicare Advantage plans to respond to standard prior authorization requests within 72 hours and expedited requests within 24 hours.
It's a big deal. Here's why it matters, and what it means for how you run your operation right now.
What the Bill Actually Does
The Medicare Advantage Improvement Act of 2026 goes beyond just putting a clock on prior auth decisions. Key provisions include:
72-hour response requirement for standard prior authorization requests
24-hour response requirement for expedited requests
Coverage criteria alignment — Medicare Advantage plans would be prohibited from using criteria more restrictive than traditional Medicare
Increased transparency and claims integrity requirements for MA plans
The legislation has broad support from provider groups, including AAHomecare, which called it "a major step forward for patients and the home medical equipment providers who serve them."
Why This Matters for DME Providers Specifically
Medicare Advantage now covers more than half of all Medicare-eligible beneficiaries. That means prior authorization bottlenecks in MA plans aren't an edge case, but a daily reality for most DME suppliers.
The downstream effects are real:
Cash flow disruption from delayed approvals holding up delivery and billing
Staff time consumed tracking, following up, and resubmitting requests
Patient dissatisfaction when equipment doesn't arrive when expected
Lost orders when patients or referral sources give up and go elsewhere
For providers operating on thin margins, these aren't minor inconveniences. They are operational drains that compound over time.
The Honest Take: Reform Is Welcome, but Not a Full Solution
We're rooting for this bill, but passing legislation is one thing — implementation is another. Even if the 72-hour clock becomes law, prior authorization will still exist. Requests will still need to be documented, submitted, and tracked. The administrative burden doesn't disappear; it just gets a deadline.
That's exactly why having software that handles prior auth workflows efficiently isn't a nice-to-have — it's a competitive necessity.
Providers who have already invested in streamlined documentation and submission processes will be positioned to take full advantage of faster response times when the law takes effect. Those who are still managing prior auth through spreadsheets, faxes, or disconnected systems will still be fighting uphill — just with a slightly shorter timeline.
What You Should Be Doing Now
Regardless of whether the bill passes this session, here are three things every DME provider should evaluate:
Audit your prior auth workflow. How many staff hours per week go into tracking authorization status? Where do requests fall through the cracks?
Know your approval rate. Under current CMS rules, providers with a 90%+ claim approval rate may qualify for prior authorization exemptions on certain items. Do you know where you stand?
Make sure your software is working for you, not against you. If your team is manually entering the same data in multiple systems, chasing down documentation that should already be attached, or missing deadlines because nothing is automated — that's a software problem, not a people problem.
The Bottom Line
The Medicare Advantage Improvement Act of 2026 is a signal that the industry's frustration with prior auth delays has finally reached a tipping point. DME providers have been saying for years that these bottlenecks harm patients and operators alike — and lawmakers are starting to listen.
At Curasev, we've built our platform around the reality that DME operations are complex, compliance-heavy, and constantly evolving. Prior auth reform — whether it comes through legislation, CMS rule changes, or technology — is something we're actively building toward alongside our customers.
Because at the end of the day, faster approvals mean faster deliveries. And faster deliveries mean patients getting the equipment they actually need.
Prior authorization (PA) is the approval a payer requires before certain DME items are provided and billed. For DME and HME providers, PA is one of the most time-consuming and denial-prone parts of the workflow, because each payer has different rules, documentation requirements, and timelines. Missing or incorrect prior authorization is a leading cause of denied claims and delayed payments in the DMEPOS space. That is why automating and tracking PA is central to a healthy DME revenue cycle.
Prior authorization reform refers to federal and payer-level efforts to make PA faster, more transparent, and more electronic - including rules pushing payers toward standardized electronic prior authorization, shorter decision timelines, and clearer requirements. For DME providers, these changes are meant to reduce the administrative burden and delays that PA creates. But reform also means providers need software that can keep up with new electronic PA workflows and changing documentation rules, rather than relying on phone calls and faxes.
PA automation uses software to check whether an item needs authorization, gather the required documentation, submit the request electronically, and track its status - all from within the order workflow. This reduces the manual phone calls and faxing that slow intake, cuts the errors that cause PA denials, and shortens the time from referral to delivery. Automated prior authorization is one of the highest-ROI capabilities in modern DME software because it protects both revenue and the patient's speed to therapy.
Most PA denials trace back to front-end problems: missing documentation, an incomplete CMN, the wrong payer rules, or a request submitted after the item was already provided. Because requirements vary by payer and change often, manual PA processes are especially prone to these errors. Catching authorization requirements at intake - and attaching the right documentation before the order moves forward - is the most reliable way to prevent PA denials and protect your days in A/R.
Good DME software flags authorization requirements automatically at intake, surfaces the exact documentation each payer needs, submits requests electronically where supported, and tracks every PA to resolution with clear status and alerts. It should also connect PA to the rest of the order and billing workflow, so an approved authorization flows straight through to the claim. This keeps orders moving, reduces denials, and gives managers visibility into where authorizations are stuck.
Curasev builds prior authorization into the order workflow rather than treating it as a separate, manual chore. It flags when PA is required, helps assemble the right documentation from intake, and tracks each authorization so nothing slips through - keeping providers ahead of changing PA rules and reform requirements. The result is fewer authorization denials, faster time to delivery, and a cleaner revenue cycle, all in one modern, cloud-based DME platform.
Curasev's Seva AI automates DME/HME document intake by capturing, classifying, and extracting data from faxes, emails, and cloud storage to create a "billing-ready" workflow.
Stop forcing your team to work around outdated software. Our end-to-end platform is built to mirror your specific HME workflow—from the first referral intake to the final collection.
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