Prior Authorization & Re-Authorization: Why Perfectly Coded Cases Still Get Denied.

Even flawless coding can't save a claim when the authorization doesn't match the procedure performed. In this episode, orthopaedic surgeons Dr. Hao-Hua Wu and Dr. Michael Rohmiller join Maia CEO Zach Ruhl to break down one of the most underestimated revenue risks in orthopaedic practices: the gap between what gets authorized and what actually happens in the OR.

The conversation digs into why prior auth remains a manual, time-consuming bottleneck — and how mismatches between planned and performed procedures quietly drive denials, underpayments, and scheduling delays.

What we cover:

• Why auth misalignment creates denials and delays even on perfectly coded cases.
• The hidden administrative burden surgeons carry — from documenting payer-specific approval processes to catching missed billing codes.
• Why one practice found 30% irregularities between what was submitted for authorization and what payers actually reimbursed.
• The brutal timeliness requirements of retro-authorizations, with some payers demanding turnaround in as little as 24 hours.
• How expired authorizations and incorrect procedure scope erode revenue.
• What an automated future looks like: submitting codes for pre-cert without manual input, reconciling op notes with prior authorizations, and triggering retro-auth automatically as needed.