Advisory Board October 16, 2025
CMS announced it plans to begin a pilot program next year that will implement prior authorization requirements for certain procedures for Medicare beneficiaries, utilizing AI companies to oversee the program — a move that experts said could incentivize the denial of care.
Program details
The Wasteful and Inappropriate Service Reduction (WISeR) program will affect Medicare patients and the providers who care for them from Jan. 1, 2026, through 2031. The program will start in six states: Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington.
The program will test the use of an AI algorithm to make prior authorization decisions for some Medicare services, including skin and tissue substitutions, electrical nerve stimulator implants, and knee arthroscopy.
According to CMS, these procedures...
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