Lexology July 8, 2025
On June 27, 2025, the Center for Medicare & Medicaid Innovation (“CMMI”) announced the Wasteful and Inappropriate Service Reduction (“WISeR”) Model, its latest model focused on reducing clinically inappropriate and low-value services in traditional Medicare.
Unlike prior CMMI models, WISeR stands out for its exclusion of traditional health care providers, such as hospitals and physician groups, as direct participants. Instead, the model invites voluntary participation from technology companies that specialize in medical necessity determinations, particularly those using AI-assisted tools. These companies, rather than providers, will be responsible for reviewing claims in designated states.
Participants will be assigned to one of six pilot states: Arizona, New Jersey, Ohio, Oklahoma, Texas or Washington, where they will operate within specific Medicare Administrative Contractor...
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