Becker's Healthcare November 11, 2025
Some health systems have been gearing up for a Medicare prior authorization pilot, the Wasteful and Inappropriate Service Reduction model from CMS. But the program is under fire, with six House Democrats, including two physicians, introducing legislation to shut it down.
Here are four things to know about the program and legislation:
- WISeR would implement prior authorization for traditional Medicare across six states starting next year. CMS said the pilot would leverage companies’ AI tools to expedite reviews.
- The program previously received backlash from the American Hospital Association, and House Democrats have been vocal over their concerns with the AI use.
- One sticking point: CMS will pay third parties based on “averted expenditures.”
- “As a doctor and former chief...
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