Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a new prior authorization model called the Wasteful and Inappropriate Services Reduction (WISeR) Model. This six-year model, starting on Jan. 1, 2026, aims to reduce fraud, waste and abuse in traditional Medicare by using technology-enabled processes for prior authorization and pre-payment review of certain services. The model will be tested in six states across specific Medicare Administrative Contractor (MAC) jurisdictions: New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. It will run through the end of 2031.
The WISeR Model uses technology, including artificial intelligence (AI), to streamline the prior authorization process and identify potential issues. It focuses on 17 service categories in which there’s evidence of potential fraud, waste and abuse, as well as cost-saving opportunities. These include such services as skin and tissue substitutes, nerve stimulators and certain surgical procedures. Providers can choose to submit prior authorization requests for the targeted services or have their claims subject to pre-payment review.
The primary goal is to minimize instances of unnecessary or inappropriate services, thereby reducing costs and improving patient safety. By leveraging technology, CMS aims to make the prior authorization process more efficient for both providers and payers. The model is designed to enhance the efficiency and effectiveness of the traditional Medicare program.
This announcement comes on the heels of the recent ACR-supported pledge by the largest payers to streamline their prior authorization processes and reduce the burden they impose on physicians. The ACR places a high priority on any policy or regulation that aims to promote the integrity of the physician/patient relationship and reduce the burden wrought by prior authorization. For further information about the ACR’s regulatory advocacy efforts, email the ACR’s advocacy team at [email protected]. ACR/ARP members can also find a time to meet directly with the ACR’s advocacy team to discuss issues and challenges you are facing; schedule time to meet via webform.
