The Centers for Medicare & Medicaid Services (CMS) announced a 6-year model to test the impact of implementing prior authorization in Medicare fee-for-service (FFS) via the implementation of technology-enabled processes for select services. The Wasteful and Inappropriate Services Reduction (WISeR) Model has the stated intent of model focused on reducing fraud, waste (including low-value care) and abuse; it would use enhanced technology, including AI, to assist payers to implement and review prior authorization requests for a range of services (full list is available on page 7 of the notice). This model will become effective on Jan. 1, 2026.
While the AOA supports reducing fraud, waste and abuse in health care, the WISeR model raises concerns about increased administrative burden on physicians and the impact on care delivery for patients. Prior to this model introduction, FFS Medicare has only used prior authorization in limited and specific cases, and this expansion of prior authorization poses questions about further expansion of FFS Medicare prior authorization. Further, many questions remain on how the model will be implemented, how CMS will operationalize its claim review process for physicians who do not opt in to conducting prior authorization, and the timeframes payers must adhere to for timely care. The AOA is advocating for policies that reduce prior authorization burden, protect physician practices and ensure patients have access to the care they need.