The AOA joined the Regulatory Relief Coalition (RRC) and other physician organizations in urging CMS to halt implementation of the Wasteful and Inappropriate Service Reduction (WISeR) Model in Medicare Fee-for-Service.
In formal comments to CMS, the coalition warned that the WISeR Model—which would expand prior authorization (PA) requirements—conflicts with the Administration’s stated goal of reducing administrative burdens. Data from physician and practice surveys show that PA frequently delays care, increases costs and negatively impacts patient outcomes, with most services ultimately approved after lengthy wait times.
The coalition also raised serious legal concerns, arguing CMS lacks statutory authority to impose broad PA requirements in traditional Medicare. Additionally, they criticized provisions allowing third-party vendors to be paid based on the volume of denied claims, warning this would create perverse incentives to restrict medically necessary care.