Earlier this year the Centers for Medicare and Medicaid Services introduced the “Wasteful and Inappropriate Service Reduction” model, a series of prior authorization requirements designed to ensure timely and appropriate Medicare payment for select items and services in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) that take effect Jan. 1.
As part of the “WISeR” requirements, CMS selected tech vendors to implement enhanced technological models to scrutinize prior authorizations involving Medicare recipients. The program set out to save money by targeting “a specific subset of items and services that may have little to no clinical benefit for certain patients and that historically have had a higher risk of waste, fraud and abuse.”