In June, the Centers for Medicare & Medicaid Services announced a new CMS Innovation Center model:  The Wasteful and Inappropriate Service Reduction Model, or WISeR.  The idea behind WISeR is for Medicare to seek to reduce waste, fraud, and abuse in the program by working through technology companies to make greater use of prior authorization and pre-payment reviews for a small group of medical items and services that the agency considers susceptible to misuse or unnecessary use.

While the program is scheduled to start next January 1 and CMS has chosen a limited number of states – Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington – to participate in the program, much about WISeR remains unknown.

CMS recently took steps to make more known about the program, however, by posting an FAQ about the program.  The questions addressed in the FAQ are:

  • Does WISeR change Medicare coverage policy?
  • Does WISeR apply to all items and services in Original Medicare?
  • How does WISeR protect patients?
  • How will WISeR streamline current coverage review for both people with Medicare and providers?
  • How will WISeR ensure Medicare savings?
  • How will WISeR safeguard against inappropriate non-affirmations (denials)?
  • How will WISeR protect beneficiary data?
  • How else will participating companies be held accountable?
  • How does WISeR align with the HHS Secretary Robert F. Kennedy, Jr’s and CMS Administrator Dr. Mehmet Oz’s pledge to fix the prior authorization system?
  • Why did CMS develop WISeR?
  • How does WISeR fit into the Innovation Center Strategy?
  • How will providers or suppliers in model test regions submit a prior authorization request?

Find the answers to these questions from this WISeR FAQ and learn more about the program, including the medical services that will be subject to the program, from the WISeR model web page.