The Trump Administration is introducing prior authorizations in Traditional Medicare, requiring mandatory preapproval for healthcare services. This change is part of the Wasteful and Inappropriate Service Reduction (WISeR) Model, developed by the CMS Innovation Center to address $5.8 billion in taxpayer-financed low-value care. The model will use technology, especially AI, for reviewing medical necessity but mandates input from clinicians to validate these determinations. While aimed at reducing wasteful spending, the expansion of prior authorizations may lead to increased challenges for patients, especially those accustomed to private Medicare Advantage plans.
The Trump Administration plans to implement prior authorizations in Traditional Medicare, expanding mandatory preapproval for healthcare services and potentially increasing complications for patients.
The WISeR Model aims to tackle $5.8 billion in low-value care by utilizing AI-driven reviews while ensuring that human clinicians validate medical necessity decisions.
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