TechnologyMedicare's WISeR AI pilot draws scrutiny over delays and denial incentives
Ars Technica reports that newly released CMS records show long waits, technical failures and high denial counts in the six-state prior-authorization program.
TLDR
Ars Technica and records released by the Electronic Frontier Foundation describe long delays, technical failures and thousands of denials in Medicare's WISeR pilot. One request reportedly remained unresolved for 83 days, while a March report showed one vendor denying 53% of reviewed requests. CMS says the program covers selected Original Medicare services in six states, requires licensed clinicians to make non-payment recommendations and rewards vendors for averted spending, with quality adjustments intended to discourage inappropriate denials.
Medicare's WISeR AI pilot draws scrutiny over delays and denial incentives
Ars Technica reports that newly released CMS records show long waits, technical failures and high denial counts in the six-state prior-authorization program.
TLDR
Ars Technica and records released by the Electronic Frontier Foundation describe long delays, technical failures and thousands of denials in Medicare's WISeR pilot. One request reportedly remained unresolved for 83 days, while a March report showed one vendor denying 53% of reviewed requests. CMS says the program covers selected Original Medicare services in six states, requires licensed clinicians to make non-payment recommendations and rewards vendors for averted spending, with quality adjustments intended to discourage inappropriate denials.
