1 Jul 2025
💵Impact of Medicare Prior Authorization Regulations on Businesses
Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
Summary
This notice announces a 6-year model focused on reducing fraud, waste (including low-value care), and abuse in Medicare fee-for- service (FFS) via the implementation of technology-enabled prior authorization processes for select services.
Agencies
- Health and Human Services Department
- Centers for Medicare & Medicaid Services
Business Impact
$$$ - High
The regulation mandates the implementation of prior authorization processes in Medicare, targeting specific services to reduce fraud and waste. This affects healthcare providers financially, influencing their operational costs and compliance burdens. Providers must adapt to new documentation requirements and may experience delays in reimbursement.