Can the Medicare Prior Authorization Pilot Be Stopped?

It is, in short, an effort to reverse a policy move that would enrich private AI contractors and hurt Medicare patients.

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The WISeR model – intended to reduce spending on seniors in traditional Medicare through Wasteful and Inappropriate Service Reduction – will require prior authorization in traditional Medicare for a set of health services and will use AI (artificial intelligence) in making the determination to authorize or deny care. We already know what is likely to occur. Preauthorization in Medicare Advantage (MA), where it is widely used to manage utilization of health services, has led to millions of seniors being denied necessary care. In contrast, traditional Medicare only uses preauthorization in very limited circumstances.

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