CMS is launching a six-year pilot of the WISeR Model, starting January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, which will use AI and human review to expand prior ...

The U.S. healthcare system is under constant pressure to manage resources effectively, particularly in federal programs like Medicare. To tackle this issue, the Centers for Medicare & Medicaid ...

Berwick is a former administrator of the Centers for Medicare and Medicaid Services. He is a senior fellow for health policy and Ducas is the VP of health policy at the Center for American Progress.

Medicare is testing the use of artificial intelligence to preapprove several healthcare services.

Medicare will significantly expand the use of prior authorization (PA) and post-service review for select services beginning next year, and private contractors will be permitted to use artificial ...

Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service ...

Imagine Medicare as the trusted old watch—the kind that keeps ticking without much thought, offering dependable service to seniors across America. Now picture the government slipping in a sleek ...

On June 27, 2025, the Centers for Medicare & Medicaid Services (“CMS”), through its Innovation Center (“CMMI”), released the Request for Applications (“RFA”) for a new payment and service delivery ...

Democrat lawmakers are calling on the CMS to release more data on a controversial pilot program that adds artificial intelligence-backed prior authorization for some services in traditional Medicare.

House Democrats press CMS on Medicare prior authorization pilot, requesting detailed data on denial rates, appeals, and audit timelines by July 15.

For now, the most reasonable stance is watchful waiting: acknowledging the real problems WISeR seeks to address, recognizing the equally real risks it introduces, and insisting on transparency and ...