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Medicare pilot program to use AI for pre-approval of medical procedures
The pilot program aims to reduce Medicare spending by using AI to expedite prior authorization for 17 high-cost procedures, potentially saving billions over six years, officials said.
- CMS announced the Wasteful and Inappropriate Service Reduction model, which will begin on Jan. 1, 2026 in six states, running six years in Original Medicare.
- Officials said the move responds to findings that Medicare spent up to $5.8 billion on low-value services in 2022, prompting the Centers for Medicare and Medicaid Services to target waste in Original Medicare.
- To run the pilot, CMS will hire private AI companies to review prior authorization requests while licensed human clinicians make final coverage decisions, paying contractors partly based on savings from denials and targeting 17 services prone to overuse.
- Democrats and health groups cautioned Earlier this month that the pilot could limit beneficiaries' access, increase clinician burden and push patients toward Medicare Advantage, altering enrollment.
- The administration projects the model will save several billion dollars over six years and could expand to other states, while experts urge the Centers for Medicare and Medicaid Services to publish data on denials and delays for transparency.
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Medicare's New Prior Approval Pilot, Explained
Some Medicare recipients are set to experience a new “prior authorization” measure as the Centers for Medicare & Medicaid Services (CMS) trials its much-discussed “Wasteful and Inappropriate Service Reduction (WISeR)” model. The initiative, announced by the CMS in June, will require recipients of Original Medicare to receive prior approval before obtaining access to certain medical services. The pilot is only due to run in six states. [time-brig…
·United States
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Medicare will require more prior authorization in some states
Medicare enrollees in Washington and five other states could soon need preapproval for certain medical services — a familiar hurdle for commercial insurance plans, including Medicare Advantage, but until now largely absent from traditional Medicare.
·Portland, United States
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Total News Sources28
Leaning Left2Leaning Right0Center26Last UpdatedBias Distribution93% Center
Bias Distribution
- 93% of the sources are Center
93% Center
C 93%
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