Apr. 3, 2026

WSMA Raises Concerns with CMS on WISeR Model Implementation

The WSMA recently sent a follow-up letter to the Centers for Medicare and Medicaid Services' Center for Medicare and Medicaid Innovation regarding physician and patient experiences under the Wasteful and Inappropriate Service Reduction Model.

In the letter, the WSMA shares real-world examples from Washington physicians highlighting delays in care, administrative challenges, and ongoing issues with prior authorization and claims processing. These include extended authorization timelines, difficulty accessing the vendor portal, and unresolved discrepancies that have left some practices unable to receive payment despite valid approvals.

The letter emphasizes that while we support efforts to improve program integrity, current implementation challenges are causing concerning disruptions in patient care and clinical workflows. We will continue to engage with CMS and advocate for improvements.

Follow WSMA guidance for Medicare prior authorizations

The WISeR model took effect Jan. 15 and subjects new prior authorization and prepayment review requirements to certain traditional Medicare services. Not sure if your practice is affected? WSMA's resource outlines impacted services and provides step-by-step guidance on documentation, prior authorization, and claims submission to help your practice navigate these new requirements.

Are you subject to WISeR? Share your experience

We strongly encourage impacted practices to share their experiences with WISeR with us—including administrative challenges, access issues, and impacts on patient care (positive or negative). The WSMA is uniquely positioned to serve as a conduit between Washington physicians, members of Congress, Virtix, Noridian, CMS, and the media. Your experience under WISeR is critical to informing ongoing congressional oversight and future CMS decision-making. Please contact WSMA Director of Policy Jeb Shepard at jeb@wsma.org to share your feedback.