Last week, the CMS Innovation Center announced a new model, known as the Wasteful and Inappropriate Service Reduction Model or WISeR Model, which aims to streamline the review process for certain items and services that are vulnerable to fraud, waste, and abuse under Medicare.
Medicare services that “pose concerns related to patient safety if delivered inappropriately, have existing publicly available coverage criteria, and may involve prior reports of fraud, waste and abuse” were selected to be involved with this program and skin substitute application was selected as one of those services. The model is voluntary and will run for six performance years, from January 1, 2026, to December 31, 2031.
This program will have no impact on current Medicare coverage or payment policies, and participation is voluntary. This program does not require prior authorization for skin substitutes and other services. Instead, the program allows Medicare providers in selected regions to choose to submit prior authorization requests for certain services. Note that the WISeR model will exclude inpatient-only services, emergency services, and services that would pose a substantial risk to patients if substantially delayed. Members should also note that the model does not apply to Medicare Advantage.