Medicare and Medicaid service centers (CMS) Recently announced about the program you will need, Confirmation of the Federal Health Insurance Program before performing certain procedures. It is expected to begin in 2026. In six states and will help “patients and service providers avoid unnecessary or inadequate care and protect federal taxpayers’ dollars,” the CMS statement said. Below we break down what it means to people in Medicare.
What do you know about the renewal of Medicare’s pre -edition
June this year CMS has announced that it will release a waste of waste and improper service reduction (Wiser), which will require “Pre -Edition” to people who Medicare expect to perform certain procedures.
It will begin 2026 January 1And it takes six years to open in Arizona, New Jersey, Oklahoma, Ohio, Texas and Washington. They will then select certain companies in these states to try the program.
“CMS is committed to crushing fraud, waste and abuse, and the Wiser model will help you know the waste in the original Medicare,” said the CMS administrator Mehmet Oz, MD, MD, MD said. A statement of the Agency’s website; “By combining the speed of technology and experienced doctors, this new model helps Medicare to the 21st Century, testing the simplified previous edition process while protecting Medicare benefits from unnecessary and often expensive procedures.”
CMS also states that the affected services “include but not limited, skin and tissue substitutes, electric nerve stimulants and knee arthroscopy knee osteoarthritis. The model does not include only inpatient services, emergency services and services that are high in risk for patients.”
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After the original report was written by several members of the congress a letter Dr Oz claims that “wise will probably limit the beneficiaries’ access to care, will increase the burden of our already overloaded health workers and create distorted incentives for patients.”
“The traditional Medicare rarely demanded prior permission. The advantages of Medicare are very different when beneficiaries regularly apply pre -edition as confirmed by the Health and Human Services Department (HHS) General Inspector General (OIG) and CMS.2, the letter states. “Although pre -edition is often described as a cost and loading strategy, it practically increases the service provider’s burden, time from patients, restricts patient access to life saving and creates unnecessary administrative burden.
They also asked to explain how CMS had chosen six states, how patients and providers would be informed of changes and other information. At the time of publication, the agency did not comment on these inquiries.
Experts share how the prior permit process can affect you
If you live in one of the six states chosen for the authorization process and you are going to experience one of the medical manufacturers, Solace Health and Patient’s lawyer Jeremy Gurewitz recommends ensuring that “your doctor provides detailed medical records, images and clinical comments – confirmations are usually in documentation.”
“If Medicare denies your application, this is not the end of the story: you have the right to apply, and many denies are abolished when the applicant provides additional evidence,” he continues.
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CMS stated: “The wiser model will not change Medicare coverage or payment criteria. Medicare’s original health care coverage remains the same, and the beneficiaries retain freedom to look for care from their provider or the supplier of their choice. ”
The agency notes: “The participants of the model will receive payments, taking into account their ability to reduce unnecessary or uncovered services (improper use) and lower costs in the original Medicare. Participants ‘benefits will be adjusted according to their results from the established quality and process tools that measure the ability of the model participants to support providers and suppliers and improve the provider and beneficiaries’ experience with the previous authorization process. ”
At this point, it is unclear how many people will affect this change. It is also unclear whether the test phase will end in 2031 and will apply to other states.
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