Cardiology groups strongly oppose expansion of Medicare AI prior authorization model
Several cardiology groups are applauding key legislative panel vote June 16 would bar the Centers for Medicare and Medicaid Services from spending funds on the controversial prior authorization pilot Wasteful and Inappropriate Service Reduction (WISeR) Model.
The House of Representatives Appropriations Committee added an amendment to the 2027 appropriations bill that prevents the Department of Health and Human Services from using federal funding to implement any payment model that implements prior authorization in traditional Medicare. This includes use of the WISeR Model, which uses artificial intelligence (AI) to review and deny claims.
"The American Society of Echocardiography (ASE) opposes the WISeR model, which would introduce prior authorization into traditional Medicare fee-for-service," the organization said in a statement. "This model risks replicating the same harmful delays and administrative burdens that plague Medicare Advantage. ASE supports Congressional efforts to halt implementation until meaningful stakeholder engagement occurs and proper safeguards are established to protect patient access to care."
This sentiment was echoed by other cardiology groups this past week in advocacy update news sent to members, including the Society for Cardiovascular Angiography and Interventions (SCAI) and the American Society of Nuclear Cardiology (ASNC).
"Of particular concern is the model’s payment structure, which would reward vendors for authorization denials. ASNC is concerned that advanced diagnostic imaging could be targeted in future years and has been advocating aggressively to curtail payer use of prior authorization, not expand it to fee-for-service Medicare," the association said in a statement.
The amendment was added by a by a unanimous vote by the House Appropriations Committee. The amendment reads that "none of the funds made available in this act or any other act" should be used to implement the WISeR model or another model that would add prior auth to traditional Medicare. The 2027 appropriations bill will undergo further congressional review on its way to final passage later this year.
The WISeR model, unveiled in June 2025, was implemented as a way to streamline prior authorization for Medicare. It was rolled out as part of the Trump administration's broader push to root out fraud, waste and abuse of Medicare dollars. However, numerous medical societies, including the American Hospital Association and the American Medical Association, have pushed back against any use of prior authorization because of the additional barriers to patient care and administrative work it creates for physicians. The use of AI in any prior authorization models, either by private insurance companies or the Centers for Medicare and Medicaid Services (CMS), has been strongly resisted for several years by most medical societies.
The WISeR model was launched in early 2026 in six states, Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Through the model, CMS contracts with third parties to use AI to review authorization requests for services that CMS says are vulnerable to fraud, waste and abuse. ASNC said the services initially targeted by the model were skin and tissue substitutes, along with electrical nerve stimulator implants, but their claims are subject to medical review to ensure the delivered service met Medicare coverage, coding and payment criteria prior to payment.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]