Author: admin
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AI Is Now Deciding Medicare Prior Authorizations — and Nobody Knows How It Works
Policy Watch Since January 1, 2026, Medicare patients in six states have had their care requests evaluated by an AI system called WISeR — the Wasteful and Inappropriate Service Reduction model, a CMS pilot active in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The program screens Medicare prior authorization requests for services deemed “low-value,”…
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Telehealth Is Extended Again. But ‘Extended’ Is Not the Same as ‘Permanent.’
Policy Watch Medicare telehealth survived another near-death experience in early 2026. When a 42-day government shutdown caused COVID-era telehealth waivers to briefly lapse, research from Brown University documented a 24% drop in telemedicine visits in just the first two weeks. Congress responded with a retroactive two-year extension through December 31, 2027, passed as part of…
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Rural Medicare Patients Get the Worst RPM Reimbursement in the States That Need It Most
Policy Watch A structural inequity built into Medicare’s reimbursement formulas penalizes remote patient monitoring in the places where chronic disease burden is highest and specialist access is lowest. The geographic payment index used to calculate RPM reimbursement means providers in Mississippi and Arkansas receive approximately $84–$85 per enrolled patient per month, while the national average…