New WISeR model puts CMS squarely in the preauthorization business, for the first time

Effective Jan. 1, 2026, CMS is getting into the prior authorization business. The Wasteful and Inappropriate Service Reduction (WISeR) Model is a pilot program set to run for six years, initially in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. It introduces new prior authorization processes for certain high-risk Medicare Part B services…

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The State of Provider Engagement

A Norwood special report Download the report here. CDI trends come and go. Retrospective reviews become concurrent and then, prospective. At the elbow record review goes remote. Regulations and code sets change, too: ICD-9 gives way to ICD-10, DRGs to MS-DRGs and HCCs. Today artificial intelligence is the buzzword and the reported cure for all…

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From Risk to Revenue Clarity: How One Health System Transformed OP CDI Performance

Register here: https://my.demio.com/ref/v1rDIDccDyru0SEW Only 31% of U.S. healthcare organizations have a dedicated outpatient CDI program—yet risk-based contracts, MSSP performance pressure, and documentation complexity are accelerating every year. The result? Most organizations are unknowingly leaving substantial RAF revenue unclaimed, exposing themselves to avoidable compliance risk, and missing the chance to influence performance before 2026 benchmarks lock…

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Telehealth requirements loosened, one of many changes in 2026 MPFS final rule

By Brian Murphy Sizable changes are coming Jan. 1 to telehealth, chronic illness and behavioral health management and reimbursement, and physician payment formulas per the recently released 2026 Medicare physician fee schedule final rule. I’ve summarized a few I find interesting. Telehealth commitment. I’m most excited about these changes. In a long overdue move CMS…

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