A Q&A with Vanessa Ploessel, VP of Revenue Cycle at WCA
Medicare's new WISeR program puts AI-powered review between your wound center and payment for skin substitutes. If you're in one of six pilot states, here's what you need to know come January 2026.
WISeR (Widespread Implementation of Supplemental Edits and Review) is Medicare's new six-year pilot program designed to reduce waste and fraud using prior authorization and AI-powered claim review. It targets skin substitutes specifically.
Starting January 15, 2026, wound centers in pilot states will have two options before getting paid:
1. Prior authorization – Submit before treatment. Get a decision in 2-3 days. Approval is good for 120 days.
2. Post-service review – Bill first, then submit clinical documentation within 45 days for AI review. Either way, your documentation is going under a microscope.
Texas, New Jersey, Oklahoma, Ohio, Washington, and Arizona.
Not in a pilot state? Keep documenting and billing as usual—but watch closely. If WISeR works, expect it to go national.
CMS says expedited requests will be available, and they're aiming for real-time approvals by 2027. But let's be honest: adding prior authorization to wound care creates friction. Delays are possible, especially early on.
The program is essentially a pre-payment audit. What happens next depends on what the AI finds. Poor documentation could trigger claim rejections, payment delays, or deeper audits down the line.
Yes. Both paths add administrative steps before you get paid. Plan for it.
If you're in a pilot state, start now:
For hospital-based wound centers: Your documentation, workflow, and clinical discipline are about to be stress-tested by AI. The time to tighten up is now—not after your first denial.
For health systems and networks: Inconsistent documentation across multiple sites means multiplied risk. One weak link can trigger denials, payment delays, and unwanted scrutiny across your entire system. Standardization isn't optional anymore.
WISeR removes the margin for error. Once a claim is filed, it's too late to fix gaps.
That's why we built the Authorization Review System. Before treatment begins, our team reviews the chart in real time—verifying coverage, medical necessity, LCD alignment, and billing accuracy for your specific state, MAC, and formulary.
The result: informed decisions up front, not after a denial. Fewer surprises. Cleaner claims. Programs that stay compliant, solvent, and open.
Don't wait for a denial to find out. WCA offers a rapid Authorization Review System review to identify your risk areas before WISeR goes live. We've spent 24 years helping wound centers navigate exactly these kinds of challenges—and we're ready to help you tackle this one. Contact us today to see where you stand.
WCA helps wound centers run better—clinically and financially. Our team brings 20+ years of wound care expertise to every engagement, backed by Luvo, our platform for real-time business intelligence, compliance, and daily operational support. Expert teams. Powerful tools. Results without giving up control. Learn more at www.thewca.com.
