Prior Authorization

Medicare AI pilot WISeR faces GAO legality finding as House GOP blocks document release

The Trump administration's WISeR pilot, launched in January, uses AI to decide whether to approve certain Medicare treatments, a step not previously required for the program. Documents obtained by the Electronic Frontier Foundation through litigation revealed provider complaints about technical failures, long delays and denials, with one clinician describing patients crying in pain while awaiting decisions. The Government Accountability Office found in May that officials did not follow proper procedure in establishing the program, and last week Rep. Suzan DelBene's push for a committee vote to release more WISeR documents was defeated by Republicans.

arstechnica.com · 2026-09-25

Healthcare RCM emerges as key testing ground for AI integration

Industry analysis argues that healthcare's administrative problems stem from fragmented information, workflows and accountability across disconnected systems like EHRs, billing platforms and payer portals, rather than a shortage of data. The revenue cycle—covering scheduling, coding, billing and payer follow-up—is identified as an ideal proving ground for AI because it combines high transaction volume, complex reasoning needs and measurable outcomes, but traditional rule-based automation struggles due to constantly shifting payer rules and frequent exceptions.

technologyreview.com · 2026-09-10