In Episode 15, Kathleen Schaum and Amiee Coriano walk Wound Care Today USA subscribers through CMS’s new WISeR Model, a national initiative designed to reduce fraud, waste, and abuse by applying prior authorization and enhanced medical review to select services in traditional Medicare. While the 2026 payment rules for CTPs are now known, this episode underscores a critical point for every revenue cycle: coverage and payment require meeting Medicare’s policy expectations—not simply billing a payable code.

Amiee details where the WISeR Model will apply first—beginning with six states and four key places of service—and clarifies the wound care category included in the model: skin substitute grafts / CTPs for treatment of diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). She also explains how WISeR participation works based on MAC jurisdiction, including the third-party participants responsible for administering the model in each state.

Finally, the episode breaks down WISeR’s operational impact starting January 1, 2026, including timelines, two pathways for compliance (prior authorization versus prepayment medical review), and how decisions, resubmissions, and peer-to-peer options function within the process. Kathleen and Amiee also highlight key submission methods and point listeners to an accompanying handout with links and resources to help teams prepare workflows and avoid preventable denials.