Before You Schedule That Procedure: What the WISeR Model Means for Your Practice

By Elina Sabilova, Billing Department, WCH

Effective January 15, 2026, a new federal payment integrity initiative is expected to change how certain Medicare procedures are reviewed for payment — not only after the fact, but in some cases before a claim is finalized. If your practice operates in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, and you bill Original Medicare for any of thirteen specific procedure categories, the WISeR Model may affect your revenue cycle upon implementation. Whether you are actively tracking it or not.

This article explains what the program is, how it works in practice, and what organizations may need to do to prepare — both to protect cash flow and to avoid learning operational requirements through denied claims.