WISeR Prior Authorization: First-Month Real Life Experience

Episode 20 of Reimbursement Readiness: Business Tips for Wound Practice delivers a timely field report on the WISER Prior Authorization Program—based on real, early experiences from stakeholders submitting requests in New Jersey, Ohio, Oklahoma, and Texas. Even listeners outside the participating states asked for this update, because the “why” behind approvals and denials is helping teams everywhere tighten documentation for reasonable and medically necessary care. Kathleen Schaum shares what she’s hearing from the first month of implementation—what surprised providers, how teams are adapting workflows, and why some are actually finding WISER beneficial (including faster clarity on coverage before purchasing a CTP). Then Kathleen interviews Kati Kauchel, DNP, FNP-C, CWS, founder of Kindling Consulting, who supports mobile wound care organizations and is actively working with groups submitting WISER requests in Texas and Oklahoma. Together, they unpack what “good” looks like under WISER: deliberate care plans, documentation that tells a clear longitudinal story, and escalation that’s clinically driven—not calendar-driven. You’ll also hear the most common patterns behind non-affirmed decisions—often not the product itself, but gaps in the record (standard of care, readiness criteria, sequencing, missing elements like vascular assessment, A1C/compression compliance, etc.). Kati closes with practical guidance to “pressure test” documentation before submission, including a provider self-assessment tool listeners can download. WISeR Professional Self-Assessment DOWNLOAD: https://wct-us.com/wp-content/uploads...