Wakely Medicare Repricing Analysis Tool (WMRAT)

The Wakely Medicare Repricing Analysis Tool (WMRAT) is a reporting tool that provides claim line level detail and summaries of medical claims repriced to Medicare FFS rates. Comparing medical claim allowed amounts to Medicare FFS rates is a common practice across the industry, as this analysis provides a useful benchmark for payers to better understand their data and payment practices and for providers to more easily analyze how they are being reimbursed. WMRAT offers a common language for comparing payment rates across multiple lines of business, categories of service, geographic locations, and providers.

Medicare FFS payments are based on a complex set of rules that change frequently and the logic and results can be nuanced. Whether you are interested in creating pricing assumptions, negotiating more competitive provider contracts, validating internal payment procedures, or setting up new capitation arrangements, Wakely’s Medicare Repricing team will work quickly to assist you with understanding how your medical claims payments compare to Medicare FFS rates and with identifying areas of focus. Examples include discovery of types of services with unfavorable payment rates or discrepancies between contracted rates and actual payment rates. Let WMRAT help you unlock the “black box” of Medicare FFS benchmarks for your medical claims.

WMRAT capabilities extend beyond client data to include repricing national data sets (e.g., Wakely ACA and the Merative™ MarketScan® data) to Medicare FFS rates.  Using WMRAT to reprice these data sets enables national and regional level benchmarking to help you understand how your payment practices compare.

WMRAT currently supports the following Medicare payment systems with more coming soon:

  • Inpatient Prospective Payment System (IPPS)
  • Outpatient Prospective Payment System (OPPS)
  • Physician
  • Durable Medical Equipment (DME)
  • Parenteral and Enteral Nutrition (PEN)
  • Part B RX
  • Clinical Lab
  • Ambulance
  • Anesthesia
  • Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)
  • Ambulatory Surgical Center Payment System (ASC)
  • Federally Qualified Health Centers Prospective Payment System (FQHC PPS)
Figure 1: Percentage of Allowed Amounts to Medicare Payments by Incurred Month

Besides providing repriced claim line level detail data, WMRAT features several useful summaries to help you understand the most important information at a quick glance. For instance, the summaries by provider exhibit can help you identify which providers are potentially being paid more than expected to help you know where to focus your contracting efforts.

Standard summaries included in the WMRAT reporting package are listed below. Custom summaries are also available upon request.

  • By Year and Incurred Month
  • By In-Network and Out-of-Network
  • By Provider
  • By Provider CBSA
  • By Member CBSA
  • By Inpatient Major Diagnostic Category
  • By Outpatient Category of Service
  • By Outpatient Status Indicator
  • By Professional Fee Schedule Type
  • By Professional Bodily System

For any questions or requests related to WMRAT or if you would like a demo, please reach out to our team at WMRATSupport@wakely.com.