FAIR Health Releases Enhancements and Additions to ASC Benchmarks

July 13, 2021

FAIR Health will be releasing enhancements to benchmarks for non-discounted charges billed by ambulatory surgery center (ASC) facilities later this month. In addition, a new set of benchmarks based on imputed amounts allowed by plans for ASC services and procedures will be released in August.

As use of ASC facilities becomes more and more common, FAIR Health’s ASC benchmarks are helpful for organizations interested in understanding billing and payments for these facilities. ASC benchmarks also can be used in connection with network and plan design and by anyone interested in understanding trends in patient care venue preferences.

Enhanced FH® ASC Facility
When first introduced, the FH ASC Facility module used two years of aggregated data. The increasing popularity of ASCs has corresponded to increasing volumes of claims for this venue of care in the FAIR Health database. Therefore, the module’s future releases will be based on a recent 12-month window of claims and refreshed twice a year. With this change, FH ASC Facility will align to most other FH® Benchmark products that include benchmarks based on 12 months of claims data.

Also beginning with the July release, the module will include both actual and derived benchmarks. When the number of charges for a procedure in a geozip are insufficient—as may happen for infrequently billed codes and in areas with limited access to ASCs—FH ASC Facility benchmarks will be derived using the charges for all procedures in a procedure code group in a geozip. A geozip is a geographic area defined by the first three digits of a zip code or groups of three-digit zip codes. Actual benchmarks will continue to be created for procedure code/geozip combinations where the volume of data is sufficient.

The addition of a derived methodology provides granular, geozip-level benchmarks for most procedure codes. National benchmarks also will be included.

FH® Allowed ASC Facility
In August, FAIR Health will introduce FH Allowed ASC Facility, a new set of benchmarks reflecting amounts allowed by payors for facility services performed in an ASC setting. Due to the proprietary nature of contracted network rates, FAIR Health employs an imputation methodology to develop the allowed amounts upon which the benchmarks are based. FH Allowed ASC Facility will be released twice yearly. The FH® Allowed Benchmark suite of products enables stakeholders throughout the healthcare sector to understand in-network payment trends by regional area.

FAIR Health President Robin Gelburd stated: “As stewards of the nation’s largest database of private healthcare claims data, we continue to enhance and expand our suite of FH Benchmark products. We are pleased to announce the new enhancements and additions to our suite of ASC benchmarks to bring additional insights to healthcare stakeholders.”

For more information on the enhancements to FH ASC Facility and the new FH Allowed ASC Facility benchmarks, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.