FAIR Health to Launch New Allowed Benchmarks

August 19, 2021

In December, FAIR Health will launch two new offerings in its suite of FH® Allowed Benchmarks: FH® Allowed Telehealth and FH® Allowed Inpatient Facility ICD Proc/Rev. These will be in addition to FH® Allowed ASC Facility, which launches this month, and the enhancements to FH® ASC Facility released last month—both of which were described in an article in the July issue of FAIR Health Access®. The new modules complement our existing charge and allowed benchmark offerings, which are described on our website at fairhealth.org.

Like FH Allowed ASC Facility, the new products coming in December are allowed benchmark counterparts to existing modules in FAIR Health’s suite of FH® Charge Benchmarks. FH Allowed Telehealth and FH Allowed Inpatient Facility ICD Proc/Rev reflect amounts allowed by payors for, respectively, services provided via telehealth and inpatient ICD-10 procedure codes associated with a set of values based on revenue codes.1 In this, they differ from their charge benchmark counterparts, which reflect undiscounted billed charges. Due to the proprietary nature of contracted network rates, FAIR Health employs an imputation methodology to develop the allowed amounts upon which the new benchmarks are based. FH Allowed Telehealth and FH Allowed Inpatient Facility ICD Proc/Rev will be released twice yearly, in December and June. Clients use FAIR Health’s allowed benchmark products for varied purposes, including claims adjudication, budgetary planning, provider network development, fee schedule review and research. The new benchmarks also will be incorporated for consumer use on FAIR Health’s free, award-winning website fairhealthconsumer.org, so consumers can effectively plan for their healthcare spending.

FAIR Health is expanding its line of allowed benchmarks so that users can have both charge and allowed views for most of its product suite, with insights into both sides of healthcare transactions—what providers charge and what insurers pay. This rounded look addresses a widely felt need. For example, to understand the differential between telehealth and face-to-face services, stakeholders may need to know what is being allowed for payment in telehealth in order to compare that to what is being allowed for in-person services. Similarly, being able to see what is allowed for inpatient services will add value to being able to see what the billed charges are.

FAIR Health President Robin Gelburd stated: “The introduction of these new allowed products enables stakeholders to understand what in-network providers have agreed to accept as payment for services provided via telehealth and for inpatient hospital stays. When these new modules are used in conjunction with our charge benchmarks, consumers and licensees alike can gain further transparency into the cost of care.”

For more information on FH Allowed Telehealth and FH Allowed Inpatient Facility ICD Proc/Rev, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

1 THE UB-04 DATA FILE, copyright American Hospital Association. All rights reserved.