FAIR Health to Launch New Inpatient Benchmark Module

In October, FAIR Health will add FH® Inpatient Facility ICD Proc/Rev to our suite of FH® Benchmarks. This new inpatient benchmark module, based on ICD-10 procedure codes and associated revenue codes, will complement our existing inpatient product, based on Medicare diagnosis-related groups (DRGs).

Organizations that need granular data to align with their payment strategies can use the new product, FH Inpatient Facility ICD Proc/Rev. This is a comprehensive product, providing charge benchmarks for procedures performed in an inpatient hospital setting for 493 distinct geographic areas across the country. FAIR Health will continue to offer and support the existing FH® Inpatient Facility DRG module for clients who need a solution for inpatient procedures grouped at the DRG level.

FH Inpatient Facility ICD Proc/Rev will include the following features:

  • Volume—Benchmarks for more than 9,500 procedures will be organized by ICD-10 procedure codes and revenue codes.
  • Procedure Codes—Each ICD-10 procedure code will be associated with a set of values based on revenue codes. Sample revenue codes include:
    • 0120—Room and board semiprivate (two beds)—general;
    • 0250—Pharmacy—general;
    • 0301—Laboratory—chemistry;
    • 0324—Radiology diagnostic—chest X-ray;
    • 0421—Physical therapy—hourly charge; and
    • 0710—Recovery room—general.1
  • Methodology—Benchmarks will be based on actual data for ICD-10 procedure/revenue code combinations in a specific geographic area over a 12-month period. If the frequency of claims for a given procedure code and revenue code is less than 11, no benchmark will be provided.
  • Underlying Data—FH Inpatient Facility ICD Proc/Rev will be based on two data sources:
    • Charges from FAIR Health’s repository of private claims data, including data from fully insured and self-insured plans; and
    • The full, nondiscounted charges billed by providers on Medicare claims.
  • Geographic Aggregation—FH Inpatient Facility ICD Proc/Rev will provide benchmarks for 493 geozips across the country plus a set of national-level benchmarks. (Geozips generally track with the first three digits of a zip code.)
  • Percentiles—Benchmark percentiles will be available from the 50th to the 95th percentiles on a total and per diem basis. Upon request, benchmarks from the 5th percentile to the 95th percentile can be provided in increments of five.

FAIR Health President Robin Gelburd stated: “We are pleased to introduce the latest addition to our suite of FH Benchmarks. FH Inpatient Facility ICD Proc/Rev meets a market need for inpatient benchmarks based on ICD-10 procedure codes and their associated revenue codes.”

For more information on FH Inpatient Facility ICD Proc/Rev, contact us by email at info@fairhealth.org or call us at 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.