Medicare-Based Reimbursement, Simplified

March 01, 2017

Stakeholders use a variety of methodologies to establish and analyze healthcare reimbursement rates. Our FH Medicare GapFill PLUS™ product helps payors and others evaluate how Medicare data compare to market-based data in order to advance sound decision making.

Because Medicare focuses on services for the elderly and the disabled, the Centers for Medicare & Medicaid Services (CMS) has not created values for a large number of services that the general population might need. Establishment and updating of rates are further complicated by the fact that Medicare delivers non-facility fees in six separate schedules, all following different formats.

FH Medicare GapFill PLUS meets both challenges. It addresses 1,500 of the missing medical and HCPCS codes with values developed by applying the scale used by CMS for Medicare fees to FAIR Health data. And, it consolidates all non-facility CMS fee schedules and FAIR Health values into a single, uniform format, facilitating file loading and report generation to further analysis and evaluation of the values presented. In addition, FAIR Health’s product maps zip codes to the geographic areas in each CMS fee schedule, aligning values to the local market. FAIR Health updates values twice per year to help maintain a current view.

To learn more about how FH Medicare GapFill PLUS can simplify Medicare-based reimbursement for your organization, contact us by e-mail at service@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.