Recent Additions to the Suite of FAIR Health Benchmarks

The suite of FH® Benchmarks has continued to expand. Widely relied upon by stakeholders throughout the healthcare sector for reflecting charge and payment practices for medical and dental procedures, FH Benchmarks have likewise been designated as the official, neutral data source for a variety of state health programs. FH Benchmarks include FH® Charge Benchmarks, based on the non-discounted charges billed by providers, and FH® Allowed Benchmarks, based on imputed amounts allowed by plans. The family of FH Benchmarks has recently been generating new additions tailored to specific uses.

All the new additions share the same basic attributes as previous FH Benchmarks: based on independent, robust, validated claims data; geographically representative to the level of geozips (493 geographic areas typically reflecting the first three digits of a zip code); and current, based on a 12-month window of claims, refreshed twice a year.

These are among the most recent additions to the suite of FH Benchmarks:

FH® Urgent Care
FH Urgent Care includes charge benchmarks, arrayed by CPT®1 and HCPCS codes, for services and procedures performed in urgent care centers. This module is useful for organizations considering opening urgent care centers and informing fee schedules for providers and payors, insurance carriers evaluating pricing and plan design, and anyone interested in understanding trends in patient care venue preferences.

FH® Telehealth
FH Telehealth includes charge benchmarks, arrayed by CPT and HCPCS codes, for professional services conducted via telehealth. The recent growth in telehealth has made this module vital for many stakeholders, including organizations considering expanding in the field of telehealth, insurance carriers considering changes in the evolving healthcare environment and providers interested in pricing the services they offer via telehealth. Policy makers may find the benchmarks helpful in evaluating telehealth reimbursement laws and regulations.

FH® Inpatient Facility ICD Proc/Rev
A complement to FH® Inpatient Facility DRG, which includes charge benchmarks arrayed by diagnosis-related group (DRG), FH Inpatient Facility ICD Proc/Rev includes charge benchmarks arrayed by ICD-10 procedure codes and associated revenue codes for services performed in a hospital inpatient setting. Together, the two modules offer flexibility to organizations that analyze inpatient facility charges at the DRG level but also to those with a need for more granular data to align with their individual payment strategies.

FH® Facility HCPCS
FH Facility HCPCS is a complement to FH® HCPCS, which includes charge benchmarks arrayed by Level II HCPCS codes for equipment, supplies and services billed by physicians, durable medical equipment companies and other providers. In contrast, FH Facility HCPCS includes charge benchmarks arrayed by Level II HCPCS codes that are billed through hospitals, ambulatory surgery centers and other facilities. When used together, these two benchmark products can reveal pricing differentials that reflect the cost structures of the entity billing for the service or material.

FH® Medical GapFill
By providing charge benchmarks for temporary and proprietary CPT codes that fall outside the traditional collection of codes covered by other FAIR Health modules, FH Medical GapFill is the ideal supplement for the entire suite of FH Benchmarks. It includes Category III CPT codes (temporary codes for emerging technologies, services, procedures and service paradigms), Proprietary Laboratory Analyses (PLA) codes and Multianalyte Assays with Algorithmic Analyses (MAAA) administrative codes.

For more information on these or other FH Benchmarks, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.

1 CPT © 2020 American Medical Association (AMA). All rights reserved.