Key decisions made by healthcare-related businesses depend on trust—the confidence that the data behind those decisions are independent, reliable and representative of today’s market. The data supporting FH Benchmarks meet and surpass those criteria. That’s why states have adopted FH Benchmarks as a reference point for consumer protection laws and as the basis for workers’ compensation fee schedules, among other uses. It’s also the reason stakeholders rely on FH Benchmarks when adjudicating out-of-network claims, developing fee schedules, facilitating network negotiations, studying trends in cost and utilization, shaping strategic initiatives and more.

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Charge Benchmarks:

• FH Medical. Billed charges for professional fees arrayed by Current Procedural Terminology (CPT^®) codes for evaluation and management (E&M), medical, surgical, radiology, laboratory and pathology procedures.
• FH Dental. Billed charges arrayed by Current Dental Terminology (CDT^®) codes for all dental procedures.
• FH Anesthesia. Billed charges arrayed by CPT Category I codes for anesthesia. In certain formats, surgical procedure codes are cross-walked to anesthesia codes.
• FH HCPCS. Billed charges arrayed by Level II HCPCS codes for equipment, supplies and services not included in CPT codes, such as ambulance services, durable medical equipment (DME), specialty drugs, prosthetics, orthotics and supplies when used outside a physician’s office.
• FH Inpatient Facility Billed charges arrayed by diagnosis-related group (DRG) for services performed in a hospital inpatient setting, based on billed charges from the CMS MEDPAR file.
• FH Outpatient Facility. Billed charges arrayed by CPT codes for services performed in a hospital outpatient setting, based on billed charges from the CMS Outpatient Standard Analytical File (OPSAF).
• FH ASC Facility Billed charges at the state, regional and national level arrayed by CPT codes for services performed in an ASC.

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Allowed Benchmarks:

• FH Allowed Medical. Fees allowed by plans for medical professional services; benchmarks available by CPT code, including E&M, medical, surgical, radiology and laboratory procedures.
• FH Allowed Dental. Allowed amounts arrayed by CDT codes for all dental procedures.
• FH Allowed Anesthesia. Allowed amounts arrayed by CPT Category I codes for anesthesia and surgical procedure codes, cross-walked to anesthesia codes.
• FH Allowed HCPCS. Allowed amounts arrayed by Level II HCPCS codes for equipment, supplies and services not included in CPT codes, such as ambulance services, DME, specialty drugs, prosthetics, orthotics and supplies when used outside a physician’s office.
• FH Allowed Outpatient Facility. Allowed amounts arrayed by CPT codes for services performed in a hospital outpatient setting, based on billed charge data from the CMS OPSAF.

CPT © 2016 American Medical Association (AMA). All rights reserved

The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), American Dental Association (ADA). All rights reserved.

Basing reimbursement on Medicare fees can present a number of challenges; FAIR Health can help you meet them. Because Medicare focuses on services for the elderly and disabled, CMS does not pay for or value a number of procedures and services commonly utilized by the privately insured population. In addition, Medicare publishes fees for non-facility reimbursement in six separate topic-specific schedules, in multiple formats, which adds time and effort to loading fees into organizations’ systems.

Offering a one-stop solution, FH Medicare GapFill PLUS consolidates all non-facility CMS fee schedules into a single product. FAIR Health then fills the gaps with values developed by applying the scale used by CMS for Medicare fees to our data and provides a consistent format for all values, all in a single, easy-to-load module.

Providing values for all codes, FH Medicare GapFill PLUS includes CMS fees, plus rates for over 1,500 current CPT® and HCPCS codes for which CMS does not provide a value. Zip codes are mapped to the geographic areas in each CMS fee schedule, aligning values to local market areas.

CPT © 2016 American Medical Association (AMA). All rights reserved.

Understanding the range of charges in the local market can offer invaluable insights for physicians and practice managers—from informing negotiations with payors to helping create and model fee schedules. FH Fee Estimator, an easy-to-use website, provides immediate access to up-to-date benchmarks for non-discounted fees for service as reported by healthcare professionals.

Available for dentistry and more than 40 medical clinical specialties in 493 geographic areas across the country, benchmark charges are provided from the 50th to the 95th percentiles. Medicare fees are provided, as well.

Physicians, dentists and practice managers use this tool to:

• Model fee schedules
• Evaluate and negotiate network participation;
• Assess expansion opportunities for new clinical or geographical areas;
• Project revenue associated with the purchase or lease of equipment;
• Compare practice data to local market data and Medicare fees; and
• Help patients understand insurance concepts with a library of co-branded articles.

FH Fee Estimator is available for license by physicians, dentists and practice managers at feeestimator.org.

With FH Online, claims administrators, customer service representatives and others can quickly look up benchmarks to research costs, respond to plan member inquiries, find information needed for appeals and much more.

Available at affordable licensing fees, this user-friendly website offers:

• Access to data contained in our service-specific FH Benchmarks—FH Medical, FH Dental, FH Anesthesia, FH Inpatient Facility, FH Outpatient Facility, FH ASC Facility and FH HCPCS; as well as FH Allowed Medical, FH Allowed Dental, FH Allowed Anesthesia, FH Allowed Outpatient Facility and FH Allowed HCPCS;
• Over 10,000 procedure codes in 493 distinct geographic areas across the US;
• A range of benchmark values from the 50th to 95th percentiles (25th to 95th in some formats) for each procedure code/geographic area combination, in addition to the mean (average) median (middle) and mode (most frequently occurring) charge in certain formats;
• Frequencies provided in many modules for procedures that are commonly performed in a given geographic area; and
• Option to download results to a PDF or Excel file.

FH Online can be licensed in conjunction with any of our FH Benchmarks modules or as a stand-alone product to provide unlimited access to module data. In addition, subscriptions are available for a pre-set number of searches.