Solutions Benchmark Data Products

Medicare GapFill PLUS

If your organization uses a Medicare-based reimbursement model, how do you determine payment for services that CMS does not value? FH® Medicare GapFill PLUS provides the solution.

All Non-Facility Medicare Values In a Single Format—with the Gaps Filled In

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.

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