FAIR Health offers benchmark charge data products to help businesses and professionals in the healthcare community meet a range of objectives. Standard product modules and custom analytics are designed to meet the needs of payors, TPAs, bill review companies, consultants, employers, unions, associations, government agencies and large provider practices and healthcare systems. FAIR Health offers products developed specifically to meet the unique needs of individual providers, small to mid-size practices and researchers.
FAIR Health makes the following benchmark modules available:
- Medical/Surgical module – includes CPT codes for evaluation and management (E&M), medical, surgical, radiology, laboratory and pathology procedures
- Dental module – includes CDT 2011-2012 codes
- Anesthesia module – includes CPT category I codes, Anesthesia codes and surgical procedure codes
- Inpatient Facility module – includes codes for services performed in a hospital inpatient setting, based on Centers for Medicare & Medicaid Services (CMS) MEDPAR data; the values for services billed and payable by Diagnosis-Related Groups (DRGs) are provided as both a total DRG charge and as a per diem per DRG, taking into account the length of stay associated with the admission.
- Outpatient Facility module – includes CPT codes for services performed in a hospital outpatient setting, based on the CMS Outpatient Standard Analytical File (OPSAF) data. Professional services, with the exception of physical therapy, are not included.
- Healthcare Common Procedure Coding System (HCPCS) module – includes Level II HCPCS codes for products, supplies and services not included in CPT codes, such as ambulance services, durable medical equipment, prosthetics, orthotics and supplies when used outside a physician’s office
- Allowed Medical module – includes fees allowed by plans rather than fees charged by providers; benchmarks are available by plan type (Aggregate, HMO, PPO) for CPT codes including evaluation and management (E&M), medical, surgical, radiology and laboratory procedures
The data modules described above are available on a national, regional and state basis.
- National modules include data for 491 geozips in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands and Guam
- Regional modules include data for each of four areas of the country: Northeast, Midwest, South and West; select one or more formats:
- Benchmark data for all geozips in the region
- Data aggregated at the state level for each state in the region
- Aggregated benchmark data for the entire region
- State modules are available for 50 states and the District of Columbia. Choose one or more formats:
- Benchmark data for all geozips within the state
- Aggregated benchmark data at the state level
Standard modules are available on CD or as a secure FTP download.
Data modules are refreshed and distributed at least two times a year. View the Release Schedule.
On-line Query Tool
To provide an easy way to access data contained in the product modules, FAIR Health offers the FH Benchmark On-Line Query tool. This simple-to-use interface enables users to quickly search and view selections of data and export data to a variety of formats including Excel.
In addition to the FH Benchmark Data modules, FAIR Health offers custom analytics on a case-by-case basis, producing special datasets to meet clients’ strategic needs and requirements. Custom analytics typically take one of two forms:
Custom Datasets of FH Benchmark Module Data
FAIR Health develops custom datasets that offer charge benchmarks for client-specified parameters including procedure codes, geographic regions, and/or time periods. Custom datasets have included the following:
- customized geographic regions/geozip combinations
- customized sets of procedure codes (e.g., to reflect episodes of care or clinical concentrations)
- charge benchmarks for a custom range of percentiles
- benchmarks for particular time periods
- benchmark data with the addition of specific charge modifiers
Analysis of FAIR Health Claims Data
FAIR Health’s team of data analysts and statisticians can perform client-specified analyses of FAIR Health claims data to help clients understand trends and patterns in service delivery and billing. Analyses performed for clients have included the following:
- the frequency with which procedures are performed in different geographic region to show how service delivery patterns or cost have changed over time
- incorporating patient-level data (e.g., gender, age) from FAIR Health’s claims data to understand patterns in care delivery
- comparative market studies
Contact FAIR Health for more information about custom analytics.
The FAIR Health database constitutes a rich repository of claims information. To promote clinical and health policy research, FAIR Health makes elements from its claims data from 2002 to the present available to academic and policy researchers. Visit the Research Support page to learn more about this program.
Data Formats for Providers
Healthcare practices and individual practitioners typically require data for a subset of procedure codes related to their particular specialties and/or geozips for the areas where they practice. For these needs, licensing standard data modules that encompass the full complement of clinical codes may not be necessary or efficient. Healthcare professionals are invited to visit www.feeestimator.org to learn more about FAIR Health’s self-service website that makes data products available for dentistry and medical specialties by geographic area.
CPT copyright 2011 American Medical Association. All Rights Reserved.
The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2010 American Dental Association (ADA).
All Rights Reserved.