FH® 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.
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All Nonfacility 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 nonfacility reimbursement in six separate topic-specific schedules, in multiple formats, which adds time and effort to loading fees into organizations’ systems.
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Offering a one-stop solution, FH Medicare GapFill PLUS consolidates all nonfacility CMS fee schedules into a single product. To fill gaps, FAIR Health compares non-discounted provider charges in our database to the fees Medicare pays for similar types of services in order to develop scaled values, which are then adjusted by geography using CMS's GPCI factors.
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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