For those members who have purchased access to the Fair Health data as a benefit of your IARP membership, please be advised that they are having some difficulties with their counter for the number of searches you have completed. For an accurate count please use your LOOK UP HISTORY, found in the <g class="gr_ gr_12 gr-alert gr_spell gr_run_anim ContextualSpelling multiReplace" id="12" data-gr-id="12">left hand</g> menu. Please find attached a screenshot from my look up history, as an example. You can see that the counter shows I have 399 of my 400 searches left, but the history shows I have used 538 searches. I mention this because you may have exceeded your count, as I have, and you may be searching on a credit that has been given to you by Fair Health as an extension of your contract. Be aware that you will be charged for these additional searches. The Board has been working with Fair Health to develop a possible payment option to break up the cost of the larger search packages. Stay tuned.
Also attached, is a fact sheet from Fair Health that provides you, as a user, with the needed foundation for your opinions about Fair Health's cost data. You may wish to keep this information sheet in your file with the other cost research back up for your care plan. You may also wish to utilize this information in your analysis of the benefits or limitations of this data source.
IARP offers access to AHD (American Hospital Directory) as a resource for cost research. AHD identifies the following as source information for their data (taken from the website):
Medicare Cost Reports
The Healthcare Cost Report Information System (HCRIS) dataset contains the most recent version (i.e. as submitted, settled, reopened) of each cost report filed with CMS since federal FY 1996. The dataset consists of every data element included in the HCRIS extract created for CMS by a provider's fiscal intermediary. Cost reports are filed annually by hospitals according to their individual reporting years. This dataset is updated quarterly by CMS. All reports based on cost report data indicate reporting periods in the column headers.
Medicare Claims Data - Inpatient
The Medicare Provider Analysis and Review (MedPAR) file contains IPPS billing records for Medicare beneficiaries using hospital inpatient services. [Patient confidentiality is carefully protected and reporting is in compliance with current CMScell size suppression policy.] The MedPAR Limited Data Set (LDS) is based on discharges during the federal fiscal year ending September 30. A preliminary file is generally available in April after <g class="gr_ gr_4935 gr-alert gr_gramm gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="4935" data-gr-id="4935">publication</g> of the proposed PPS rule. A final file is generally available in early August after <g class="gr_ gr_4937 gr-alert gr_gramm gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="4937" data-gr-id="4937">publication</g> of the final PPS rule. (PPS rules are based on historical claims data from the fiscal year preceding their publication. For example, the rules for FY2011 are published in FY2010 using data from FY 2009.) All Inpatient Utilization reports based on MedPAR information indicate the fiscal year period in their headers.
Medicare Claims Data - Outpatient
The Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set contains claim records for all Medicare beneficiaries using hospital outpatient services. [Patient confidentiality is carefully protected and reporting is in compliance with current CMS cell size suppression policy.] The final file is usually provided by CMS about one month after publication of the OPPS final rule in late November. (The OPPS rule is based on historical claims data from the year preceding <g class="gr_ gr_5004 gr-alert gr_spell gr_run_anim ContextualSpelling" id="5004" data-gr-id="5004">its</g> publication. For example, the rule for 2011 is published in 2010 using data from 2009.) All Outpatient Utilization reports based on this information indicate the reporting period in their headers.
There are differences between the data you get from Fair Health and AHD. As an example, AHD provides <g class="gr_ gr_5000 gr-alert gr_gramm gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="5000" data-gr-id="5000">length</g> of stay and facility specific charge data that you will not find with Fair Health. AHD also provides data about Medicare reimbursement for a projected DRG stay. AHD does not provide data for a DRG if it there <g class="gr_ gr_11474 gr-alert gr_gramm gr_run_anim Grammar multiReplace" id="11474" data-gr-id="11474">are</g> not enough incidences of that diagnosis for the subject year. Fair Health uses the same Medicare sources, but they will provide a price for your requested DRG using a derived methodology listed in the fact sheet I have attached. Fair Health does not offer information on <g class="gr_ gr_5801 gr-alert gr_gramm gr_run_anim Grammar only-ins doubleReplace replaceWithoutSep" id="5801" data-gr-id="5801">length</g> of stay in the data we currently have access to through our IARP membership. Each year new CPT codes are introduced for new procedures, these codes do not have a history. The way they are priced is based on this derived methodology:identifying codes that use similar resources and time. I recently had an experience where the same CPT code was listed with a $20K difference between sources (PMIC MEd Fees vs. Fair Health). Fair Health Customer service is available to assist you with these sorts of questions.
Each year new CPT codes are introduced for new procedures. These codes do not have a history, so they are priced using the derived methodology: identifying codes that use similar resources and time. I recently had an experience where the same CPT code was listed with a $20K difference between sources (PMIC Med Fees vs. Fair Health). Fair Health Customer service is available to assist you with these sorts of issues.
Finally, the Life Care Planning section board is working with Fair Health to develop a FAQ document and webinar for your use. It would be of great benefit to us if you could provide us with questions that you would like addressed.
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Liz Holakiewicz, BSN, RN, CCM, CNLCP
Liz Holakiewicz & Associates
liz@lcpnurse.comCarlsbad, CA United States
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