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FAIR Health Changes

Physicians and other health care professionals may notice a difference in medical reimbursement due to changes in FAIR Health’s benchmarking methodology.

HCS’ clients use FAIR Health data to determine the usual, customary and reasonable (UCR) reimbursement amount to be paid to providers for services. In May 2017, FAIR Health changed its reporting methodology from derived values to a unified product that includes both actual charges and derived values.

The new reporting methodology results show that the value of some CPT codes is lower than what was published in previous releases. As a result, physicians and other health care professionals may notice a decrease in reimbursement for services rendered where the UCR value changed.

FAIR Health is an independent nonprofit organization that collects data from privately billed health insurance claims and makes it available to consumers and organizations throughout the health care sector as benchmark values for decision-making purposes.