Nav: Home

Nation's largest private health care database acquires all Medicare claims data

March 17, 2017

New York, NY--March 15, 2017--FAIR Health announced today that as a result of its designation last year by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity (QE), it is adding four full years of Medicare claims data to its database of more than 23 billion private healthcare claims. FAIR Health is one of only four organizations certified by CMS under its Qualified Entity Certification Program (QECP) to receive Medicare Part A (hospital and facility services), Part B (medical services) and Part D (prescription drug services) claims data for all 50 states and the District of Columbia. To date, FAIR Health has received from CMS 100 percent of claims for Parts A and B services rendered nationwide from January 2013 through September 2016, and all Part D claims from 2013 through 2015. FAIR Health expects to receive the balance of the data by April 2017, giving the organization all Parts A, B and D claims from 2013 through 2016. Moving forward, FAIR Health is scheduled to receive Parts A and B data quarterly and Part D data annually.

CMS is providing FAIR Health with claims that represent the experience of more than 55 million individuals enrolled in Medicare Parts A and B coverage. These claims will supplement FAIR Health's collection of private claims from both fully insured and self-insured plans that represent more than 150 million individuals. FAIR Health regularly receives private claims from approximately 60 of the country's national and regional commercial insurers and thus holds data assets offering a uniquely comprehensive record of healthcare costs and utilization across the country. FAIR Health's private claims database now includes more than 23 billion medical and dental records dating back to 2002, with more than 2 billion private claims added each year.

Public and Non-Public Reports to Include Medicare and Private Claims Data

As part of its QE responsibilities, FAIR Health will produce and publish public quality reports and data analytics--based on its database of private insurance claims, in combination with Medicare information--to support efforts to promote transparency, improve the quality of care and reduce costs. FAIR Health also plans to use the Medicare data for internal analyses that will contribute to the evolution of its products and analytics and enrich its offerings in support of transparency in policy making and health systems research.

In addition, with its QE designation, FAIR Health is able to create, for clients who contribute their private claims data to FAIR Health, non-public aggregate reports that reflect information from Medicare Parts A, B and D claims data. The reports will incorporate data from the privately billed claims from the vast FAIR Health repository and/or the client's own data. These types of comprehensive analyses can open up a broad range of opportunities for an organization to evaluate its claims data for strategic, operational, clinical, budgetary and other purposes.

FAIR Health President Robin Gelburd remarked, "FAIR Health's QE certification demonstrates the trust the healthcare sector places in our data security and mission-driven activities. It also gives us the opportunity to conduct analyses incorporating vast amounts of Medicare and private claims data, offering a unique, overarching perspective on the workings of the healthcare system today."
-end-
About FAIR Health

FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health oversees the nation's largest repository of private healthcare claims data, comprising over 23 billion billed medical and dental charges that reflect the claims experience of over 150 million privately insured Americans. FAIR Health licenses its data and data products--including data visualizations, custom analytics, episodes of care analytics and market indices--to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health has been certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, eligible to receive all Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health data are referenced in statutes and regulations around the country and have been designated as the official, neutral source of cost information for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. Many states have approached FAIR Health with respect to proposed consumer protection laws governing balance billing for surprise out-of-network bills and emergency services, and two states have made FAIR Health a standard in their balance billing legislation. FAIR Health uses its database to power a free consumer website, available in English and Spanish and as an English/Spanish mobile app that enables consumers to estimate and plan their healthcare expenditures. FAIR Health also offers a rich educational platform on health insurance on its website and app. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. For more information on FAIR Health, visit fairhealth.org.

Contact:

Dean Sicoli
Executive Director of Communications and Public Relations
FAIR Health
646-664-1645
dsicoli@fairhealth.org

FAIR Health

Related Medicare Articles:

Study: Medicare could overpay medicare advantage plans by $200 billion over ten years
Research conducted at University of California San Diego School of Medicine found that current trends in diagnostic coding for patient risk scores will lead to Medicare overpaying Medicare Advantage (MA) plans substantially through 2026-likely to the tune of hundreds of billions of dollars.
10,000 Medicare patients die in the seven days after discharge from the ED
Researchers found that, each year, about 10,000 generally healthy patients die in the seven days after discharge from the ED.
Hospitals in Medicare ACOs reduced readmissions faster
The Accountable Care Organization model of paying for health care appears to help reduce hospital readmissions among Medicare patients discharged to skilled nursing facilities, a new study suggests.
Highest out-of-pocket cancer spending for Medicare patients without supplement
Which Medicare beneficiaries shoulder the highest out-of-pocket costs after a cancer diagnosis?
Medicare's new way of paying hospitals could cause a bundle of problems for some
Hospitals that take care of the oldest, sickest and most complicated patients could suffer financially under the Medicare system's new approach to paying for some types of care, a new study finds.
Study examines opioid agonist therapy use in Medicare patients
Few Medicare enrollees appear to be receiving buprenorphine-naloxone, the only opioid agonist therapy for opioid addiction available through Medicare Part D prescription drug coverage, according to a study published online by JAMA Psychiatry.
Possible to account for disadvantaged populations in Medicare's payment programs
A new report from the National Academies of Sciences, Engineering, and Medicine says that Medicare's value-based payment programs could take into account social risk factors -- such as low socio-economic position, residence in disadvantaged neighborhoods, or race and ethnicity -- but any proposal to do so will entail both advantages and disadvantages that need to be carefully considered.
The association between Medicare eligibility and rehabilitative care
Researchers from the Center for Surgery and Public Health at BWH found that becoming Medicare eligible at age 65 (as compared to age 64) was associated with an abrupt 6.4 percentage-point decline in the number of people who were uninsured and a 9.6 percentage-point increase in rehabilitation.
Telemedicine use increases among rural Medicare beneficiaries
Telemedicine use in Medicare has been increasing rapidly, and in 2013 there were over 100,000 telemedicine visits for Medicare beneficiaries.
Study examines use of telemedicine among rural medicare beneficiaries
Although the number of Medicare telemedicine visits increased more than 25 percent a year for the past decade, in 2013, less than 1 percent of rural Medicare beneficiaries received a telemedicine visit, according to a study appearing in the May 10, 2016 issue of JAMA.

Related Medicare Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#530 Why Aren't We Dead Yet?
We only notice our immune systems when they aren't working properly, or when they're under attack. How does our immune system understand what bits of us are us, and what bits are invading germs and viruses? How different are human immune systems from the immune systems of other creatures? And is the immune system so often the target of sketchy medical advice? Those questions and more, this week in our conversation with author Idan Ben-Barak about his book "Why Aren't We Dead Yet?: The Survivor’s Guide to the Immune System".