Answers to the most common questions about the data set for the Balance Billing Protection Act.
Why is there a flag next to my results?
Results in the data set are marked with a flag when fewer than 50 claims were used in the calculation.
Why are there no results for anesthesiology services?
This year's data set did not have sufficient detail about anesthesiology claims to accurately calculate the median allowed amount. Onpoint, the vendor in charge of the All Payer Claims Database data set (Excel, 3.17 MB), has revised the 2020 guidelines for submitting claims so that the information needed to calculate the median allowed amount will be available in time to develop the 2021 data set.
In order to develop appropriate calculations for emergency department facility claims that provide reliable median amounts for the same or similar services, more analysis of the claims data is needed. The data set work group will continue to work on this issue in the coming months.
Why are there no results for the service I’m interested in?
There are several reasons why you may not be able to find results for a given service. Here are several:
- No one received the given service in the state or region during the base year.
- The given service was performed but was paid on other than a fee-for-service basis.
How was the median calculated?
The median is the middle value of all individual claims for a specified Current Procedures Terminology (CPT) code and region combination.