Simply put, shoppable procedures are specific medical services members and patients can schedule well ahead of time, usually on an out-patient basis.
The Centers for Medicare & Medicaid Services (CMS) defines a shoppable service as “a service package that can be scheduled by a healthcare consumer in advance.” In the regulation, CMS specifies 70 services for which hospitals must make price information available for if they provide them. The remaining 230 will be selected by hospitals. These services are defined by diagnosis-related group (DRG), ICD-10 Diagnosis Codes and Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) codes.
For instance, lab tests for a chronic condition or a cholesterol level check, colonoscopies, yearly mammograms, and imaging tests, like MRIs, CT scans, and echocardiograms, can all be scheduled on an out-patient basis if not needed due to an emergency.
Making shoppable services for healthcare easier for the member
According to the Health Care Cost Institute (HCCI), the difficulty in learning the full cost of services before receiving them makes it nearly impossible to opt for lower-cost services or providers, even when you are scheduling a procedure well in advance.
That’s where SmartShopper comes in.
Since, it’s difficult to realistically shop for a healthcare service unless you are able to compare the cost and other information about the provider to others offering the same service in your area, supporting “shoppability’ requirements can be a challenge. For employer group members, SmartShopper takes that burden off by using incentives to steer members to certain shoppable procedures that offer a similar standard of quality at a lower cost.
While there is more to the coming regulations, SmartShopper can be an excellent tool to get out in front as the rules unfold.