Defining Shoppable Services for Price Transparency

The list must have plain-language descriptions of the shoppable services and group them with ancillary services.

A version of this article was first published December 14, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

Q: How does CMS define a "shoppable service"? What information needs to be included in the list of 300 shoppable services required by the Hospital Price Transparency final rule?

A: A shoppable service is typically a nonurgent service a patient can schedule in advance, Hartstein said. The list of shoppable services must include 70 services selected by CMS and 230 services selected by the hospital for a total of 300 services. If your hospital doesn’t offer one or more of the CMS-selected services, you must indicate that the service isn’t offered at your hospital, said Marc Hartstein, MA, principal at Health Policy Alternatives in Washington, D.C., during his session “Analyzing the Impact of Requirements for Hospitals to Make Standard Charges Public” on day three of Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event, held October 6–8, 2020.

The list must have plain-language descriptions of the shoppable services and group them with ancillary services. It should indicate the location where each service is provided, including whether it is provided on an inpatient or outpatient basis or both, Hartstein said. CPT® codes, HCPCS codes, DRGs, and other common billing codes should be included as applicable, he added.

The list must also provide the following price information:

• De-identified minimum and maximum negotiated charges
• Discounted cash prices
• Payer-specific negotiated charges

Alternatively, hospitals can use a patient-facing price estimator tool to fulfill this requirement. See 45 CFR §180.60 for additional details on this requirement and use of a price estimator tool.

For more information, see "Gaining perspective on price transparency" in the December 2020 issue of HIM Briefings.