SCGhealth Blog


Open payment 45 day review period is now open

Thursday, April 23, 2015

by Marla Durben Hirsch

Physicians and academic medical centers should check to see whether any pharmaceutical or medical device manufacturer has reported making payments to them, now that CMS has opened up the 45 review period of such reports made to the Open Payments program.

The Open Payments program, created by the Affordable Care Act and also known as the Sunshine Act, requires the manufacturers to report direct or indirect payments or other “transfers of value” made to physicians and teaching hospitals, as well as certain ownership or investment interests of physician owners or investors. Reports are required to be made annually. Payments required to be reported include consulting fees, gifts, food, travel and other items. Providers can either affirm the record or initiate a dispute if they disagree with the report.

There are 15 days immediately after the 45 day review period for manufacturers to continue to make corrections before the payments are posted on the internet, which is slated for June 30, 2015. Data corrections can be made at any time; however, if a dispute is not resolved within those timeframes the report change won’t be reflected until next year.

The review period window opened on April 6.

This is the second reporting cycle for the program, covering payments made in 2014. CMS published information on 4.45 million payments valued at $3.7 billion for the last five months of 2013, according to CMS’ website.

In an April 15 educational call, CMS reiterated that to review any payments attribute to them, physicians and teaching hospitals must register in both the Enterprise Identity Management system and the Open Payments System. CMS also will not mediate disputes between providers and manufacturers regarding the reports.

System inconsistent, underutilized

Note that the Open Payments program, which got off to a delayed start, still needs to work out a few kinks. For instance, the “nature of payment” has been interpreted different ways by different manufacturers, creating inconsistencies. There have also been mistakes in reporting, such as attributing a payment to the wrong physician with a similar name.

Perhaps a bigger problem for physicians is that they’re not taking advantage of the opportunity to review whether a report has been made about them in order to affirm or dispute it. According to an article in The Health Lawyer, the flagship Journal of the American Bar Association’s Health Law Section1, CMS defines the total physician population as 926,400, and 546,000 physicians have been identified in the Open Payments database. However, only 26,000 physicians have even registered to review their payments, let alone actually done so.

That oversight could have far-reaching implications. Since this is a public data base, and the whole premise of the Open Payments program is transparency, anyone, including patients, disgruntled employees, the media, and the government have free reign to access the data base and view the same data. Depending on the data, physicians could be subject to allegations of undue influence, conflicts of interest, billing fraud, malpractice and other claims.

It’s in a physician or teaching hospital’s best interests to check out the data base. According to CMS, it takes about 30 minutes to register. The agency also notes that:

Physicians and teaching hospitals who registered during program year 2013 do not need to register again

A physician may nominate one authorized representative to perform system functions on his or her behalf

Teaching hospitals can designate up to 10 authorized representatives and authorized officials to act on their behalf in the Open Payments system

All physician profiles are vetted against CMS-approved sources to confirm that the registrant is a covered recipient physician

Physicians are vetted using information supplied during Open Payments system registration, including: First and last name National Provider Identifier (NPI)

State license(s) information

Primary type (if no NPI is provided)

Physicians will receive an email confirming vetting success or failure

If vetting is unsuccessful, physicians should contact the Open Payments Help Desk

Open Payments Help Desk: openpayments@cms.hhs.gov or 1-855-326-8366.

Resources:
CMS education outreach presentation
CMS open payments website

1 See Abraham Gitterman, Esq. Update to: Shedding Some Light: Reporting Obligations and Compliance Implications of the Sunshine Act, The Health Lawyer, Volume 27, Number 3, February 2015, p 45.



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