August 1, 2013, is the initial date that all applicable manufacturers must begin recording qualifying payments or transfers of value to teaching hospitals or physicians in accordance with federal regulations commonly known as the Physician Payment Sunshine Act or OPEN PAYMENTS. The Centers for Medicare and Medicaid Services (CMS) refers to the Physician Payment Sunshine Act as OPEN PAYMENTS. Please click here for a brief overview of the OPEN PAYMENTS program. For 2013, applicable manufacturers will record qualifying payments or transfers of value from Aug. 1, 2013 until Dec. 31, 2013. Applicable manufacturers will then report to CMS the payments or transfers of value by March 31, 2014. CMS will compile and publish the reports on a publicly available website. Below are five tips to help with the data-recording process.
- Providers should personally record their interactions with applicable manufacturers, too. Both providers and applicable manufacturers should independently record their interactions and any potential payments or transfers of value. If a provider records his, her or its interaction with an applicable manufacturer, then the provider will be more prepared to respond to the publicly reported payment data and dispute any erroneous reports. Providers will have the option to register in the OPEN PAYMENTS system and review and dispute the payments or transfers of value listed for the particular provider. Disputed payments or transfers of value will still be publicly available during the dispute resolution process. If both sides record applicable payments, the process of resolving a disputed transaction will be expedited.
- There is a free app for that. Providers and applicable manufacturers should develop a consistent method of recording payments and transfers of value. CMS has released reporting templates for (a) general payments and transfers of value; (b) research-related payments and transfers of value; and (c) physician ownership. These templates can be used to create a system for recording payments and transfers of value. Alternatively, smartphone apps allow both providers and applicable manufacturers to conveniently record payments or transfers of value. CMS recently released OPEN PAYMENTS apps for both Apple® and Android™ phones specifically for physicians and applicable manufacturers. CMS is also hosting a contest to develop apps that are able to easily record payments and transfers of value. Using a smartphone app may be a convenient way for both providers and manufacturers to record payments or transfers of value.
- Record everything. It will be easier to record every potential payment or transfer of value, initially, and later determine whether the payment or transfer of value must be reported or if it is exempted from reporting requirements. For example, payments or transfers of value over the annual aggregate amount of $100 must be reported. Even though an individual meal or coffee may be under the $10 individual payment or transfer of value minimum, throughout the entire year, the total monetary amount of lunches or coffee may increase to over $100. This aggregate amount must be reported. If every exchange is recorded, it is much easier to calculate the aggregate monetary amount and accurately report all qualifying payments and transfers of value.
- Collaborate and confirm. Applicable manufacturers and providers should work toward developing a collaborative system of confirming recorded payments and transfers of value in advance of the dispute resolution period. Developing a collaborative system for reporting payments and transfers of value may help reduce the number of disputed payments and help maintain a positive and productive relationship between providers and applicable manufacturers.
- State law reporting requirements remain in effect. OPEN PAYMENTS preempts some but not all state laws requiring reporting for payments or transfer of value from manufacturers to healthcare providers. For example, some states require reporting of payments or transfers of value to physician extenders in addition to teaching hospitals and physicians. Also, some states require reporting of different types of payments and transfers of value or require reporting from different parties making the payment or transfer of value. Applicable manufacturers must continue to comply with applicable state law reporting requirements in addition to complying with the OPEN PAYMENTS regulations. Failure to comply with either state or federal law could result in monetary penalties.
If you have questions about the Physician Payment Sunshine Act, OPEN PAYMENTS and recording and reporting applicable payments, transfers of value or physician ownership, please contact one of the authors.