Physician Payments Sunshine Act: Beginning of Dispute Process: Open Payments Portal Provides Limited Options, Dispute Discussions Must Be Held Off-Line

 

The Dispute Resolution period of the Physician Payments Sunshine Act has been open for two days now. Physicians are able to register in Open Payments, look through the manufacturer’s transfer of value reports, and either (1) affirm their payment, (2) dispute it with an explanation, or (3) withdraw a dispute. This information will be sent to only a small number of employees at the manufacturer—the Open Payments submitter and potentially other officers designated in the system. These may not be the ideal staff members to receive large amounts of inquiries and disputes.

The email from the physician or teaching hospital making the dispute will contain the following information:

• CMS Record ID: as assigned in the CMS portal
• Payment Date
• Payment Amount
• Payment Category: General vs Research
• Covered Recipient Name
• Dispute ID: new unique CMS generated ID
• Dispute Details: free text box where covered recipient can enter any comments about why they are disputing

Notably, physician and teaching hospital contact information will NOT be provided in the email. CMS has stated for a long time now that their obligation is to publicly post information, not facilitate conversations as part of the dispute process. The Open Payments dispute resolution set up shows that any back and forth between manufacturers and covered recipients will have to take place off-line.

As stated above, physicians and teaching hospitals are able only able to choose between three options, per CMS’ covered recipient instructions:

1. Affirm – confirms the payment or other transfer of value as identified. You may affirm a record as long as the selected record does not have any disputes in an initiated or acknowledged status.
2. Dispute – disputes the payment or other transfer of value reported, or
3. Withdraw –withdraws a dispute you previously initiated.

Manufacturers have only two options if they acknowledge the dispute:

1. Resolved with No Change or
2. Resolved, which means that there was an update and a resubmission.

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A few days before the dispute resolution process, CMS advised physicians to “Organize your industry contact information as you will be working directly with them to resolve any disputes or answer any questions you may have in regards to the data they’ve reported.”

Given the short time window to address this issue, and the fact that many may not have received this announcement, physicians likely do not know how to contact the proper resources at a large pharmaceutical company over their disputed payments. The Open Payments Portal does not facilitate any type of back and forth—the communication goes from the covered recipient to manufacturer, then the process ends. Thus, companies must communicate to all internal employees and third parties exactly how to get in touch with the resources responsible for Open Payments submission, since there is now a potential for covered recipients to reach out to a Manufacturer however possible.

Another issue, as physician groups noted in the Dispute Resolution call for comments, is that it will be up to manufacturers to determine, how much, if at all, they want to try to follow up and locate covered recipients. Manufacturers will need to make a decision around how much to follow up with physicians and teaching hospitals about disputes aren’t cut and dry. For example, we have heard from companies that covered recipients may argue that they didn’t attend a certain speaker program. If a manufacturer has the doctor on a sign-in sheet, they could either keep the disputed transaction the same because they have proof or also try to contact the covered recipient to tell them why that is the case.

Thanks to Polaris for some of the insight, and we will be providing more information about the Dispute Resolution process in the coming weeks.

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