Physician Payments Sunshine Act: Open Payments 2015 Timeline; Enhancements to the System

Unlike the first Open Payments program year, which took place over a 5 month period from August 2013 – December 2013, the second year covers all of industries’ 2014 payments or transfers of value to covered recipients. Data collection wrapped up on December 31, 2014.

Following a month-long outage to Open Payments this January in order for CMS to address some technical issues, companies are expected to be able to submit their 2014 payment data during the months of February and March. The review and dispute process will follow, likely in April-May. Physicians and teaching hospitals will have at least 45 days to access the system and examine their reports. While usability on the data side of the Open Payments has seen improvement, it will be interesting to see whether the physician registration process has been smoothed out. Last year the complicated registration led to some physicians giving up mid-way. CMS addresses this aspect some in their Open Payments System Enhancements (addressed below).

For first time users of Open Payments, registration is a two-step process—users must register first in CMS’s Enterprise Identity Management (EIDM) and then request access to the Open Payments system. The EIDM system is used as an identity verification process and may take some time to work through. Also note that EIDM will lock a user account after 60+ days of inactivity and will deactivate a user account after 180+ days.

Applicable manufacturers and GPOs will complete re-certification when the Open Payments system becomes available after system enhancements are completed in January 2015. This process confirms that details in the Open Payments system are accurate. Re-certification is required in order to perform any Open Payments system functions. Entities due for re-certification are given a status of “Pending Recertification.” Re-certification can only be performed by users who hold the officer role. Outdated or inaccurate information can be updated during this time. Re-certification is not required for physicians and teaching hospitals. 

Note that changes to the following fields will trigger “re-vetting” of the applicable manufacturer or applicable GPO:

• Registering Entity Legal Name
• Tax ID Number/ Employee ID Number
• Dun and Bradstreet Duns Number (D&B)

 

Open Payments System Enhancements (Highlights in bold)

Enhacements for Registration

For one, physicians will not be able to edit their first name, last name, and National Provider Identifier (NPI) in the Open Payments system after CMS has vetted, or verified, their identity. The first and last name will be pre-populated from the EIDM profile, and can be updated up until successful vetting. Physicians will now receive emails regarding the status of the vetting process.

Furthermore, special characters are now allowed in physician and entity names and state license number. CMS lists the following allowable special characters:

= [] \ ; ‘ , . / ? > < “ : | } { + _ ) ( * & ^ $ # @ ! ~ ` 

Enhancement for Submission

CMS is offering validated physician and teaching hospital lists, but some of their enhancement could actually bring extra work for companies. For example, deleting records will now trigger “re-attestation” requirements, and no longer will users be able to override unmatched records to move on with the Open Payments submissions. Enhancements include:

• Validated physician list is downloadable in CSV format. It contains the first and last name with variations, NPIs, and state license numbers for physicians who have been reported on in the Open Payments system. CMS encourages manufacturers and GPOs to consult the list “to avoid inconsistencies in reporting.” However, this list only refers to physicians who were reported on in 2013. Physicians with no reportable transfers in 2013, but with transfers in 2014 will still have to be reported on without reference to CMS’s list. 
• 2014 Teaching Hospital List, which provides hospitals’ “doing business as” names, legal names, & NPPES business address. CMS states that program year 2014 submission should be made using the hospitals’ “doing business as” name instead of legal name.
• Enhanced data matching for submitted records.
• Deleting records will now trigger “re-attestation.”
• Users will be unable to override unmatched records—they will be treated as validation errors.
• Special characters are now allowed in physician and entity names, and state license numbers.
• XML is no longer an accepted bulk data file format. CMS notes that during 2013, XML was not used much by reporting companies.
• “Delay in Publication” status is now visible on the “Review Records” page of Open Payments.

Enhancements for Review and Dispute

CMS states that principal investigators will have the ability to review and dispute research records attributed to them. In 2013, PIs didn’t have this ability, which contributed to much of the research payments being “de-identified.”

CMS states that PIs may only dispute their own association with the reported payment or other transfer of value. All other details, such as payment amount, date, nature of payment, etc., can only be disputed by the covered recipient. They also will not be able to see identifying information about other PIs in the records. CMS states that additional review and dispute instructions for PIs is forthcoming. 

What can users do now?