Physician Payments Sunshine Act: Doug Brown of CMS Addresses Data Submission Issues in Latest Q&A

 

The Centers for Medicare and Medicaid Services (CMS) hosted a call today to assist stakeholders with the data submission process for Open Payments. During the call, Doug Brown covered a number of issues that applicable manufacturers and GPOs have been experiencing when attempting to submit their payment records to CMS.

Final submit button is missing

Brown noted that numerous companies have reported issues related to the final submission step—after all of a company’s records have been matched and passed validation, for some reason the “Final Submit” button does not appear.

Brown advised that an often successful work-around to this would be where manufacturers have the words “United States” written out, instead of “U.S.”, in their files. Brown advised that these companies should delete their records and re-upload using “U.S.”, which “should take care of the problem.” Brown did note that there are a few times where this fix still is not the answer—CMS is working on additional fixes in the next week.

Data Download Functionality

CMS is aiming to have “data download functionality” for manufacturers and GPOs by this Friday, March 13, but Brown notes that working through matching and submission issues may be a priority that pushes back the timeline for the download capability.

CMS Can Trace Deleted Records When Contemplating Audits and Penalties

Brown stated that even given Open Payments’ revamped matching process, a situation may still arise where (1) a physician is not on CMS’s validated physician list and (2) when companies submit the seemingly correct information, it is still being rejected by the system. “If we have a record that has an NPI, state license, and first and last name, and CMS cannot validate it using NPPES and PECOS,” than the system will not accept the record, Brown stated. ”So, there will be records attributable to covered recipients that the system will not be able to accept.”

Brown notes that he “does not want this to be something that “comes up down the road in an audit.”

To avoid problems during an audit and resulting Civil Monetary Penalties, Brown advised companies to separate out the physician records that are problematic and that have been rejected. He stated that companies should separately submit all of the physician records that the system accepts, and attest to these. For the rejected pile of records, companies should nonetheless upload these records, which will be rejected, and then delete the entire file. Brown stated that Open Payments has a traceability capability that saves a lasting record that the company has submitted this file. Thus CMS will know that the company submitted transfers of value about individuals, even if there were problems with the ultimate submission process.

“Even when you delete the entire file, we do retain a record of this transaction actually occurring. And we can then look back later on, before contemplating any audit or any CMP action to make sure we have a firm understanding of those records that you attempted to report about,” Brown states.

Validated Physician List

Finally, Brown advised companies that even if CMS’s validated physician list contains potentially inaccurate information, CMS will allow those records to come into the system and be matched. However, Brown notes that where companies are debating between clearly incorrect information from the validated physician list, he would much prefer reporting, for example, a “non-suspect state license number” instead of trying to submit a state license number that is “all zeros.”

For more information on the data submission process, visit https://www.cms.gov/OpenPayments/Program-Participants/Applicable-Manufacturers-and-GPOs/Data-Submission-and-Attestation.html

Also, yesterday, CMS issued five new Open Payments FAQs.