On November 2, 2021, the United States Centers for Medicare and Medicaid Services (CMS) issued the Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule. While many updates were made in the Physician Fee Schedule, this article focuses on the updates and changes to the Open Payments. A companion article to this one can be found here, which goes into greater detail of the specifics of much of the Physician Fee Schedule.
As our readers may know, Open Payments is a transparency program that requires pharmaceutical and device manufacturers, as well as group purchasing organizations, to report payments or transfers of value to physicians, teaching hospitals, and other providers to CMS. As of January 1, 2022, PAs, NPs, CNSs, CRNAs, and CNMs, are also included as a covered recipient and payments or transfers of value must be reported to CMS under the Open Payments Program.
In the 2022 Physician Fee Schedule, CMS has made the following revisions, effective for data collection beginning in CY 2023 and reporting in CY 2024:
- Adding a mandatory payment context field for records to teaching hospitals so that the records include sufficient information to identify reported payments or transfers of value in their own records and verify records during the review and dispute process without having to obtain additional information
- Adding the option to recertify annually even when no records are being reported
- Disallowing record deletions without a substantiated reason
- Updating the definition of ownership and investment interest
- Adding a definition for physician-owned distributorships as a subset of applicable manufacturers and group purchasing organizations (for the purposes of the Open Payments program reporting only)
- Requiring reporting entities to update their contact information
- Disallowing publications delays for general payment records
- Clarifying that the exception for short-term loans applies for 90 total days in a calendar year, regardless of whether the 90 days were consecutive
- Removing the option to submit and attest to general payment records with an “Ownership” Nature of Payment Category
With respect to the revision regarding disallowing record deletions without a substantiated reason, CMS notes that they have not seen evidence of such conduct but believe the existing regulations “might allow entities to be compliant by reporting and attesting to records, then deleting those records so that they are never publicly available.”
CMS believes that these changes will increase the usability of the data and address concerns they have heard from stakeholders. Additionally, the agency is hopeful that the implementation timeline gives reporting entities enough time to prepare for changes to their data collection and reporting procedures.
For any issues regarding Open Payments not identified in the final rule, CMS states to contact Kathleen Ott, (410) 786-4246.