Life Science Compliance Update

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June 13, 2014

Physician Payments Sunshine Act: CMS Pushes Dispute Resolution to August/September; Still Plans to Post Public Database in September

The Centers for Medicare and Medicaid Services (CMS) held a webinar yesterday aimed at physicians and teaching hospitals. While CMS mainly provided a broad overview of the steps covered recipients must take to register with EIDM and Open Payments, the 75 page PowerPoint for physicians and teaching hospitals, introduced new FAQs and their latest timeline. They also released a 196 page Open Payments user guide.

During the presentation, CMS noted that their auditing process of manufacturer reports would begin after publication of the data, and would include an appeals process. Furthermore, they stated that they had no intention of expanding the covered recipient list to include physician assistants and nurse practitioners, which would have to come from new legislation. We recently saw tis at the state level in Minnesota and Connecticut.

Sunshine Timeline

Notably, CMS has not yet announced when physicians will be able to access the Open Payments system to check their payments. CMS has, however, now stated that the 45-day Dispute Resolution period will take place in "Aug/Sept TBD." As you can see in the timeline, they still are holding true to the September 2014 public release of the payment data.

Nico Fiorentino, JD, a compliance advisor at G&M Health LLC, pointed out that the September 30, 2014 deadline is actually not part of the Final Rule. While the transparency provision of the Affordable Care Act (Section 6002) originally mandated CMS make the data available "not later than September 30, 2013," in the Final Rule CMS stated: "[g]iven the timing of the final rule, no data will be collected for CY 2012, so the first data publication will be in 2014 for data collected in 2013." Thus, CMS could actually push the date back at least two months and still be within the 2014 deadline.

As we recently reported, numerous physician groups have requested that CMS (1) extend the time for physicians to be able to access their data and (2) push back the date in which they publish the payments information. The official comment period for the Dispute Resolution phase ended June 2nd, and we await CMS' response. Currently, physicians and teaching hospitals get a 45 day window to dispute their payments. If the company and the physician do not come to a resolution within the 15 day period following, the payment will be published with an asterisk noting the dispute.

New Frequently Asked Questions:

QUESTION 1: I have successfully registered in CMS' Enterprise Portal (via EIDM) but I can't register in the Open Payments system. Why is that?

ANSWER: Remember, you will not be able to access the Open Payments system before Phase 2 begins in July – so if you attempt to access Open Payments through the Enterprise Portal, the radio buttons and functions that you will see on the "Welcome to Open Payments" main screen will not be operational until the system opens for Phase 2 in July.

QUESTION 2: Can physicians delegate system access to other users?

ANSWER: Yes, after physicians have registered themselves through the CMS Enterprise Portal and in the Open Payments system, they can delegate an authorized representative who can review and dispute data on their behalf. The representative will also have to go through the CMS Enterprise Portal (EIDM) and Open Payments registration process, and they would need to also accept their nomination as an authorized representative.

QUESTION 3: Will physicians be able to limit the access of their authorized representative?

ANSWER: Yes. Physicians will have the ability to select one of three access levels for their authorized representative:

1) View only, which will enable the authorized representative to only view the data that was submitted about the physician;

2) Review and dispute, which will enable the authorized representative to dispute records that were reported relating to that physician, and

3) Modify profile, which enables the authorized representative to modify information in a physician's profile, such as update their business address or phone number

QUESTION 4: Will the authorized representative of the physician and teaching hospital have access to the physician's private personal data that is used for identification?

ANSWER: Authorized representatives will be able to view a physician's first and last name, business address, business telephone and email, NPI, and state license numbers. Authorized representatives will not have access to physician user IDs or passwords and will not be able to modify or reset them.

QUESTION 5: How many users from a teaching hospital can register to review the pre-published data?

ANSWER: A teaching hospital may have up to 10 users registered; however, one of the 10 users, but no more than 5, must be an authorized representative. The teaching hospital may also delete one authorized representative and replace him/her with another individual.

QUESTION 6: How many users may a physician delegate to review the pre-published data?

ANSWER: A physician may have 1 authorized representative at a time. The physician may also delete one authorized representative and replace him/her with another individual.

QUESTION 7: Does the Open Payments system allow the user to register multiple physicians at the same time. For example, physicians in the same group practice?

ANSWER: No, each physician must register separately and individually.

CMS also answered a few questions from people calling in. The main points for the Q&A include:

  • Physicians may have IACS credentials for CMS. However, this will not work for Open Payment—they will need to register in EIDM.
  • If covered recipients do not register, the repercussion is that they can't review and dispute payments with industry. Furthermore, once physicians register, they can get up to date notes about changes to any payments they disputed.
  • If a company offered a large lunch to medical office costing $1000 for the entire practice and only 2 covered recipients partook among the 50 people, would they split $500 allotted to them? No, $20 each.
  • Hospitals will have to work independently of CMS to track which of their physicians have signed up to the system
  • For the EIDM System you will have to change your password every 90 days.

CMS encouraged a "best practice" among physician group practices to be for everyone to register in the system and get on CMS' mailing list so that they will be ready to review their payments when the time comes.

CMS also announced that in future years the date for the public reporting will be June 30th. It will be interesting to see if they can accomplish this. For now we will see if this razor thin timeline actually holds up.

 

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