Open Payments Review & Dispute Resolution Ends May 20 for Physicians and Teaching Hospitals; No Extensions for Lost Disputed Records, Web Downtime
On April 6, the Centers for Medicare and Medicaid Services (CMS) opened the review and dispute period, during which healthcare providers can log-in to Open Payments and review the payments attributed to them. Originally, CMS announced on April 6, 2015 that physicians and teaching hospitals have 45 days from April 6, 2015 to voluntarily review data reported by drug and medical device makers about them, and, if necessary, dispute payments.
This week they clarified that the 45 day period ends on May 20, 2015. Payments that are disputed but not resolved within 15 days after the review period (June 3) will be made public on June 30th. Providers can continue to register disputes until the end of the year, but resolutions will not be publicly displayed until the next reporting cycle.
As we recently reported, the dispute resolution period got off to a rocky start for physicians looking to check on their data. Doctors reported that registration issues and website outages cost them a fair amount of time. The Open Payments system locks accounts if there is no activity for 60 days or more and deactivates accounts if there is no activity for 180 days or more, which also added to the challenge.
Most troubling, though, applicable manufacturers and covered recipients were notified by CMS that during an approximately 3 day window, records that had been disputed by physicians were lost in the system. This same email went to both manufacturers and covered recipients (physicians and teaching hospitals) the email is written in code for which the translation is "Our computer system lost the record of your disputes please enter again":
It is now up to the physicians to figure out whether their disputes are still there, then re-enter the disputes, before manufacturers can do anything about it. At CBI's aggregate spend conference in San Diego last week, Doug Brown of CMS spoke to the issue of lost disputes. He stated that CMS doesn't want manufacturers to correct the lost disputes, but instead to wait until covered recipients re-enter the dispute before they can correct them. CMS also noted that they are unsure how many disputes were lost in their system.
If you received notifications for disputes initiated by HCPs within the first few days of the 45-day dispute window, you may have a hard time locating them in the Open Payments system. This is due to a data refresh that occurred on April 8th, resulting in all disputed initiated between April 6th – 8th being lost. CMS has since reached out to HCPs letting them know if they initiated a dispute during this timeframe, they will have to do it all over again because it’s not longer in the system. However, this issue has not been proactively communicated to the Applicable Manufacturers that initially received the dispute notifications by email. So pay attention to the disputes that you’ve gathered and are researching, they may no longer be valid.
Despite the issues with the dispute resolution process (and the confusion surrounding the dispute date as evidenced by news reports running varying dispute deadlines - See bellow), CMS is holding to May 20th as the deadline for disputes.
This is the second reporting cycle for Open Payments, and it covers payments made in 2014. Last year, CMS published information about 4.45 million payments valued at $3.7 billion for the last five months of 2013. During the first year's review and dispute period, 26,000 physicians registered in the Open Payments system to review payments attributed to them. This is out of 366,000 physicians in the system--so only around 7 percent. It will be interesting to see whether the second year of the review phase attracts more interest from physicians, and if the final stretch of the process is hassle-free.
For an interesting inside look at some of the problems affecting physicians engaged in the dispute process, see Steven Ladd's Twitter account, which he updates regularly. Ladd, the President of Primacea, is an expert at the review and dispute process, his company having monitored Open Payments data for a substantial number of physicians as their “Open Payments agent” over the past year.