August 18, 2014

One of our readers asked us recently what his group needed to report under the Physician Payments Sunshine Act.  The answer: nothing.  The Sunshine Act, which is part of the Affordable Care Act, requires pharmaceutical and medical device manufacturers to report payments and other items of value worth more than $10, as well as certain ownership interests held by physicians and immediate family members.  (See our Alert of August 5, 2013, Drug Manufacturers’ Payments to Anesthesiologists Are Now Reportable under the Sunshine Act.)  It does not impose any tasks on physicians.

Prudent physicians will want to take advantage of the option to verify the information that will be posted under their name in the Open Payments System before publication, though.  Time is running.  If you log on to the American Medical Association website (www.ama-assn.org), the first thing you will see is this message.

Detailed information about how to complete each part of the process is available on the AMA’s Sunshine Act Web page.

CMS requires a two-step registration process before you can proceed to Step 3, “review and dispute:”

Step 1:  complete CMS' e-verification process via the CMS Enterprise Portal (EIDM).  Accept the terms and conditions, being sure to read the “Consent to monitoring” and “Collection of personal identifiable information” sections.  Identity verification is required for all users requesting access to any CMS application.

• Enter your personal information.  You’ll speed up the verification process by completing all fields, including those that aren’t required.
• Select your user ID, password and security questions.
• Complete registration and wait for your confirmation email.  CMS has contracted with Experian, a credit-reporting company that also specializes in identity theft protection, to verify your identity.  This verification process takes some time, so be sure to complete this step as soon as possible.

Step 2: register in CMS' Open Payments System via EIDM as quickly as possible, but no later than September 3, 2014.

• Log in to the CMS Enterprise Portal.
• Click the button on the far right that says “Request access now,” then click “Request new system access."
• Select “Open Payments” from the drop-down menu and input your personal information.
• Log out of the system and wait two minutes, then log back in.
• Select “Create my profile.”
• Select “Start profile” at the bottom of the next screen.
• Select the profile type “Physician” and then select “Continue.”
• Enter your personal information, making sure to fill in the required fields that are marked with an asterisk.  When you are done, select “Continue.”  Do not choose “Cancel” unless you want to start over; canceling will erase all data.
• Enter your details, making sure to fill in the required fields that are marked with an asterisk.
• When the system asks for your specialty identification code, what it really requires is your provider taxonomy code.  The list of these codes is provided in a CMS document, which lists the codes by specialty.  Enter the taxonomy code in the Open Payments system.
• Physicians are required to enter at least one license number by selecting “Add license” and entering the state in which the license is held and the license number.  When you are finished, select “Continue.”
• If desired, choose an individual to represent you within the Open Payments system by entering the required information and the access level.  You do not need to designate an authorized representative during this initial registration and may choose to do so later.
• Review the information you’ve entered. Select “Back” to edit any information.  If the information is correct, select “Submit.”

The entire registration process will take about 30 minutes to complete and must be finished in a single session, according to CMS.  Users cannot save entries or complete their profiles at later times.  In addition, the system times out after 15 minutes of inactivity, and it does not have an auto-save feature.

CMS recommends using only Internet Explorer version 8 or later to register for the Open Payments system.  CMS also cautions users against using their browser’s navigation buttons, which can delete registration data.

If you experience any difficulties while attempting to use the Open Payments system, you can contact the CMS help desk via email or phone at (855) 326-8366.

After completing Steps 1 and 2, you can request your individual report, review it and flag disputes.  CMS has indicated that it will not resolve disputes, but errors can be reported to manufacturers through the Open Payments System or directly through Open Payments contacts listed on most manufacturer websites.

Step 3:  Review your data by September 8, 2014.  Start by logging in to the Open Payments system.

• Select the “Review and dispute” tab.
• Select the physician name and program year you wish to review data for, and then click the “Show records” button. If records have been reported about you, then you will be taken to the “Review and dispute” page. If no records have been reported about you, you will receive an error message stating there are no records to review. If you do not see your name in the list, that could mean that no financial data has been reported about you.
• On the “Review and dispute” page, you will see a list of all submitted records.  You can filter using the tools in the search box.  View all information available for each record, including links to view the payment record, using the scroll bar at the bottom of the table.
• Review your records by scrolling to the right and selecting the “View” link under the “View record” column.
• Choose whether you want to affirm or dispute the record.  You may also withdraw a dispute you previously initiated.  Select the desired record and click on the corresponding button.  Follow the on-screen text to complete the action.

To dispute your data:  you must enter a reason for the dispute within the text box before continuing.  The text box allows you to input up to 4,000 characters.  Any text you enter into this box will be made available to the organization that reported the payment, and the organization will receive an email notifying them that you have initiated a dispute.

Records that have been disputed will be listed with one of the following statuses:

• “Initiated” indicates that you have initiated a dispute against a record.
• “Acknowledged” indicates that the industry organization has received and acknowledged the dispute initiated against them. Acknowledging a dispute will trigger a notification to you, letting you know your dispute has been received.
• “Resolved, no change” indicates that either the manufacturer does not agree with the dispute or the manufacturer has discussed the dispute with you and it was determined that no change in the data was necessary.  You can initiate a new dispute if you disagree with the “resolved, no change” status.
• “Withdrawn” indicates that you have withdrawn a dispute you initiated against a record.
• “Resolved” indicates that disputed data was updated and then resubmitted and re-attested to by the manufacturer.

Industry organizations either will correct disputed data, or, if not corrected right away, that data will be marked as disputed when it is released to the public.

CMS is scheduled to make data received from medical device and pharmaceutical manufacturers concerning payments to doctors available to the public on September 30, 2014.  Some physicians who have already checked their data have found serious errors on the Open Payments website.  Earlier this month, for example, David Mann, MD, an electrophysiologist in Louisville, KY found payments attributed to him that were in fact made to another physician with the same name in Florida.  While examining that issue, CMS found "intermingled data," meaning that physicians were being linked to medical license numbers or national provider identification numbers that belonged to other individuals.  As a result, one-third of the records expected to be released next month—potentially millions of record—will be withheld because of “data inconsistencies” and will not be posted until June 2015 at the earliest, a CMS spokesman told Pro Publica in an August 15th e-mail message.

Problems with the registration tool caused CMS to postpone the original registration deadline by a week.  They were also behind an August 5 letter signed by the AMA, ASA, MGMA and numerous other provider organizations urging CMS to delay for six months the publication of the information collected in the Open Payments System until March 31, 2015.  Because of the rapid approach of the registration deadline and the short period in which physicians can dispute erroneous information, it would be wise to proceed as though there will be no further delays.  If anything changes, we will of course let you know.

With best wishes,

Tony Mira
President and CEO