Open Payments Program: Critical Information for Medical Practices

You may have recently become aware of the Open Payments Program, previously called The Sunshine Act, through the California Medical Board and may be asking, “What is it and how does it affect my practice?”

The Open Payments Program (aka Sunshine Act) supports transparency in public reporting of payments made to physicians, and now newly added covered recipients by drug and medical device companies. This reporting is made through a data collection site that the public can access and search at: https://openpaymentsdata.cms.gov/

On-Demand Webinar: Key Strategies for Ensuring a Profitable Independent Practice
During this one-hour program, practice management expert Debra Phairas discusses how various business models and operational enhancements can increase revenue to help your practice remain successful in today’s competitive marketplace.

The data are updated annually and covered recipients (physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and anesthesiologist assistants, and certified nurse-midwives) have the opportunity to register for the portal and review the data and dispute payments they disagree with. You can visit the portal here: https://www.cms.gov/OpenPayments/Program-Participants/Covered-Recipients...

The timeline for the Open Payments Calendar highlights important dates in the data collection and reporting process: https://www.cms.gov/openpayments

Effective January 1, 2023, the covered recipients have a responsibility to notify patients or their representatives that there is a public database on Open Payments and inform them on how to access the data by posting the following notice in every location in which the physician or covered recipient practices in an area likely to be seen by all patients:

“For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. https://openpaymentsdata.cms.gov/
The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.”

To download a sample template of the required office posting, please visit: www.CAPphysicians.com/OpenPaymentsOffice

Additionally, effective January 1, 2023, upon their initial visit of the year, all patients need to be notified electronically if an electronic system is used (EHR/patient portal/HIPAA secure text messaging) and a record kept of the notification. If a paper-based chart system is used, the patient must be notified via a paper document with the ability to date and sign the document. The original should be placed in the paper chart and a copy given to the patient or representative.

The following verbiage is to be provided to every patient (or their representative) either electronically or in written form:

“The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.”

To download a sample template of the required patient notification, please visit: www.CAPphysicians.com/OpenPaymentsPatient

Lastly, by January 1, 2024, if a covered recipient utilizes a website, the patient notification verbiage that is posted in the office/clinic, must also be posted on the website in a conspicuous location.

Resources are available for covered recipients at the following links:

https://www.cms.gov/OpenPayments/Program-Participants/Covered-Recipients

https://www.cms.gov/files/document/open-payments-overview.pdf

 

For more information, please contact Andie Tena, Director of Practice Management Services, at ATena@CAPphysicians.com or at 213-473-8630.