Reimbursement News

Healthcare Orgs to Review Healthcare Costs on Open Payments

Healthcare providers can review healthcare costs reported on their behalf by drug and medical device manufacturers before CMS posts the payments to the Open Payments website.

By Jacqueline LaPointe

- According to a recent blog post, CMS is offering healthcare providers a chance to review and dispute healthcare costs related to manufacturers and group purchasing organizations, which will be published on the Open Payments data website on June 30.

Healthcare providers can review healthcare costs reported to Open Payments program

Open Payments is a program that creates a public database of payments made by drug and medical device companies to healthcare providers. It is designed to help patients communicate with their physicians and make more informed healthcare decisions.

Healthcare providers will have until May 15 to view the financial information reported on them. To request changes, providers will need to use or create an account with the Open Payments website.

CMS reported that this will be the only opportunity for healthcare providers to dispute inaccurate or incomplete data before it is published on the website. If providers fail to request changes during the open period, they will have to wait until the end of the year that the financial data is published.

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  • “Doctors, teaching hospitals and others receiving payments or other transfers of value that are sent to us from reporting entities, should take steps to ensure that this information about you, your related research, ownership, and other financial concerns are accurate,” stated the blog post.

    The Open Payments program was developed under the Physician Payments Sunshine Act, a part of the Affordable Care Act, to increase transparency of financial relationships between healthcare providers and the healthcare industry, including medical device manufacturers and pharmaceutical companies.

    Manufacturers and group purchasing organizations are required to report certain payments, such as consulting fees, speaking fees, gifts or vacations, entertainment, travel and lodging, education, research activities, and grants.

    These type of payments may create conflicts of interest, reported CMS. The program does not identify controversial payments. Instead, it intends to increase public awareness about financial relationships in the healthcare industry.

    “It simply makes the data available to the public,” said Shantanu Agrawal, MD, Deputy Administrator and Director of CMS’ Center for Program Integrity in a statement from the first round of the program. “So while these data could discourage payments and others transfers of value that might have an inappropriate influence on research, education, and clinical decision-making, they could also help identify relationships that lead to the development of beneficial new technologies.”

    CMS has encouraged all healthcare providers, even if they do not treat Medicare and Medicaid patients, to review the financial information that is submitted on their behalf by drug and device manufacturers. Healthcare providers should also keep track of financial interactions and work with industry groups to manage payment information.

    Some industry groups have criticized the program for its inaccuracies and inconsistencies with data reporting. Since its launch in 2014, healthcare groups have found an abundance of spelling errors and de-identified payments, which made the payment data difficult to interpret and misleading.

    As the Open Payments program matures, CMS aims to resolve system flaws and inaccuracies to develop an easy and functional website for consumers to view financial information and healthcare providers to review payments data.