A blog by attorneys for anyone interested in or affected by The Sunshine Act.

Review, Dispute and Correction Process Begins July 14, 2014

July 14, 2014
Ruselle W. Robinson

The day finally has arrived. The Sunshine Act review, dispute and correction process (formerly known as the dispute resolution process) began on July 14, 2014 and will run through September 11, 2014, a total of 60 days.

The review, dispute and correction process will be divided into two periods.  The first period will last 45 days.  It began on July 14th and will run through August 27th.  During the first period, registered physicians and teaching hospitals can review and initiate disputes over incorrect or incomplete payment or physician ownership data submitted about them by applicable manufacturers or applicable group purchasing organizations (GPOs).

Applicable manufacturers and applicable GPOs must examine the disputed data and work with physicians and teaching hospitals on necessary corrections.  CMS will not mediate any of the dispute negotiations.

The second period, lasting 15 days, will begin on August 28th and conclude September 11th.  The purpose of the second period is to allow applicable manufacturers and applicable GPOs additional time to submit corrections to CMS.

CMS still intends to post the 2013 payment and physician ownership data on its website on September 30, 2014.

In order to participate in the review, dispute and correction process, physicians and teaching hospitals must be registered with CMS.  The registration process has two phases—first in the CMS Enterprise Portal, and then in the Open Payments system.  Registration in the Enterprise Portal requires identity verification that can take a length of time.  CMS therefore encourages any physician or teaching hospital that wishes to review and dispute 2013 data to register in the Enterprise Portal as soon as possible.

CMS recommends the following preparations for physicians and teaching hospitals:

  1. Register in the Open Payments system (using the Enterprise Portal user ID and password you created).
  2. Nominate system users (such as a physician or authorized official(s) of the hospital) who will use the Open Payments system on your behalf.
  3. Gather your records of Sunshine Act payments and/or physician ownership for the period August 1, 2013 through December 31, 2013.  You likely will be at a disadvantage during any discussions with applicable manufacturers and applicable GPOs  if you do not have adequate records.
  4. Review and dispute data submitted by applicable manufacturers and applicable GPOs.
  5. Collect your contacts with applicable manufacturers and applicable GPOs to begin the process of resolving your disputes with the reported data.

CMS has updated the Open Payments User Guide by completing Section 8 on the review, dispute and resolution process (see my post of June 13, 2014).  The new Section 8 offers a comprehensive step-by-step guide on the review, dispute and resolution process beginning on page 201.  You can find the User Guide at http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Downloads/Open-Payments-User-Guide-[July-2014].pdf.

CMS will host a National Provider Call on July 22, 2014 on the review, dispute and correction process.  The registration link for the call will be posted on the Event page of the Open Payments website at http://go.cms.gov/openpayments.

Finally, you can contact the CMS Live Help Desk with your questions.  You can send an email to the Help Desk at openpayments@cms.hhs.gov.  Or you can call 1-855-326-8366, M-F, 7:30 am to 6:30 pm (CT).

I will post updates as new information becomes available.

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