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Open Payments (aka "Sunshine Act")


What is Open Payments (aka “Sunshine Act”)?

Open Payments is a common name for the National Physician Payment Transparency Program. It also referred to as the “Sunshine Act.” It’s a section of the Patient Protection and Affordable Care Act of 2010, commonly known as “ObamaCare.”

Open Payments is a federal law that requires certain pharmaceutical and device manufacturers to annually report to the secretary of Health and Human Services certain payments or other transfers of value (both direct and indirect) furnished to U.S. licensed physicians and CMS teaching hospitals (see “covered recipients” below). Open Payments does not ban payments but does require reporting of payments and transfers of value.

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Who are ‘covered recipients’ under Open Payments?

Covered recipients include the following health care professionals who are licensed in the U.S.: medical doctors, doctors of osteopathy, podiatrists, dentists, optometrists, and chiropractors. Fellows are covered recipients. Residents are excluded from reporting.

Other U.S. health care providers such as pharmacists, doctors of pharmacy, scientific researchers with credentials not included above, and medical doctors who are not licensed in the U.S. are not covered by this law and are excluded from reporting under its provisions.

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What types of payments are companies required to report under Open Payments?

Under Open Payments, all companies must report payments and other transfers of value made to U.S. physicians and teaching hospitals. This includes the cost of meals provided to physicians in any setting, as well as payments made to physicians or teaching hospitals as part of a contracted service such as speaker programs, advisory boards, consulting, and clinical trials.

In addition to meals and payments, companies will also have to report other transfers of value provided to physicians or teaching hospitals, including but not limited to honoraria, consulting fees, educational items, stocks, and grants. Also reportable are expenses covered or reimbursed, such as hotel and travel arrangements. Even if a physician asks the company to donate the funding to a charitable organization, the law requires that it will be reported to the physician as the covered recipient.

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What information are companies required to report?

  • Covered recipient name and business address
  • NPI number and specialty
  • State professional license #(s) for at least one state
  • The amount and date of payment
  • Form of Payment
    • Cash or cash equivalent
    • In-kind items or services
    • Stock, stock option, ownership interest
    • Dividend, profit, or other return on investment
  • Nature of such payment (16 categories)
    • If payment or transfer relates to marketing, education, or research of a drug, device, biological, or medical supply, the related product must also be identified.
  • Context: 200 characters
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What if I live in a state that already has state laws or prohibitions? Does Open Payments replace my state laws?

Open Payments is a federal law and preempts any state laws requiring reporting of the same type of information concerning payments or other transfers of value made by applicable manufacturers to covered recipients. States may require reporting of non-required categories of information for payments or other transfers of value reported to CMS, including any exclusion from the Sunshine Act. Some states have additional requirements that include other health care providers as covered recipients.

If you work in California, Connecticut, District of Columbia, Louisiana, Massachusetts, Minnesota, Nevada, Vermont, or West Virginia, click here for a detailed summary of your state laws and codes that include additional reporting requirements for some health care providers not covered under Open Payments.

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Why is the ATS collecting NPI and state license numbers?

Under the reporting rules of Open Payments, companies are required to report NPI (National Provider Identifier) number and at least one state license number for a covered recipient. The ATS is collecting these numbers as part of ATS 2017 International Conference registration in order to fulfill its reporting requirements with our companies that support the conference.

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Will I see any changes at ATS 2017 as a result of Open Payments?

Open Payments has been in place for a few years now, but if this is your first conference in a while,  you will see only a few changes. You can still go the Exhibit Hall to learn about new products, get some hands-on practice with the latest equipment, pick up information for your patients, and get a cup of coffee or a snack all without worrying about reporting.

If you request a reprint or other educational resource from industry that is covered by Open Payments, the ATS will supply your data through badge scan for reporting purposes.

Attending an Industry Theater or Non-CME Evening Symposium will likely have a reporting component to it. Also, any private company event that serves food or beverages will also be reportable if you are a covered recipient. Companies typically have signs at the door to alert covered recipients exactly how much will be reported if they choose to participate, and they will need to sign in to verify attendance. ATS attendees from certain states may be able to attend the event but not partake in food or beverage due to the state laws where they reside.

Some travel scholarships provided by the ATS that are supported by educational grants may have reporting requirements associated with them. For ATS 2016, this was applicable to scholarships for the Fellows Track Symposium . Grant availability has yet to be confirmed for ATS 2017. Please see individual programs for more specific information. The Assembly Abstract Scholarships were restructured prior to ATS 2014 and are not reportable under Open Payments.

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What’s the most important thing I can do as a covered recipient?

The most important thing a covered recipient can do is verify that the data in the National Plan & Provider Enumeration System (NPPES) is up to date and accurate to avoid reporting discrepancies.

You can update your NPPES record at any time by visiting nppes.cms.hhs.gov or by obtaining a paper NPI Application/Update Form (CMS-10114) from the NPI Enumerator or from the CMS forms page (cms.gov/Medicare/CMS-Forms/CMS-Forms) and mailing the completed, signed form to the NPI Enumerator.

Providers who need assistance in editing their records should contact the NPI Enumerator by phone at 1-800-465-3203; email customerservice@npienumerator.com; or letter, NPI Enumerator, P.O. Box 6059, Fargo, ND 58108-6059.

Reports on 2015 data were released to the public Sept. 30, 2016, and are available at cms.gov/openpayments

Questions about Open Payments? You can email the CMS Open Payments Help Desk at openpayments@cms.hhs.gov or call (855) 326-8366.

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What other resources are available?

  • The American Medical Association has developed a toolkit that includes a webinar, templates, how to challenge incorrect reports, and other helpful links- AMA Resource Kit
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Other reference websites

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