CMS Announces Updated Guidance Related to CME Reporting and Issues New Sunshine FAQs

Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it updated its Open Payments Law and Policy webpage and issued 3 frequently asked questions (FAQs) related to the reporting of payments and transfers of value related to continuing medical education (CME). As we previously discussed, there has been confusion in the industry regarding CMS’ changes to reporting requirements for CME beginning in January 1, 2016, which were implemented as part of the 2015 Medicare Physician Fee Schedule. In sum, CMS reiterated that it expects applicable manufacturers to report payments and other transfers of value related to CME if the payment or transfer of value meets the definition of “indirect payment” and the manufacturer “knows or finds out the identity” of the physician speakers and/or attendees within the reporting year or by the end of the second quarter of the following reporting year. “Indirect payment” is defined as “a payment or other transfer of value made by an applicable manufacturer to a covered recipient through a third party, where the applicable manufacturer requires, instructs, directs, or otherwise causes the third party to provide the payment or transfer of value, in whole or in part, to a covered recipient.”

There remains some concern among industry regarding its obligation to identify physician speakers and attendees. Although CMS uses in several instances the “knows or finds out the identity of” language, one FAQ uses slightly different and potentially more problematic language – “knows or can determine the identity of the covered recipient.”

CMS also released last week another round of Open Payment FAQs primarily related to its June 30, 2015 release of data. The new FAQs are the following:

11966 Do applicable manufacturers and applicable GPOs need to re-certify their Open Payments system registration each program year?
11968 What happens if I do not re-new a record’s delay in publication status?
11970 Why am I receiving a “Failed Matching Validation” message for payment records that were accepted last year?
11972 How do I re-new a record’s delay in publication status?
11974 How do I remove a delay in publication request for a previously submitted record?
12358 How many records did CMS release on June 30, 2015? What is the value of those records?
12360 What data is CMS publishing on June 30, 2015?
12362 In what formats is the data presented?
12364 Is CMS planning to provide any type of data summary sheets?
12368 When calculating number of payments a doctor received, should users count entries (rows) or tally the number of payment fields within each payment?
12370 Is any “de-identified” 2014 data being published?
12372 How is “de-identified” 2013 data being treated?
12374 Are there any records that you are not publishing?
12376 Did doctors and teaching hospitals have a chance to review the financial data reported about them?
12378 What if a physician or teaching hospital registered (or tried to register) prior to May 20, 2015, but was unable to dispute records until after May 20?
12380 How often is Open Payments data refreshed or updated?
12382 My organization already downloaded the 2013 data last year; should we download just the new 2014 data this year?
12384 Is there a way to get a crosswalk between the specialties listed for providers and the taxonomy codes that accompany them?
12386 Is there a methodology guide available providing technical details about the published data?
12388 How can disputes initiated by physicians and teaching hospitals be resolved?
12390 What happens if physicians or teaching hospitals initiated disputes with the reported data before/after the review and dispute period ended on May 20, 2015?
12392 Can a physician or teaching hospital still register in the Open Payments system and initiate a dispute after the May 20, 2015 deadline?
12394 What is CMS doing to make sure this information is friendly for consumers?

 

 

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