The Open Payments Program (aka Sunshine Act) Now Applies to More Healthcare Professionals

Implement an effective compliance program, including regular compliance monitoring.

Starting January 1, 2021, Open Payments Program reporting requirements apply to physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists.

Starting January 1, 2021, physicians aren’t the only healthcare providers who need to track and reconcile their payments from pharmaceutical and medical device companies. Physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists are covered by the Open Payments Program of the Centers for Medicare & Medicaid Services (CMS).

The Open Payments Program, which was a part of the Patient Protection and Affordable Care Act (ACA), is a national transparency program intended to highlight the financial relationships between physicians, teaching hospitals, and drug and device manufacturers. Originally known as the Physician Payments Sunshine Act, the Open Payments Program requires drug and medical device companies (“medical companies”) to report to CMS payments or transfers of value they make to certain healthcare providers and teaching hospitals for research, consulting, meals, travel, gifts, speaking fees, and more.

Medical companies must submit annual data on payments and transfers of value to covered recipients into Open Payments, CMS’s national disclosure program (a searchable database). Providers have 45 days to review the Open Payments data—and then approve or dispute its accuracy and completeness prior to the data becoming available to the public. Reviewing the Open Payments data is voluntary but encouraged to ensure data accuracy. The Open Payments Program also requires “applicable manufacturers” and group purchasing organizations (GPOs) to annually report certain ownership or investment interests held by physicians and their immediate family members.

Each year CMS makes the data available so the public can see it. CMS collects and publishes the information submitted by the reporting entities, without offering an opinion about which financial relationships constitute conflicts of interest. CMS merely publishes the data for public review and interpretation.

In 2021, the Open Payments Program is expanding to include reporting requirements for payments or transfers of value to five additional provider types: physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists. Beginning January 1, 2021, drug and medical device companies will start reporting payments or transfers of value to these additional healthcare providers, who will have an opportunity to verify that data before it’s made public.

TractManager’s Compliance Suite facilitates providers’ reconciliation of Open Payments Program data. Gift Alert simplifies the tracking and reporting of gifts and other nonmonetary compensation that providers receive from medical manufacturers. The Conflict of Interest Capture makes it easy to collect and report information about financial relationships (including ownership and investment interests) between providers and medical manufacturers.

Read The Experts’ Guide to Healthcare Compliance to learn more.

Author:

Brooke Brown, RN, BSN

Vice President of Product Management

Brooke Brown joined TractManager’s Contract Management division in 2017

 

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