CMS Open Payments Disputes

CMS Open Payments Disputes

Can you dispute CMS open payments? 

Open payment records are available to the public. The national program aims to make the healthcare system more transparent and those within it more accountable by ensuring that financial transactions are reported and made available to the public. 

The main types of payments covered under the open payments CMS system mainly include those from drug and medical device companies to physicians and other healthcare professionals. The payments can consist of both monetary exchanges, for example, fees paid to pharmaceutical bureau speakers, and indirect payments, for example, for meals. 

Under the CMS open payments system, there are two main participants; reporting entities and covered recipients. Reporting entities primarily include drug and medical device companies, manufacturers, and GPO (group purchasing organizations). Covered recipients include physicians, certain non-physicians, and teaching hospitals that receive payments from Medicare. 

There are a few exceptions with regards to the covered recipients. For example, medical residents and employees of a reporting entity do not have to report to CMS open payments. You can learn more about the details of who is and who is not included on the CMS open payments participants page

Relevant participants must collect data regarding their financial transactions year-round and submit them between February 1st and March 31st. All collected data is published around June 30th, just two months after data submission closes. 

Of course, mistakes are possible when collecting, collating, and submitting data. To avoid potential errors being published and potentially leading to an unfair representation of covered recipients or reporting entities, all parties are given a limited time to review, dispute, and correct submitted data. 

If you wish to dispute a CMS open payment, you must do so before the data is published. Covered recipients must review and dispute data between April 1st and May 15th, while reporting entities have from April 1st till May 30th to make their corrections. 

Steps to dispute a CMS open payment: 

  1. Participants in the open payments CMS system must first log in to the CMS portal

  2. Once logged in, you simply need to go to the menu and click on the ‘Review and dispute’ tab. 

  3. Covered recipients should select the appropriate option from the ‘Choose a covered recipient’ menu. 

  4. You can select the ‘Show Records’ button from the drop-down menu to see a summary of all payment records that can be reviewed and disputed. 

  5. Covered recipients can click on the ‘Show Records’ button to find the ‘Review and Dispute’ page. 

  6. Users can review all payments and use filters to search for specific results. 

  7. To initiate a dispute, users must click the ‘Dispute Record’ button to open the main page for disputing records. 

  8. On this page, you must enter your contact information and why the dispute is being initiated (using less than 4,000 characters, including spaces). 

  9. Select the ‘Send Dispute’ button, and an email containing the dispute and your contact information will automatically be sent to the relevant reporting entities. 

  10. You’ll see confirmation that the dispute has been initiated on the ‘Dispute Confirmed’ page, and the total number of disputes made will also appear in the header of your records. 

For more assistance managing your CMS open payments, from recording to reviewing and disputing, contact MedCompli

MedCompli is a compliance solution company that uses software and industry expertise to simplify compliance procedures like open payments CMS reporting.