CMS Open Payments FAQ

CMS Open Payments FAQ

Also known as the Sunshine Act, Open Payments is a national disclosure program that promotes a more transparent and accountable health care system by making the financial relationships between applicable manufacturers and group purchasing organizations (GPOs) and health care providers (physicians and teaching hospitals) available to the public.
Physicians, hospitals, life-science manufacturers in general, and group purchasing organizations are applicable for Open Payments. Beginning next year in 2021, payment data for additional provider types will be collected for an inaugural year of reporting set for 2022. More information is available on this topic in the Venops Knowledge Base, accessible by our members.

The law requires CMS to collect and display information reported by applicable manufacturers and group purchasing organizations (GPOs) about the payments and other transfers of value these organizations have made to physicians and teaching hospitals. Between the time of data collection and public release, registered physicians and teaching hospitals can review and, if needed, dispute payments reported about them. Data is then displayed on the public Open Payments website.

CMS Open Payments data is published every year to reflect a full 12-month calendar year. That data is always published in June of the following calendar year. For example, the Open Payments data submitted for the 2018 calendar year was published on June 30, 2019.

All applicable manufacturers (life-science manufacturers in general) and group purchasing organizations have to report any payments or other transfers of value to physicians and to teaching hospitals.

States and CMS have worked closely to ensure compliance with the health insurance accountability and consumer protections in federal law. The vast majority of states are enforcing the Affordable Care Act health insurance market reforms. Some states lack the authority, the ability to enforce these provisions, or both. CMS has responsibility for enforcing these requirements in a state that is not enforcing the health insurance market reforms either through a collaborative arrangement with the state or by direct enforcement to ensure all residents of the state receive the protections of the Affordable Care Act.

A civil monetary penalty of not less than $1,000, but not more than $10,000, for each payment or other transfer of value or ownership or investment interest not reported. The total amount of civil monetary penalties will not exceed $150,000.

Knowingly failing to submit payment information will result in a civil monetary penalty of not less than $10,000, but not more than $100,000, for each payment. The penalty will not exceed $1,000,000.

Combined, penalties may not exceed $1,150,000.

CMS open payments reports include the declared expenses and other third-party financial data for all physicians. 

Creating your Venops CMS OPR is very similar to generating your screening reports.

To begin – Venops connects directly with the CMS Open Payments physician profile database to organize and download the data for each report on-demand. Each report requires approximately five minutes to be available for review.

For a Venops member the process of creating each report is simple:

Download the appropriate template from your Venops dashboard and enter the name(s) for the provider(s) you want to include.
Securely upload the template from your Venops dashboard.
Your steps for creating this report are done. In minutes you will be able to download your report from the Venops dashboard.