Lance's Corner

CMS Announces Open Payments Dispute Resolution Period Ends May 15, 2024

May 14, 2024

Per the notice below, the Centers for Medicare and Medicaid Services (CMS) has issued notice that the Open Payments Program dispute resolution period is ending May 15, 2024.

Centers for Medicare & Medicaid Services

Open Payments Pre-Publication Review and Dispute Ends Tomorrow!

Open Payments Pre-Publication Review and Dispute ends tomorrow, May 15, 2024.

Open Payments is a national disclosure program that promotes a transparent and accountable health care system.  Open Payments houses a publicly accessible database of payments that reporting entities, including drug and medical device companies, make to certain health care providers, which are referred to as covered recipients.  The definition of a covered recipient includes the following health care providers:

  • Physicians and Dentists
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists and anesthesiologist assistants
  • Certified nurse-midwives
  • Teaching Hospitals

Pre-Publication Review and Dispute Activities

The Pre-publication review and dispute period provides covered recipients the opportunity to review data attributed to them prior to the data publication.  During this time covered recipients may review and affirm that the data is correct or if necessary, they may dispute data that they believe to be incorrect or inaccurate in any way.  Simply reviewing the data does not indicate if it is correct.  To note that you agree with the data attributed to you, you should take the action of affirming.

The Program Year 2023 Pre-publication Review and Dispute period ends tomorrow, May 15, 2024.

Please keep in mind the following reminders:

  • Disputes must be initiated by May 15, 2024, in order to be reflected in the June 2024 data publication.  For more information on review and dispute timing and publication, refer to the Review and Dispute Timing and Data Publication Quick Reference Guide.
  • CMS does not meditate or facilitate disputes.  Covered recipients should work directly with reporting entities to resolve disputes.  Remember to provide your most up to date contact information when initiating a dispute; this is beneficial in case the reporting entity needs to contact you directly to reach a dispute resolution.
  • Registration in the Open Payments system is required in order to participate in review and dispute activities.

Detailed information about the Review and Dispute process is available in the Review and Dispute Tutorial for Covered Recipients, located on the Resources for Covered Recipients page.  Covered recipient review of the data is voluntary, but strongly encouraged as this ensures the accuracy of the data.

Registration Information

To participate in the Pre-Publication Review and Dispute period, covered recipients must be registered in the CMS Identity Management System (IDM) and have access to the Open Payments System.  Registration is a two-step process:

  1.  Register self in IDM at the CMS Enterprise Portal and request access to the Open Payments System
  2.  Register as a covered recipient in the Open Payments System

Registration details are available on the Covered Recipient Registration Page.  The Open Payments team recently released two registration videos.  These videos provide information for covered recipients about the registration process, including a step-by-step tutorial of the registration process.  There are two versions of the registration video, one for physician and non-physician practitioner (NPP) covered recipients and one for teaching hospital covered recipients.  The videos are available at:

Open Payments Resources

There is an Open Payments Overview Video which provides details about what the program is, who is involved, and how the program operates.  Also, there is a Review and Dispute Video that explains the covered recipient review and dispute process.  Along with the tutorials are quick start guides that provide information for what you should have on hand when you start the registration process.  These items are available on the Covered Recipient Registration Page.

Questions - Contact the Open Payments Help Desk

Need help or have questions?  Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or call 1-855-326-8366 (TTY Line: 1-844-649-2766).  The Help Desk is operating on extended hours and is currently available Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET), excluding Federal holidays.  The Help Desk refers media inquiries to CMS’ Press Office.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc