What's New from CMS
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Open Payments - (Physician Payments Sunshine Act) Training Modules for Providers
On February 8, 2013, the Centers for Medicare & Medicaid Services (CMS) published a final rule that is intended to increase public awareness of financial relationships between manufacturers of drugs, devices, biologicals and medical supplies, as well as between applicable Group Purchasing Organizations (GPOs), and physicians and teaching hospitals. Known as "Open Payments (Physician Payments Sunshine Act)," this is one of many steps in the Affordable Care Act designed to create greater transparency in the health care market.
Applicable manufacturers of covered drugs, devices, biologicals, and medical supplies must report payments or other transfers of value to physicians and teaching hospitals to CMS. Applicable manufacturers and applicable GPOs must also report certain ownership or investment interests held by physicians or immediate family members. Applicable GPOs must report to CMS payments or other transfers of value made to physician owners or investors if they held ownership or an investment interest at any point during the reporting year.
CMS will collect the data annually, aggregate it, and publish on a public Web site. Applicable manufacturers and applicable GPOs must begin to collect the required data on August 1, 2013, and report the data collected through December 31, 2013 to CMS by March 31, 2014.
Two Continuing Medical Education Activities are Available
The first module, "Are You Ready for the National Physician Payment Transparency Program?" describes the provisions of Open Payments (Physician Payments Sunshine Act) and its implementation in 2013 - 2014. Through this activity, participants will learn more about Open Payments, the steps involved in collecting and reporting physician data, key dates for implementation, and actions physicians can take to verify their information in advance of Web site publication. This module can be found at http://www.medscape.org/viewarticle/780900?src=cmsaca.
Dr. Peter Budetti, Deputy Administrator and Director of the Center for Program Integrity and Dr. Shantanu Agrawal, Medical Director of the Center for Program Integrity and Director of the Data Sharing and Partnership Group are featured in this module.
The goal of the second module, "The Physician Payment Transparency Program and Your Practice" describes the process of collecting, verifying, and publicly reporting transfers of value to physicians and teaching hospitals under Open Payments (Physician Payments Sunshine Act). Through this activity, participants will be able to identify opportunities for physicians to review transfers of value attributed to them and differentiate types of transfers of value that will or will not be reported under Open Payments. This module can be found at
http://www.medscape.org/viewarticle/807771.
Dr. Shantanu Agrawal, Medical Director of the Center for Program Integrity and Director of the Data Sharing and Partnership Group, and Anita Griner, Deputy Director of the Data Sharing and Partnership Group, are featured in this module.
Accredited by the Accreditation Council for Continuing Medical Education, physicians or health care professionals can earn one (1) credit of continuing medical education for the first module and 0.25 credits for the second module. Medscape accounts are free and users do not have to be health care professionals to register. Registration can be found on the Medscape Web site www.medscape.com .
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October 2013 Release "Dark" Days for the Common Working File Hosts
For the upcoming October 2013 Release, Common Working File (CWF) will be making Trailer 15 format changes related to Change Request (CR) 8244 (Discontinuation of Home Health Type of Bill 33X) and creating new Part A claims data fields for CR 8217 (Affordable Care Act Provider Specific File Interface Update for Inpatient Prospective Payment System, Inpatient Psychiatric Facilities, Inpatient Rehabilitation Facilities and Long Term Care Hospitals). Due to the format and new data field changes, there will be one "gray" day occurring on Thursday, October 3, 2013, and two "dark" days on Friday, October 4, 2013 and Saturday, October 5, 2013.
Below is a list of scheduled events for the release:
■CWF Hosts will implement the Out of Service Area (OSA) drop for 09/30/2013 through 10/04/2013.
■CWF Hosts will not perform any XREF or Health Insurance Correction Record (HICR) transactions from 09/30/2013 through 10/05/2013.
■10/03/2013 will be considered a "gray" day for the CWF Hosts. This means the CWF online Health Insurance Master Record (HIMR) inquiry will be available for all Medicare Administrative Contractors (MACs). In addition, CWF Hosts will process In Sector Area (ISA) claims during the night on 10/02/2013, and deliver response files back to the MACs in the old format through early morning 10/03/2013 for processing.
■CWF Hosts will hold the claims received from MACs on 10/03/2013 and 10/04/2013.
■CWF Hosts will install the CWF October quarterly release on 10/05/2013.
■CWF Hosts will combine the held 10/03/2013 and 10/04/2013 MACs files on 10/05/2013 and will send the combined files to the Fraud Prevention System (FPS).
■On 10/07/2013, the online Health Insurance Master Record (HIMR) inquiry will be available for all MACs under the new release. CWF Host will receive responses from the FPS by the afternoon of 10/07/2013. The FPS response files will be loaded for CWF ISA processing on the night of 10/07/2013. Response files will be sent to MACs in the new format for 10/08/2013 night's processing.
