What you need to know about the 2013 Open Payments dispute process

By Ben Carmel

With the official Open Payments 2013 dispute process kicking off yesterday, Polaris wanted to share some insight gained through conversations with individuals at CMS.

 Open Payments
1. If a covered recipient initiates a dispute it will go to the Submitter and Officer roles via an email from CMS

2. The email will contain:

      • Record ID: as assigned in the CMS portal
      • Payment or transfer of value (POTV) Date
      • POTV Amount
      • POTV Category: General vs Research vs Physician Ownership
      • Covered Recipient Name
      • Dispute ID: new unique CMS generated ID
      • Dispute Details: free text box where covered recipient can enter any comments about what they are disputing

3. Covered recipient contact information will not be provided
4. Confirmed that the CMS dispute process will be linear only

      • For a Covered Recipient, the only steps in the dispute process will be to Confirm a Payment, Initiate a Dispute or Withdraw a Dispute
      • Completion of these actions by a Covered Recipient passes the information one way only to a Manufacturer.
      • For a Manufacturer, the only steps in the dispute process will be to Acknowledge the dispute and mark the record as Resolved with No Change or Resolved, which means that there was an update and a resubmission
      • At this point, the dispute process comes to a linear end, with the Manufacturer making one of two decisions and initiating the resubmission process, or not

5. According to CMS, their mandate is to publically post this information, not facilitate the conversation between covered recipients and manufacturers

    • Polaris was told that CMS is telling HCPs to contact manufacturers directly if they have questions, but are not providing contact details.
    • It will therefore be up to manufacturers to determine, how much, if at all, they want to try to follow up and locate covered recipients if the dispute is not black and white.
    • The Portal is not facilitating any type of back and forth, the flow goes from the covered recipient to manufacturer, then the process ends

Two big takeaways as we see it:

1. Manufacturers will really need to communicate to all internal employees and third parties exactly how to get in touch with the resources responsible for Open Payments submission, since there is now a potential for Covered Recipients to reach out to a Manufacturer however possible

2. Manufacturers will need to make a decision around how much to follow up with Covered Recipients when disputes aren’t cut and dry. For example, Covered Recipient said they didn’t attend a speaker program and the Manufacturer has them on a sign in sheet do you: a) keep the transaction the same because you have proof or b) do option A, but also try to contact the Covered Recipient to tell them why that is the case?