2022 Physician Fee Schedule and Open Payments

In the Calendar Year 2022 PFS, CMS finalized the proposed changes to the Open Payments program to support the usability and integrity of the data for the public, researchers, and reporting entities. The following is a summary of the changes finalized for the Open Payments Program:

• Addition of a mandatory payment context field for records attributed to teaching hospitals
• Addition of the option for reporting entities to recertify annually even when no records are being reported by the reporting entity
• Disallowing record deletions without a substantiated reason
• Added definition for physician – owned distributorship(s) (PODs) as a subset of applicable manufacturers and group purchasing organizations as well as an updated definition of ownership interest
• Requirement for reporting entities to update their contact information
• Disallowing publication delays for general payment records
• Clarifying the exception for short-term loans; adding clarification that the exception for short term loan applies for 90 total days in in a calendar year, regardless of whether the 90 days were consecutive
• Removal of the option to submit and attest to general payment records with an “Ownership” Nature of Payment category.

The updates to the Open Payments program will be effective for data collection beginning in Calendar Year 2023 and applicable to data reported in Calendar Year 2024.

SUPPORT Act and Open Payments

The Support Act:

• Enabled Open Payments to expand the definition of a covered recipient to include five additional provider types:
  • Physician Assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists and anesthesiologist assistants
  • Certified nurse midwives
• Allows CMS to publish National Provider Identifiers (NPIs) within the Open Payments Data

2020 Physician Fee Schedule and Open Payments

In addition to the changes outlined in the SUPPORT Act above, the 2020 Physician Fee Schedule Final Rule includes:

• Updates to the Natures of Payment categories to add debt forgiveness, long term medical supply or device loan, and acquisitions
• Consolidation of the Continuing Medical Education and Natures of Payment into one category
• Additional reporting requirements for the ‘device identifier’ component of the unique device identifier for devices and medical supplies, which will help standardize data

Changes enacted by the SUPPORT Act and the 2020 Physician Fee Schedule applies to Open Payments data collected in calendar year 2021. This is the data that reporting entities will submit to CMS in 2022.