CMS Open Payments

The CMS Open Payments program is a national transparency program that requires reporting entities to publicly disclose certain payments and transfers of value from drug and medical device manufacturers to physicians and teaching hospitals. These include general payments, research payments, ownership, and investment interests. Each year, the Centers for Medicare and Medicaid Services (CMS) updates the rules and rates that determine maximum allowable reimbursements for procedures performed in facility settings. This year’s update included some significant changes that affect WC medical costs. For 2023, CMS revised its proposed calculations related to physician compensation in determining final weights. This change reflects stakeholder feedback on how these factors impact the overall GPCIs. The result is a slight shift in relative weights used to calculate the Medicare fee schedules and telehealth payments.

CMS Fee Schedule for Physical Therapy

Whether you’re a physical therapist, occupational therapist, or speech-language pathologist in private practice, you need to be familiar with the CMS fee schedule. The schedule lists all of the healthcare Common Procedure Coding System (HCPCS) codes and their maximum reimbursement amounts. However, it’s important to remember that these numbers are not the actual amount you will receive for your services. In fact, the Medicare reimbursement rates vary by state and even by MAC. To find your MAC’s reimbursement rates, visit the CMS Physician Fee Schedule Look-Up website.

In addition to the above win, CMS finalized the policy allowing PTs and PTAs to bill in part for services furnished under direct supervision through virtual presence when the total time exceeds a de minimis threshold. This should greatly expand access to PTs and PTAs’ care, especially during the COVID-19 pandemic. CMS also reopened the door for future consideration of making this provision permanent. The agency also called for comments on valuable preventive services that can reduce downstream costs and improve outcomes – another great win for PTs.

CMS Open Payments Teaching Hospital List
CMS Open Payments 1

CMS Open Payments Teaching Hospital List

The CMS open payments teaching hospital list contains records of payments and transfers of value made by drug or medical device manufacturers to doctors and teaching hospitals. The database is publicly accessible and provides high-level summary data for each reporting period. It includes physician names, dates of payment, and the 10-digit National Drug Code assigned by the FDA for each reported drug or biological product. The database also lists the marketed covered drug name, product name, and package code.

Physicians and teaching hospitals must register with the CMS Enterprise Identity Management System to request access to the open payments portal. This is a mandatory process; failure to register can result in unintended personal and professional consequences. To ensure compliance, healthcare organizations should provide physicians and their authorized representatives with training and resources on registering and using the OPS. They should also be familiar with the submission data mapping documents and updated information on the Nature of Payments categories.

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