Closing the Book on Open Payments


If you’ve ever gone to the Center for Medicare and Medicaid Services (CMS) website and looked up the frequently asked questions page about open payments, you know that there is a lot of confusion surrounding the subject. The rules are complicated.Even if you understand all the regulations, it’s difficult to affectthe large-scale changes necessary for compliance on the organizational level in even an average-sized medical operation. Sometimes the task is finding out what your organization is required to report, and sometimes it’s whether you are required to report anything at all. You’ll also need to know what consequences there or if an organization fails to comply.

Learning the Rules

It might not come as a surprise to many healthcare administrators that the rules for open compliance are complicated. There are a lot of conditional statements, with rules based largely on whether or not relevant manufacturers or service providers meet certain definitions laid out in the legal language of the act. What might be surprising is how much simpler the rules become when those basic definitions are fully understood.

Getting some insight into how organizations qualify for these classifications doesn’t require a law degree. There are resources and consultants out there who make it a point to translate the legal language into information that’s immediately relevant and accessible to busy executives and healthcare administrators.

Creating Change

Even for health professionals who have a knack for learning new rules and understanding dense legal tomes, making sure practices based on the open payments act are implemented in an organized and efficient way can be a challenge. Sometimes asking for outside help is the best way to overcome challenges like this, especially when it comes in the form of a consultancy that’s used to handling complex healthcare compliance issues. These third parties are often most useful for people who understand the rules, but don’t worry if that doesn’t apply to you. They’ll often have educational materials designed to provide all the information necessary for decision-makers to take action on affecting open compliance.

Knowing the Risks

Nobody wants to be faced with the possibility of an audit, but this is an even more unpleasant situation if you don’t know exactly what penalties you might incur. The CMS is authorized to impose hefty fines based on very specific situations. These include failure to report complete information or returning inaccurate data. They can also fine organizations that are late in replying with the requested information. Of course, a manufacturer or other organization has to first fit the requirements to be audited for compliance. With requirements for records dating back at least five years, it might be a good idea to call in a specialist to manage challenges with retention or communication of data relevant to the CMS.

In conclusion, if you’re part of an organization that you think might be required to comply with open payments under the Affordable Care Act, it might be a good idea to seek out a consultant. They can usually help by providing a clear overview of the information available through the CMS website as well as by acting as direct consultants. Through excellence in expense management, these third parties are able to organize and analyze financial records of enterprise-level organizations efficiently in order to maintain compliance and identify risk.