CMS posts answers to dozens of questions regarding the Sunshine Act with only weeks left until reporting for physician payments—excluding those for claims reimbursement— becomes mandatory Aug. 1.
 
The Sunshine Act, finalized Feb. 4, requires pharmaceutical and device manufacturers and group purchasing organizations to track and report payments, gifts and other “transfers of value” of $10 or more and “ownership and investment interests” they provide to physicians and teaching hospitals.
 
Here are few of the top FAQs CMS addressed under the “National Physician Payment Transparency Program” topic:
 
  • What items or materials are considered education materials and are not reportable transfers of value? “Education materials and items that directly benefit patients or are intended to be used by or with patients are not reportable transfers of value,” CMS writes.  “Additionally, the value of an applicable manufacturer’s services to educate patients regarding a covered drug, device, biological, or medical supply are not reportable transfers of value.  For example, overhead expense, such as printing and time development of educational materials, which directly benefit patients or are intended for patient use are not reportable transfers of value.” 
  • If an applicable manufacturer makes a payment or transfer of value to a group practice rather than a specified physician, how should the applicable manufacturer correctly report the payment or transfer of value?  Should the payment be reported in the name of one physician or to all the physicians included in the group practice? CMS says, “A payment or other transfer of value provided to a group practice (or multiple covered recipients generally) should be attributed to each individual physician covered recipient who requested the payment, on whose behalf the payment was made, or who are intended to benefit from the payment or other transfer of value. Payments or other transfers of value do not necessarily need to be reported in the name of all members of a practice, rather, applicable manufacturers should divide payments or other transfers of value in a manner that most fairly represents the situation. For example, many payments or other transfers of value may need to be divided evenly, others may need to be divided in a different manner to represent who requested the payment, on whose behalf the payment was made, or who was intended to benefit from the payment or other transfer of value.” 
  • Are payments for travel, lodging and meals to speakers and faculty of accredited or certified CME events that meet all three conditions established in the final rule included in the total compensations that are exempt from reporting? “Yes. Lodging, travel and meals for speakers of an accredited or certified CME event meeting … will be deemed to be included in the total speaker compensation and, therefore, exempt from reporting under Open Payments,” CMS says. “However, travel, lodging and meals and all other natures of payments provided in conjunction with the accredited or certified CME event (with the exception of educational materials included in the tuition fees for an accredited or certified CME program that meets all three exemption conditions, such as handouts, web downloads or printed slides) will need to be reported for physician attendees (who are not speakers).” Moreover, “these payments would need to be reported under the appropriate nature of payment categories, such as food and beverage, travel and lodging, or entertainment, as appropriate. The excluding characteristic for meals is when allocating the cost of the meal among covered recipients in a group setting where the cost of each individual covered recipient’s meal is not separately identifiable,” the agency writes.