Open Payments, managed by the Centers for Medicare & Medicaid Services (CMS), is a national disclosure program created by the Affordable Care Act (ACA).
Open Payments is a federally mandated program that collects and publishes information about payments reporting entities make to covered recipients. The Open Payments database is publicly accessible.
The program promotes transparency and accountability by helping consumers understand the financial relationships between pharmaceutical and medical device companies, physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, anesthesiologist assistants, and certified nurse midwives otherwise referred to as Non-Physician Practitioners (NPP), and teaching hospitals. The healthcare providers included in Open Payments are collectively called ‘covered recipients.’
These financial relationships may include consulting fees, research grants, travel reimbursements, and payments made from the industry to medical practitioners. It is important to note that financial ties between reporting entities and covered recipients do not necessarily indicate an improper relationship; the data is open to personal interpretation.
Methodology
The Open Payments program functions on a yearly cycle of four key activities:
- (1) Data Collection,
- (2) Data Submission,
- (3) Pre-Publication Review, Dispute, and Correction, and
- (4) Data Publication.
Reporting entities collect data on payments made to covered recipients from January 1 through December 31 of each year, along with any ownership or investment interests held by physicians or physicians’ immediate family members in the reporting entity during that time.
If necessary, the covered recipient associated with the record(s) in the Open Payments system may review and dispute this data.
The diagram below provides a high-level representation of the various steps during a program year.
Steps 1 and 2: Data Collection and Submission
Applicable Manufacturers and applicable GPOs submit their data for a program year during a designated submission period in the subsequent calendar year.
For example, data collected from January 1- December 31, 2023 (“Program Year 2023”) was submitted during the submission period, which ran from February 1 to March 31, 2024. During the submission period, Applicable Manufacturers and applicable GPOs may also submit data from prior program years and update previously submitted data.
Physicians and Non-Physician Practitioners (NPPs) may be identified as covered recipients of payments or transfers of values or as principal investigators associated with research-related payment records.
Applicable Manufacturers and applicable GPOs must include the names of the covered recipients and other identifying information, including the covered recipient’s state medical license number(s) and National Provider Identifier (NPI) if the covered recipient has one. These details aid in accurately identifying the covered recipient(s) associated with each record.
Teaching hospitals may also be identified as covered recipients. The CMS defines teaching hospitals as any hospitals receiving payments for Medicare direct graduate medical education (GME), inpatient prospective payment system (IPPS), indirect medical education (IME), or psychiatric hospital IME programs during the last calendar year for which such information is available.
The CMS has made lists of reportable teaching hospitals for each program year available on the Resources page of the Open Payments website: https://www.cms.gov/OpenPayments/About/Resources.html.
The Open Payments system checks the information during submission to verify that the reported identifying data matches valid physicians, NPPs, and teaching hospitals. This initial system matching can result in some records being rejected. These records must be corrected and resubmitted by the Applicable Manufacturer or applicable GPO to be eligible for review, dispute, and publication.
Step 3: Review and Dispute Data/Review and Correct Data
Physicians, NPPs, and teaching hospitals may review the data attributed to them in the Open Payments system before its publication.
Their participation is voluntary, but they can affirm their data is correct or dispute any data they believe to be inaccurate.
Each program year has a designated pre-publication review, dispute, and correction period that follows the data submission period.
The pre-publication review, dispute, and correction period starts with a 45-day review and dispute period (April 1 – May 15) for covered recipients to review, affirm, or, if necessary, dispute records that were attributed to them and work with the Applicable Manufacturer or Applicable GPO to resolve any disputed record(s); this includes records submitted for the previous program year and any newly submitted records from prior program years.
Similarly, records flagged for publication delay by the reporting entity are eligible for review and dispute by physicians, NPPs, and teaching hospitals.
Immediately following the pre-publication, a 45-day review and dispute period is an additional 15-day correction period for reporting entities, from May 16 to May 30, to make final corrections to records and resolve any active disputes before the annual data publication.
The designated pre-publication review and dispute period affects how the record is displayed in the initial data publication.
Covered recipients may continue reviewing, affirming, and disputing records within the Open Payments System through the end of the calendar year (December 31). However, disputed data after the pre-publication review and dispute period will not be published as disputed or published with corrected information until a subsequent data refresh or data publication.
These records will no longer be available for review and dispute within the Open Payments System on January 1, 2025.
Suppose a covered recipient wishes to take action on any of these records after the December 31 deadline. In that case, they must work with the reporting entity outside the Open Payments System to resolve the issue.
Therefore, covered recipients should continue to seek a resolution until a dispute is resolved and are encouraged to contact the reporting entity outside of the Open Payments system if any corrections are required to the published data after the end of the calendar year.
Step 4: Data Publication
Only data submitted and attested to by the submission closing date is eligible for publication in the subsequent initial and refresh publications.
Data submitted and attested after the submission closing date is considered late and will not be eligible for publication until the initial publication in the following calendar year.
The Modified-Without-Dispute Cutoff Date is the end date for edits to undisputed records to be included in the refresh publication; data that did not have any disputes against it and was modified after the modified-without-dispute cutoff date in November will not be available for review and dispute until the next calendar year during the review and dispute period.
This data will not be included in the refresh publication but will be eligible for the following initial publication.
Data submitted to Open Payments eligible for publication is published twice annually, as explained below.
Initial Data Publication
- Occurs annually on or by June 30.
- The first publication of the eligible records submitted and attested on or before the submission closing date of the latest program year.
- The republication of eligible records from prior program years, including updates to records made since the previous publication.
- The data published is the latest attested version of disputed and resolved payment records at the end of the correction period.
Refresh Publication
- Occurs at least once annually, typically at the beginning of the calendar year.
- Publishes updates to the data made since the initial publication.
- Contains updates made to records after the latest program year’s correction period and before the calendar year’s end (or before the modified-without-dispute cutoff date in November for records not under dispute).
- The data published is the latest attested version at the end of the calendar year.
CMS publishes the Open Payments data for public use at https://openpaymentsdata.cms.gov.
Effect of Disputes on Data Publication
Disputes initiated within the pre-publication review and dispute period and resolved by the end of the correction period will be published and identified as non-disputed in the initial data publication.
If an initiated dispute is not resolved by the end of the correction period, the record will be published and identified as disputed.
Disputes initiated or determined after the full 60-day review, dispute, and correction period are not reflected in the initial data publication and will be published as original attested-to data.
Those disputes and related data changes will be published in the following publication, which may be a refresh publication or the following program year data publication.
The table below lists dispute initiation and resolution scenarios and explains how records are identified in data publications based on those scenarios.
| Dispute Initiated/Resolved | Published As Disputed in Initial Publication? | Published As Disputed in Refresh Publication? |
|---|---|---|
| Initiated: During the 45-day Pre-Publication Review and Dispute Period Resolved: By the end of the 15-day Correction Period | No | No |
| Initiated: During the Pre-Publication 45-day Review and Dispute Period Resolved: After the end of the 15-day Correction Period | No | Yes, unless the dispute is resolved before the end of the calendar year |
| Initiated: During the 15-day Correction Period Resolved: By the end of the 15-day Correction Period | No | No |
| Initiated: During the 15-day Correction Period Resolved: After the end of the 15-day Correction Period | No | Yes, unless the dispute is resolved before the end of the calendar year |
| Initiated: After the Correction Period Resolved: By the end of the calendar year | No | No |
| Initiated: After the Correction Period Resolved: After the end of the calendar year | No | Yes |
Note: If a record was initially disputed during the Pre-Publication 45-day review and dispute period and more disputes are initiated on that same record during the 15-day correction period, then the data attested to as of the end of the 15-day correction period is published in the initial publication, including any changes made due to dispute resolution.
Data Sources and Types
Applicable manufacturers and applicable GPOs must enter detailed information about payments, other transfers of value, or investment interests into the CMS Open Payments system.
These payments, other transfers of value, and ownership or investment interests are categorized into three (3) payment types:
General Payments
Payments or other transfers of value made that are not connected to a research agreement or protocol.
Research Payments
Payments or other transfers of value are made in connection with a research agreement or protocol.
Physician Ownership or Investment Interest Information
Information about physicians who hold an ownership or investment interest in an applicable manufacturer or applicable GPO or who have an immediate family member holding such interest.
Reporting Limitations and Exclusions
The Open Payments data published by CMS is subject to limitations and exclusions.
Certain payments or other transfers of value are excluded from reporting, such as product samples and educational materials intended for patient use. These should not be submitted to the Open Payments system.
These exclusions are outlined in the Open Payments final rule, at 42CFR §403.904(h) Exclusions from reporting.
Publication Rules
The publication rules for Open Payments are as follows:
- Eligible records submitted and attested before the end of the data submission period will be published in that year’s initial and data refresh publications.
- The data published in the June (initial) publication is the latest attested version at the end of the correction period.
- The data published in the early year (refresh) publication is the latest attested version at the end of the preceding calendar year (December 31).
Records may not be eligible for publication based on publishing limitations.
Publishing Limitations
The following limitations apply to what records are published:
Data attested after the submission closing date is considered late and will not be included in the initial or following data refresh publication. Late submissions may be eligible for publication in the following year’s data publication.
Records in which the physician/NPP or principal investigator identifies information changes after the submission end date will not be included in the initial or subsequent data refresh publication.
Such a change requires deleting the original record and submitting a new corrected record; after the submission closing date, the corrected record would be a late submission.
These corrected records may be eligible for publication in the following calendar year’s initial data publication.
Records deleted before the end of the correction period for that year will not be published in the initial data publication or any subsequent publications.
Records deleted after the correction period but before December 31 of that calendar year will be published in the initial publication but removed from the data refresh publication and subsequent publications.
Records without disputes that are updated after submission will not be published in the initial data publication.
The record may be eligible for the following data refresh publication if it was resubmitted and attested by the modified-without-dispute cutoff date in November of that year.
Updates to undisputed records that are resubmitted and attested after the modified- without-dispute cutoff date in November will not be published in the subsequent refresh publication but may be eligible for publication in the following calendar year’s publication.
Records that were previously published, edited after publication, and not re-attested by the end of the following correction period are not published.
Reporting entities may request a delay in the publication of research payment record(s) if the record(s) relate to research or development of a new drug, biological, device, or medical supply; a new application of an existing drug, biological, device, or medical supply; or clinical investigations regarding a new drug, biological, device, or medical supply.
Records for which submitters requested a delay in publication or a renewal of a delay in a publication before the end of the submission period will not be published for the year they are delayed.
These records will be eligible for publication in the next year’s publication unless the delay in publication is renewed.
Records may be delayed up to four years from the payment year (i.e., the record’s program year).
Records without disputes that are updated to remove the delay in publication after the submission period will not be published in the initial publication but in the refreshed publication.
Reporting entities may not submit records for program years that are closed or archived. Program Years 2013 – 2017 are no longer eligible for submissions.
Open Payments archives older Program Year data. Archived program years are available publicly through the archived Program Year Dataset Downloads (https://www.cms.gov/OpenPayments/Archived-Datasets).
The data for Program Years 2013 – 2016 are no longer eligible for submissions and are archived. Program Year 2017 is no longer eligible for submissions and will be archived with the June 2025 Publication.
Accessing the Public Data
Open Payments data is published at https://openpaymentsdata.cms.gov. It can be viewed online and downloaded.
Online Data Access
The Open Payments data is accessible through the Open Payments Search Tool and the Open Payments Data Explorer.
The Search Tool https://openpaymentsdata.cms.gov/search/ allows users to search Open Payments data for physicians, NPPs, teaching hospitals, and companies.
The Data Explorer https://openpaymentsdata.cms.gov/datasets/ will enable users to browse program year datasets and filter by reported record fields.