Open Payments Glossary & Acronyms

Program Expansion

Open Payments has expanded to include five new covered recipient types. Learn more on the Newly Added Covered Recipients page.

For information about changes that will affect Applicable Manufacturers and Group Purchasing Organizations, visit the Changes for Reporting Entities page.

Open Payments Glossary

Applicable Group Purchasing Organization (GPO)

Applicable group purchasing organizations (GPOs) are entities that operate in the United States and purchase, arrange for or negotiate the purchase of covered drugs, devices, biologicals, or medical supplies for a group of individuals or entities, but not solely for use by the entity itself.

Applicable Manufacturers

Applicable manufacturers are entities that operate in the United States and (1) are engaged in the production, preparation, propagation, compounding, or conversion of a covered drug, device, biological, or medical supply, but not if such covered drug, device, biological or medical supply is solely for use by or within the entity itself or by the entity's own patients (this definition does not include distributors or wholesalers (including, but not limited to, repackagers, relabelers, and kit assemblers) that do not hold title to any covered drug, device, biological or medical supply); or (2) are entities under common ownership with an entity described in part (1) of this definition, which provides assistance or support to such entities with respect to the production, preparation, propagation, compounding, conversion, marketing, promotion, sale, or distribution of a covered drug, device, biological or medical supply. (See 42 CFR 403.902)

Covered Recipients

Covered recipients are any physicians (excluding medical residents) who are not employees of the applicable manufacturer that is reporting the payment; or teaching hospitals that receive payment 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. (See 42 CFR 403.902)

Natures of Payment

Natures of payment categories are categories that must be used to describe why a payment or other transfer of value was made (See 42 CFR 403.904(e)(2)). The categories are:

  • Consulting fees
  • Compensation for services other than consulting, including serving as faculty or as a speaker at an event other than a continuing education program
  • Honoraria
  • Gifts
  • Entertainment
  • Food and beverage
  • Travel and lodging
  • Education
  • Research charitable contributions
  • Royalty or license
  • Current or prospective ownership or investment interest
  • Compensation for serving as faculty or as a speaker for an unaccredited and non-certified continuing education program
  • Compensation for serving as faculty or as a speaker for an accredited or certified continuing education program
  • Grants
  • Space rental or facility fees (teaching hospital only)

National Provider Identifier (NPI)

The NPI is a unique identification number for covered health care providers. The NPI is a 10-position numeric identifier, with a check digit in the 10th position and no intelligence about the health care provider in the number. (See 45 CFR 162.406)

Newly Added Covered Recipients

Open Payments expanded in January 2021 to include five new provider types: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists & anesthesiologist assistants, and certified nurse-midwives.

Non-Physician Practitioner Covered Recipient

Health care providers who practice either in collaboration with or under the supervision of a physician, including physician assistants, nurse practitioners, and clinical nurse specialists, are referred to as non-physician practitioners (NPPs).

Ownership or Investment Interest

Ownership and investment interest includes, but is not limited to:

  • Stock
  • Stock option(s) (other than those received as compensation, until they are exercised)
  • Partnership share(s)
  • Limited liability company membership(s)
  • Loans
  • Bonds or
  • Other financial instruments that are secured with an entity’s property or revenue or a portion of that property or revenue

This may be direct or indirect and through debt, equity or other means (See 42 CFR 403.902). Please note that there are exceptions to the definition.

Physician

For the purposes of Open Payments, a “physician” is any of the following types of professionals that are legally authorized by the state to practice, regardless of whether they are Medicare, Medicaid, or Children's health Insurance Program (CHIP) providers:

  • Doctors of Medicine or Osteopathic Medicine
  • Doctors of Dental Medicine or Dental Surgery
  • Doctors of Podiatric Medicine
  • Doctors of Optometry
  • Chiropractors

Note: Medical residents are excluded from the definition of physicians for the purpose of this program.

Reporting Entities

Reporting entities are applicable manufacturers or applicable GPOs.

Research

Research is a systematic investigation to develop or contribute to generalized knowledge about public health, including behavioral and social-sciences research. This definition includes basic and applied research, and product development. (See 42 CFR 403.902)

Teaching Hospital

Teaching hospitals are hospitals that receive payment for Medicare direct graduate medical education (GME), IPPS indirect medical education (IME), or psychiatric hospital IME programs during the last calendar year for which such information is available. (See 42 CFR 403.902)

For the purposes of Open Payments, “teaching hospitals” are hospitals that received payment 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.

Third Parties

Third parties are other individuals or entities, whether or not they operate in the United States.

Transfers of Value

Payments or other transfers of value are anything of value given by an applicable manufacturer or applicable GPO to a covered recipient or physician owner/investor that does not fall within one of the excluded categories in the rule. (See 42 CFR 403.902)

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Frequently Used Acronyms

CHIP

Children's Health Insurance Program

CIA

Corporate Integrity Agreement

CMP

Civil Monetary Penalty

CME

Continuing Medical Education

CMS

Centers for Medicare & Medicaid Services

DU

Data Users

DUA

Data Users Agreement

FDA

Food and Drug Administration

GME

Graduate Medical Education

GPO

Group Purchasing Organization

IME

Indirect Medical Education

IPPS

Inpatient Prospective Payment System

NDC

National Drug Code

NPI

National Provider Identifier

NPP

Non-Physician Practitioner

NPPES

National Plan and Provider Enumeration System

OPPS

Outpatient Prospective Payment System

OTC

Over the Counter

PECOS

Medicare Provider Enrollment, Chain and Ownership System

TIN

Taxpayer Identification Number

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Page Last Modified:
04/29/2021 10:14 AM