The CMS Open Payments System: A Small Practice Owner's Tutorial (42 CFR § 403.906)

The CMS Open Payments system publishes industry payments and ownership interests tied to physicians and certain other clinicians. While manufacturers and GPOs do the filing, small practices live with the public consequences, which means they must be expert users of the system’s review, dispute, and research-related delayed publication features. Under 42 CFR 403.906, certain research payments can be withheld from immediate public posting when statutory conditions are met. That timing logic, combined with the reporting mechanics in 403.904 and the dispute process in 403.908, defines how and when information appears on a clinician’s public profile.

For a lean clinic, success comes from rhythm: confirm identity settings, enable delegate access, pre-stage evidence for likely disputes, and understand when a research entry qualifies for delayed publication. Working from 403.906 and its neighboring provisions, this tutorial turns the Open Payments cycle into a predictable, low-friction routine that protects accuracy and reputation.

Open Payments' transparency is now part of routine credentialing checks by payers, hospitals, and media. Even though the duty to submit falls on manufacturers and GPOs, clinics must operate as if they were co-owners of the data. The system has three pillars, you should know cold:

1. Reporting mechanics under 42 CFR 403.904, which explain what gets reported and at what granularity.

2. Research timing under 42 CFR 403.906, which allows delayed publication of specific research-related payments when the conditions are met.

3. Review, dispute, and correction under 42 CFR 403.908, which is your annual opportunity to correct errors before data go live.

This tutorial aligns each pillar to an operational playbook for small practices that have limited budgets, few administrators, and clinicians with busy schedules.

Legal Framework & Scope Under 42 CFR 403.906

What 403.906 covers.
 Section 403.906 establishes when certain research payments or other transfers of value may be delayed from public posting. The idea is simple: where revealing details would compromise research (for example, because of product development sensitivity or blinding), the regulation allows deferral of publication for a defined period if the manufacturer properly indicates delayed publication during submission and the relationship fits the regulatory criteria. That deferral is specific to research-type entries; it does not remove reporting obligations, it only shifts when the data are shown to the public.

How 403.906 fits with 403.902, 403.904, and 403.908.

• 403.902 (definitions) governs key terms used across the program, such as covered recipient, payment or other transfer of value, and research—you will rely on these definitions to understand whether an entry is even eligible for the 403.906 delay.

• 403.904 (reports) sets the data elements and categories filers must submit. Its structure determines the fields you’ll see in the system during the clinic’s review.

• 403.908 (review, dispute, and corrections) codifies the window and process clinics use to challenge inaccuracies before publication, and to request corrections after publication if necessary.

Federal requirements vs state flexibility.
 Open Payments is a federal program with national posting and uniform definitions. Some states or health systems maintain their own conflict-of-interest processes. Those do not modify federal publication timing under 403.906; they are parallel obligations. Clinics should avoid conflating them when preparing evidence.

Risk and friction reduction.
 Understanding the delayed publication pathway under 403.906 reduces misunderstandings about why an expected research payment is not yet visible, or why a research payment unexpectedly appears because the delay period expired. Knowing the lane markers lowers unnecessary disputes and aligns expectations across clinicians, sponsors, and the public.

Administrative authority.
 CMS administers Open Payments, receives the manufacturer/GPO submissions, controls the delayed publication flags under 403.906, and hosts the review/dispute workflow under 403.908. CMS also publishes the annual data set and allows post-publication corrections.

Common triggers for clinic involvement.

• Filer outreach requesting clinic confirmation of research details tied to a clinician, often to determine eligibility for 403.906 delayed publication.

• Pre-publication notifications prompting clinicians or their delegates to review entries for accuracy, including whether a research notification, properly flagged for delayed publication or not.

• Media/payer questions regarding why a known research relationship is absent (due to delayed publication) or suddenly appears (delay expired).

• Disputes when a clinic asserts that a research entry was mis categorized or not eligible for delay under 403.906, or that a non-research entry was mistakenly delayed.

Your leverage comes from documentation: if you can show how a study meets the research definition and delay criteria, or why it doesn’t, CMS’s workflow becomes straightforward for all parties.

The following controls are designed to be lean, non-duplicative, and directly mapped to the regulations most relevant to using the Open Payments system, especially 403.906. Each item includes implementation, evidence, a low-cost method, and the authority tie-back.

Control 1. Lock identity and delegate access before the window opens

How to implement. Ensure every physician has an active Open Payments account with at least one delegate authorized to review/dispute on their behalf. Confirm profile data (NPI, license, practice address) are current to reduce false matches.

 Evidence to retain. Screenshots or exported confirmation pages showing active accounts and roles.

 Low-cost method. A 10-minute annual “portal check” meeting with a screen-share; store confirmations in a shared compliance folder.

 Authority. 42 CFR 403.908 (review/dispute workflow presupposes access).

Control 2. Create a single “Research Entry Map” for each study touching your clinic

How to implement. For any study where a clinic physician participates, log: sponsor, product, study phase/type, whether the manufacturer requested or designated the involvement (per 403.902 definitions), and whether the filer intends to flag delayed publication under 403.906.

 Evidence to retain. Clinical trial agreement, budget, and any sponsor correspondence indicating publication timing constraints.

 Low-cost method. One spreadsheet tab per study; add yes/no columns for “eligible for 403.906 delay?” and “flag used by filer?”

 Authority. 42 CFR 403.906 (delayed publication for research); 403.902 (definitions).

Control 3. Stage an “evidence bundle” for likely disputes

How to implement. Before the review window, assemble PDFs showing the facts that tend to drive disputes: dates, dollar amounts, nature category, and, if you research, whether the 403.906 criteria apply.

 Evidence to retain. Executed contracts, payment schedules, agendas, blinded study documentation, and any designation language.

 Low-cost method. A short index page with hyperlinks to exhibits; label each exhibit with the precise field it supports (amount, date, nature, delay status).

 Authority. 42 CFR 403.904 (data elements to be supported); 403.908 (dispute).

Control 4. Use a strict internal taxonomy to separate research vs non-research support

How to implement. Categorize each industry relationship at intake: Research (potential 403.906 delay) vs Non-Research (no delay). Train staff not to assume that educational grants or general support qualify as research.

 Evidence to retain. Sponsor scope-of-work and protocol; if general, capture the non-research purpose in writing.

 Low-cost method. A one-page decision tree taped to the intake desk or inside the contracting playbook.

 Authority. 42 CFR 403.902 (definitions clarify “research”); 403.906 (applies only to certain research entries).

Control 5. Run a “two-minute check” on any research entry that appears public

How to implement. If a research entry appears on a clinician’s profile and the clinic believes it should be delayed, verify whether the delay period expired or whether the filer simply failed to apply the 403.906 flag.

 Evidence to retain. Email to the filer requesting confirmation of delay eligibility and timing; copy of the study’s confidentiality terms and timeline.

 Low-cost method. A template email with checkboxes for the key 403.906 criteria.

 Authority. 42 CFR 403.906 (delayed publication logic).

Control 6. Standardize your dispute briefs

How to implement. When disputing an entry, include: (1) the field(s) in error; (2) the correction with a source citation; (3) the regulatory anchor (for research timing, cite 403.906; for data fields, 403.904; for the process, 403.908); and (4) attached evidence.

 Evidence to retain. Dispute text and final resolution screenshots.

 Low-cost method. A fill-in template with placeholders and an exhibit list.

 Authority. 42 CFR 403.908 (review, dispute, correction).

Control 7. Calendar the review window and a “freeze date” for internal artifacts

How to implement. Place the public review window and an earlier internal freeze date on the shared calendar. On the freeze date, confirm that all evidence bundles are final, and every clinician can log in (or their delegate can).

 Evidence to retain. Calendar exports and a checklist showing “evidence bundle ready” status for each clinician.

 Low-cost method. A Kanban board with three columns: “Ready,” “Needs Doc,” “Dispute Filed.”

 Authority. 42 CFR 403.908 (time-bound review/dispute actions).

Playbook wrap-up: These controls keep the clinic’s Open Payments posture light but strong: identity is clean, research entries are mapped to 403.906, evidence is ready for 403.904 data fields, and disputes flow through 403.908 without last-minute scrambles.

Case Study

Scenario (de-identified): A multisite practice participates in a manufacturer-sponsored clinical trial. The sponsor submits research payments to Open Payments. The clinic expects the entry to be withheld from immediate public posting because the trial is blinded, but the payment appears on the clinician’s profile just before publication.

Clinic analysis:

• The contract includes blinding and confidentiality provisions consistent with research as defined in 403.902, and the sponsor previously indicated intent to use 403.906 delayed publication.

• Upon inquiry, the sponsor reveals that the original delay period expired, and the entry rolled into public status during the current cycle.

Actions taken using the playbook:

1. The clinic’s delegate downloads the evidence bundle: protocol summary, contract clauses on confidentiality and timing, and payment schedules.

2. The delegate files a targeted inquiry asking whether the 403.906 flag is still applicable or whether the delay period is over, citing 403.906 for the delayed publication rule and 403.908 for the dispute process.

3. The sponsor confirms the delay period ended; the entry is appropriately public. The clinic updates its Research Entry Map to reflect the expiration date and adds a note for future cycles.

Outcome: Because the clinic used a research map and had an evidence bundle ready, the exchange took one day. The practice also adds a proactive step: 60 days before the expected delay expiration, it reminds clinicians that the research will soon appear publicly, reducing surprise and reputational risk.

Checklist wrap-up: These tasks operationalize the Open Payments cycle, so a small clinic can respond quickly and precisely within the legal framework, especially where 403.906 timing might otherwise cause confusion.

Risk Traps & Fixes Under 42 CFR 403.906

To minimize avoidable errors, focus on how research timing interacts with reporting and dispute processes. The following traps pair the error, the legal reference, and the practical consequence.

• Assuming any study qualifies for delayed publication.
   Fix: Confirm whether the entry meets the regulatory research construct and the filer actually marked it for delay per 403.906; if not, do not promise a clinician it will be hidden.
   Consequence: Prevents false expectations and last-minute reputational surprises.

• Treating general educational support as research.
   Fix: Use your taxonomy to separate research from general support; only research can be delayed under 403.906, while all entries remain subject to 403.904 reporting.
   Consequence: Avoids misclassification that leads to incorrect disputes.

• Ignoring the expiration of the delay period.
   Fix: Track delay expiration dates on your Research Entry Map; remind clinicians before entries roll public, per 403.906.
   Consequence: Reduces frantic explanation requests from partners or media.

• Disputing research entries without evidence.
   Fix: Attach the protocol/contract sections that support eligibility or timing per 403.906 and cite the specific data fields under 403.904 that must be corrected.
   Consequence: Speeds manufacturer corrections within 403.908 timelines.

• Letting identity mismatches derail review.
   Fix: Keep NPI/license/address current and ensure delegate access works before the review window as required to use 403.908 effectively.
   Consequence: Prevents access issues that waste the time-limited review period.

Wrap-up: Addressing these traps ensures your clinic uses 403.906 correctly, applies 403.904 fields accurately, and executes 403.908 disputes efficiently, cutting cycle time and reputational risk.

With a lean team, culture is about cadence. Assign a single compliance lead to own the Open Payments calendar and templates. Name at least one delegate per clinician, so coverage exists during vacations. Train for 15 minutes each quarter on three topics: (1) spotting research versus general support, (2) reading an entry’s fields so you can match them to 403.904 requirements, and (3) the 403.906 timing logic and how expiration dates affect public visibility.

Track two simple metrics that demonstrate control: (1) percentage of clinicians with verified accounts and active delegates (target: 100%), and (2) average time from notification to dispute submission with complete evidence (target: ≤3 business days). These numbers prove operational readiness if anyone audits your process and create internal accountability without new hires.

The Open Payments system becomes manageable when clinics anchor operations to the regulations that govern what gets reported, when research can be delayed, and how disputes work. By pairing 403.906 delayed publication knowledge with 403.904 data discipline and 403.908 dispute readiness, a small clinic can protect the accuracy of its public profile with minimal cost.

Immediate next steps for a small clinic:

1. Confirm access: Verify each clinician’s account and enable at least one delegate per clinician ahead of the review window (403.908).

2. Map research: Build a Research Entry Map listing each study, the sponsor, and whether 403.906 delayed publication applies; add expected delay expiration dates (403.906; 403.902).

3. Stage evidence: Assemble evidence bundles tied to the exact fields manufacturers report under 403.904, so disputes file cleanly (403.904; 403.908).

4. Standardize disputes: Adopt a one-page dispute template that cites 403.906 for research timing and 403.904 for data corrections (403.908).

5. Calendar cadence: Set an internal evidence freeze date two weeks before the review window and run a 20-minute readiness drill to catch access or documentation gaps (403.908).

• 42 CFR 403.906 — Delayed publication of payment or other transfer of value for research
  

• 42 CFR 403.904 — Reports of payments or other transfers of value and of physician ownership or investment interests
  

• 42 CFR 403.908 — Procedures for review, dispute resolution, and corrections
  

• 42 CFR 403.902 — Definitions (Open Payments)

• 42 U.S.C. 1320a-7h — Transparency reports and reporting of physician ownership or investment interests