The Physician's Role in the Dispute Resolution Process (42 CFR § 403.910(b))

Under 42 CFR 403.910(b), physicians have a defined role in the dispute resolution process when they believe an Open Payments record is inaccurate. The rule anticipates active participation: confirming facts, providing documentation, and working with manufacturers to correct errors. While manufacturers submit and own the reports, physicians’ timely engagement is essential to preserve accuracy before publication and to prevent reputational harm.

Small practices should operationalize the physician’s role with clear ownership of records, rapid evidence retrieval, and standardized dispute texts keyed to the published data elements in 42 CFR 403.904(c). When physicians supply precise, document-backed corrections and respond quickly to manufacturer questions, disputes are more likely to be resolved within the review period established at 42 CFR 403.910(a). Treat the physician’s involvement not as optional but as a core compliance function.

Open Payments promotes transparency, but that transparency is only as good as the underlying data. Records can be wrong, amounts misattributed, dates off by months, or products incorrectly linked. 42 CFR 403.910(b) places physicians at the center of dispute resolution, because they are best positioned to confirm whether a transfer occurred, in what amount, and for what purpose.

For small practices, the challenge is capacity: physicians are busy and administrative staff are thin. The solution is structure. Define the physician’s role, delegate a trusted proxy with portal access, and standardize the inputs physicians must provide to win a dispute. This article frames those tasks so that disputes move swiftly from assertion to correction.

Legal Framework & Scope Under 42 CFR 403.910(b)

What 403.910(b) covers.
 Section 403.910(b) governs the dispute and correction mechanics between covered recipients and reporting entities. A physician (or an authorized representative) may dispute any record believed to be incorrect and should engage the reporting manufacturer to resolve it. The regulation expects cooperative resolution where feasible, and the portal records the status (e.g., disputed, resolved, or unresolved at posting).

Relationship to 403.910(a) and 403.904(c).

• 403.910(a) sets the timing (the review and dispute period), while 403.910(b) addresses the physician’s role in the resolution of disputes.

• 403.904(c) defines the fields that are published; these fields should also frame the physician’s dispute (amount, date, nature of payment, form, associated product, recipient identity/NPI, ownership/investment details, etc.).

Scope limits.
 Dispute resolution is about accuracy of the reported record, not the broader policy merits of industry-physician relationships or the reportability of categories that are squarely required under program rules. Physicians should confine disputes to facts or categorical misclassification consistent with the regulations.

Why this matters.
 Because published data are public, physicians who quickly correct inaccuracies protect their professional reputation, reduce payer and credentialing questions, and avoid the administrative drag of post-publication clarifications.

Administrator: CMS administers Open Payments, including the portal functions that allow physicians to review, dispute, and track resolution status. Manufacturers are responsible for report submission and for processing disputes in coordination with the physician.

Review/complaint triggers tied to the physician’s role:

• Opening of the annual review period and appearance of records that contradict the physician’s personal records.

• Manufacturer outreach requesting confirmation or evidence to resolve a physician-initiated dispute.

• Approaching public posting with unresolved disputes, which may require a physician-approved public-facing statement from the clinic to explain status.

Implication: Physicians should be reachable and prepared to validate facts quickly. Silence can result in incorrect data going live.

The following controls position physicians to succeed under 403.910(b) without creating a heavy administrative burden. Each control explains implementation, evidence to retain, and a low-cost method.

Control 1. Assign a “record owner” physician per NPI with an authorized proxy

• How to implement: For each physician, designate them as the record owner and enroll a proxy (practice administrator or compliance lead) with portal permissions. The proxy can file disputes, but must obtain the physician’s sign-off on facts.

• Evidence to retain: Proxy authorization confirmation, clinician roster with NPIs, and contact information for top reporting manufacturers.

• Low-cost method: A single roster spreadsheet and a one-page proxy agreement template.

• Authority: Ensures the physician fulfills the participatory role contemplated in 403.910(b).

Control 2. Use field-driven dispute templates aligned to 403.904(c)

• How to implement: Build short templates that cite the exact field(s) in question (e.g., amount, date, nature of payment, associated product, recipient identity). Physicians supply the minimum documents to prove the correction (e.g., contract page, receipt, agenda).

• Evidence to retain: The template text used, the exhibits, and the portal confirmation of filing.

• Low-cost method: Shared text snippets plus a “drag-and-drop” evidence folder per physician.

• Authority: Aligning to 403.904(c) fields accelerates agreement during 403.910(b) dispute resolution.

Control 3. Adopt a 72-hour physician response standard for manufacturer queries

• How to implement: Physicians agree to respond to manufacturer follow-ups within 72 hours during the dispute window. The proxy pre-screens questions and sends a one-line prompt: “Approve, reject, or edit the attached answer.”

• Evidence to retain: Time-stamped emails showing physician approval or edits.

• Low-cost method: Canned email prompts and a simple SLA tracker in the spreadsheet.

• Authority: Rapid response supports timely resolution under 403.910(b).

Control 4. Pre-stage a “facts-only” affidavit for contested items

• How to implement: Create a one-paragraph physician declaration format: “I, [Name, NPI], attest that on [date], I received [form/nature] in the amount of [$X] from [entity], for [purpose/product]. Attached are [documents]. The reported record states [disputed detail], which is inaccurate; the correct detail is [correction].”

• Evidence to retain: Signed PDF plus attachments (receipts, contracts, agendas).

• Low-cost method: A Word template that autofills from your dispute tracker.

• Authority: A contemporaneous statement from the physician is persuasive evidence during 403.910(b) resolution.

Control 5. Distinguish fact disputes, identity disputes, and classification disputes

• How to implement: Tag each dispute as:

  • Fact (wrong amount/date),

  • Identity (wrong recipient/NPI), or

  • Classification (wrong nature of payment or associated product).
     Route accordingly: identity disputes get priority due to reputational sensitivity; classification disputes cite definitional language and supporting context.

• Evidence to retain: Dispute log with tags, supporting definitions or examples from program guidance, and any vendor correspondence.

• Low-cost method: A color-coded column in your tracker.

• Authority: Clear categorization helps resolve the right issue under 403.910(b).

Control 6. Physician-approved external statement for unresolved items at posting

• How to implement: Draft a neutral statement physicians approve in advance: “This record is under formal dispute consistent with 42 CFR 403.910(b). We have supplied documentation and are working with the reporting entity to resolve remaining differences.”

• Evidence to retain: Final physician-approved text and the portal status screenshot.

• Low-cost method: Short text snippets stored in each physician’s folder.

• Authority: Communicates dispute status in line with 403.910(b) without disclosing sensitive details.

Control 7. Post-resolution verification and close out

• How to implement: After a manufacturer updates a record, the proxy sends the physician a single-page summary of the changed fields for confirmation. Only then mark the dispute “closed.”

• Evidence to retain: Before/after screenshots, manufacturer confirmation, and physician sign-off.

• Low-cost method: A one-page “delta sheet” generated from your tracker.

• Authority: Ensures the final outcome reflects the physician’s verified facts, consistent with 403.910(b).

Playbook wrap-up: These controls operationalize the physician’s role as the definitive fact source. Fast, field-specific, and documented engagement is the shortest path to resolution under 403.910(b).

Case Study

Scenario: A cardiologist in a four-physician clinic finds a $1,800 entry classified as “Food and Beverage” linked to a coronary stent product. The physician recalls a $300 lunch-and-learn and a $1,500 consulting call for a different device line.

Action:

• The clinic’s proxy files two field-specific disputes:

  1. Amount and Nature of Payment, the $1,500 should be a Consulting Fee, not Food and Beverage.

  2. Associated Product, the consulting was for a different product family.

• The physician supplies a signed one-paragraph affidavit with the agenda for the consulting call and the lunch receipt showing $300.

• Within a week, the manufacturer acknowledges the evidence, splits the entry into two records, corrects the product association, and reclassifies the $1,500 as consulting. The physician verifies the updates and closes the disputes.

• Outcome: The corrected records post accurately. The clinic avoids the appearance of high-value meals and a mismatched product link next to the cardiologist’s name.

Checklist wrap-up: This table assigns clear physician and proxy actions that track the regulatory process and preserve an audit-ready trail.

Risk Traps & Fixes Under 42 CFR 403.910(b)

The most expensive disputes are the ones that linger because the physician’s input is late or incomplete. These traps and fixes keep the process tight.

• Trap: Physician is not formally assigned as “record owner.”
   Fix: Name a record owner per NPI and a proxy in writing, so both can act quickly under 403.910(b). Consequence avoided: disputes stall and post incorrectly.

• Trap: Disputes describe problems vaguely (“this seems wrong”).
   Fix: Cite the precise 403.904(c) field(s) and attach evidence. Consequence avoided: multiple clarifications that exhaust the window.

• Trap: Identity/NPI disputes treated like amount disputes.
   Fix: Triage identity errors first; they carry the highest reputational risk. Consequence avoided: wrong name posted, prolonged public confusion.

• Trap: Physician responses exceed a week.
   Fix: Enforce a 72-hour physician response standard with proxy-prepared drafts. Consequence avoided: unresolved status at posting.

• Trap: Closing disputes without physician verification of final edits.
   Fix: Require a one-page delta review and sign-off before closure. Consequence avoided: corrections that introduce new errors.

• Trap: No external statement ready for unresolved items.
   Fix: Physician-approved neutral statement referencing 403.910(b) to explain ongoing resolution. Consequence avoided: inconsistent ad hoc replies to payers or media.

Wrap-up: These fixes convert the physician’s role into a predictable, high-signal contribution that speeds resolution while reducing reputational and administrative risk.

Make the physician’s role explicit in policy: the physician is the authoritative source for facts; the proxy is the process driver. Hold a 20-minute annual briefing where physicians review the dispute templates, evidence expectations, and the response-time standard. Track three simple metrics per physician during the window: (1) average response time to manufacturer queries, (2) percent of disputes resolved pre-posting, and (3) number of corrections accepted without rework. Review metrics at the next staff meeting and adjust the templates or evidence checklists accordingly.

Establish continuity: if a physician is on leave, the proxy should have pre-signed authority to submit disputes backed by documented evidence, with post hoc physician confirmation when they return.

42 CFR 403.910(b) expects physicians to be active partners in dispute resolution. In small clinics, that role becomes manageable when you standardize who owns records, what evidence is needed, and how quickly physicians respond to clarifying questions. Use field-specific templates tied to 403.904(c) so manufacturers can implement precise corrections, and insist on a final physician check before closure.

Immediate next steps for a small clinic

1. Publish a one-page policy that names the “record owner” physician per NPI and designates a proxy with portal privileges, aligned to 403.910(b).

2. Load field-based dispute templates into your tracker (amount, date, nature, product, identity) so the proxy can file within minutes.

3. Have each physician sign a standing facts-only affidavit template and place it, plus core artifacts, in their evidence folder.

4. Adopt a 72-hour physician response standard for manufacturer questions during the review period; monitor compliance weekly.

5. Draft a neutral, physician-approved external statement for unresolved items at posting and store it with the record ID for quick use.

• 42 CFR 403.910 — Review, dispute, and correction process
  

• 42 CFR 403.904(c) — Publication of payment data elements
  

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

• CMS Open Payments — Physician review and dispute guidance

• Federal Register Preamble — Open Payments program clarifications on dispute and correction