NPDB National Practitioner Data Bank - CQ What Why How

NPDB Background Enacted legislation by Congress Opened September 1990 Due to increasing occurrence of medical malpractice litigation Due to growing need to improve quality of medical care nationwide Need to restrict the ability of incompetent physicians and dentists to move from State to State without disclosure or discovery of the physician's previous damaging or incompetent performance. Congress felt that the threat of private money damages liability under Federal laws, including treble damages liability under Federal antitrust law, unreasonably discouraged physicians and dentists from participating in effective professional peer review. Therefore, Congress sought to provide incentives and protection for physicians and dentists engaging in effective professional peer review.

3 Significant Laws Governing the NPDB Title IV Section 1921 Section 1128E Established the NPDB as a clearinghouse of information on medical malpractice payments and adverse actions related to licensure, clinical privileges, and professional society memberships of physicians, dentists, and, in some cases, other health care practitioners. Information also includes DEA registration actions and Medicare/Medicaid exclusions. Adds certain adverse actions taken by State licensing and certification authorities, State law enforcement agencies, Medicaid fraud control units, State agencies administering State health care programs, peer review organizations, and private accreditation organizations. Subjects of reports can include health care practitioners, entities, providers, and suppliers Adds certain final adverse actions taken by Federal agencies and health plans against health care practitioners, providers, and suppliers

Eligible Entities reporting to NPDB Medical malpractice payers Hospitals and other health care entities, Professional societies, health plans, peer review organizations, private accreditation organizations, quality improvement organizations, and certain Federal and State agencies. By law, eligible entities report to the NPDB, query the NPDB, or both. Health care practitioners, entities, providers, and suppliers are authorized to query on themselves for information reported to the NPDB, since they may be the subjects of NPDB reports.

Submitting a Query Eligible entities that are registered with the NPDB may query the NPDB in one of two ways: A One-Time Query (formerly known as Traditional Query) involves submitting the name of a health care practitioner, entity, provider, or supplier and receiving a query response that includes all NPDB reports on that individual or organization that the eligible entity is authorized to receive. The current fee for each query is $3.00 per queried practitioner or organization A Continuous Query involves enrolling practitioners for a 12-month period. Once practitioners are enrolled, the eligible entity receives a confirmation of enrollment, all current reports (a One-Time Query response), and notice of new reports within 24 hours of NPDB’s receipt of the reports during the enrollment period. The current fee is an annual charge of $3.00 for each enrolled practitioner. NOTE: Fees are charged both for queries that are successfully processed by the NPDB, and queries that are rejected because they are improperly submitted or incomplete NOTE: The NPDB does not receive federal funding (appropriations) to support its operations. Therefore, according to federal law the fees charged by the NPDB must cover the cost of operations. Major credit cards, debit cards, or electronic funds transfers (EFT) are accepted as payment

Continuous Query Continuous Query keeps you informed about your enrolled practitioners 24 hours a day, 365 days a year. You will receive email notifications within 24 hours of a report received by the NPDB. Continuous Query is only for querying on practitioners, not health care organizations. Continuous Query meets legal and accreditation requirements for querying the NPDB as long as your practitioners remain enrolled.

How to Activate Continuous Query A Data Bank administrator may activate Continuous Query notifications by following these steps: 1. The Data Bank Administrator must sign into the NPDB. On the Select an Option page, select Administrator Options.

continued On the Administrator Options page, select Activate Continuous Query

continued Complete the Activate Continuous Query form.

Enroll and Receive Continuous Query Notifications Once you activate Continuous Query, you must enroll practitioners to begin receiving Continuous Query notifications. Continuous Query meets legal and accreditation requirements for querying the NPDB. Enrolled practitioners are continuously monitored, and you are alerted when a new report is received or an existing report is revised, corrected, or voided.

To Enroll 1. Sign into the NPDB. 2. On the Select an Option page, select Query.

continued On the Query Options page, select Start a Query or Enrollment.

continued On the New Query or Enrollment page, select Continuous Query.

continued On the Enroll New Subjects page, select Enroll Single Subject, Enroll Stored Subject, or Enroll from Subject Database.

continued To enroll a single subject, complete the Enroll Subject form. Note: If you are querying as an authorized agent organization, you will complete the subject information, then select the entities on whose behalf you will enroll the subject. To enroll a stored subject, select the practitioner names you wish to enroll. Once highlighted, choose Select Subjects. The names appear in the Subjects Selected box. Verify the information and select Enroll. Note: If you are querying as an authorized agent organization, you will select the entity on whose behalf you stored the subject. To enroll from your subject database, select the names you wish to enroll. Once all are highlighted, choose Select Subjects. The names appear in the Subjects Selected box. Verify the names, and select Continue. Note: If you are querying as an authorized agent organization, you will select the entity on whose behalf you wish to enroll the subject before selecting a subject from your subject database.

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continued 6. Select your method of payment. Note: If you are querying as an authorized agent organization, you must query the practitioners by payment type. If you use a different form of payment, you will have to query the practitioner separately. Complete the Submitter Certification information.

To View To View Enrollment Confirmations or Disclosure Notifications 1. Sign into the NPDB. 2. On the Select an Option page, select Query. 3. On the Query Options page, select View Initial Responses. 4. On the View Responses page, select a Subject Name link to view the enrollment confirmation. If you have multiple unviewed responses, you may select the Download All Unviewed Responses without having to select each subject's name. Note: If you are viewing responses as an authorized agent organization, you may view responses for all entities, or you may select a specific entity to view responses for. Then select the Responses tab. Enrollment confirmations are provided at initial enrollment, and show all prior reports on a practitioner. Confirmations of enrollment are available on demand for up to 4 years after enrollment ends. Remember to cancel practitioner enrollments when a practitioner no longer has a relationship with the organization.