During the credentialing process, sanction checks are required to maintain patient safety and the preserve the facility’s integrity. Among the sanction checks, the NPDB report is valuable for examining a physician’s history of malpractice and adverse actions.
In 1986, Congress created The National Practitioner's Data Bank as an information repository used by the healthcare industry. Qualified entities are required to report accurate information about the physicians or else they will face penalties. The information is used to evaluate the credibility and statuses of adverse actions during the applicant’s credentialing process.
Credential managers may query the NPDB to receive reports on their subjects of interest for a one-time fee of $3.00. The report includes information on the subject of interest, their history of reports, as well as the reporting entity.
In this article, we will be walking through the sections of a sample NPDB report. A full version of the report can be found here.
The NPDB logo should appear on the left side of the header along with the official organization address and website URL.
The box on the top right corner contains the Data Bank Control Number (DCN) which is the identification number assigned to each query and report. The number is used to submit corrections, revisions, or voids. Below the DCN, you’ll find the process date, total pages, name of the individual being queried, and the name of the organization that is authorized to use the NPDB report information.
Section A: Subject Identification Information
Section A contains the identification information for the subject of the report. NPDB maintains the most current and accurate information to ensure that the individuals are informed when reports are made about them.
After receiving the report, it’s best to verify that the subject identified is the subject of interest. Cross-check the identification information with the information you have on file.
Section B: Query Information
To be considered an eligible entity to query the NPDB, your facility must be defined by the provisions of Title IV, Section 1921, Section 1128E. If the facility does not qualify, you are not eligible to receive and use information from the NPDB.
Query Type: The NPDB allows for two types of queries: continuous query and one-time query.
Continuous Query: You will continuously receive queries and updated reports throughout the year for each practitioner.
One-time Query: You will receive one report for a practitioner. You will not be notified if there are new reports submitted after you submit your query.
Entity Name: The name of the facility of the individual submitting the query.
Authorized Submitter: The name and contact number of the individual submitting the query.
Section C: Summary of Reports
This section gives an overview of the existing reports as of the query date. It is broken up into 10 different types of reports or actions.
“No reports” will be printed to the right of the action name if there are no reports found. If there are reports, “Yes, see below” will be printed to the right of the action name.
For each report, there will be a short summary under the name of facility and action type.
Basis for action: Summary of reason for report
Initial action: The resulting action of the report. This section is usually a limiting action against the practitioner.
Date of action: Date the resulting action was made.
DCN: Data Bank Control Number for the action reported.
Part II: The Unabridged Report
Each NPDB report contains unabridged reports following the first summary page. Beneath the header, you’ll find a table containing the summarizing information about that particular unabridged report. The information is the same as the last section in Part I in “Summary of Reports.”
Section A: Reporting Entity
Information on the entity that filed the report against the physician is located here.
Section B: Subject Identification Information (Individual)
Detailed subject identification can be found in this section. In addition to the individual’s full name and address, Section B also includes social security, education, and licensure information.
The Credential Manager should always cross-check the subject identification information to confirm that the person is their subject of interest.
Section C: Information Reported
The type of report, date, duration, and actions taken are found in section C. The NPDB uses a Codes List to classify the type of action reported.
There are 4 types of reports that can be filed against the individual:
Adverse Action Report - Title IV Clinical Privileges Action
Reports made by medical facilities on professional review actions that affect a physician's clinical privileges for 30 days or more, limitations of clinical privileges while the physician is under investigation for incompetence or improper conduct.
Adverse Action Report - State Licensure Action
Reports made by state licensing authorities on adverse actions taken against physicians. Adverse actions include involuntary license limitations, dismissal of proceedings due to license limitations, denial or withdrawal of licensure renewal application, and public negative actions or findings.
Adverse Action Report - Peer Review Organization Finding
Report made by peer review organizations on any negative actions or findings against the physician.
Judgment or Conviction Report
Report made by the state on Federal or State health care-related criminal convictions and civil judgments.
Section D: Subject Statement
The subject of a report will be notified when there is a new report made. The individual has the opportunity to submit a subject statement up to 4,000 characters to give his or her side of the story at any time after they are notified. A statement can be submitted regardless if the report is disputed or not. Once submitted, their statement becomes a part of the NPDB report in Section D.
The subject statement may be taken into consideration when screening an applicant for facility privileges.
Section E: Report Status
The subject of the report can challenge the NPDB entry by disputing the report if the information. After initiating the dispute, the reporting entity is allowed up to 60 days to respond. The dispute is elevated to a “Dispute Resolution” or review by the Secretary of Health and Human Services if the reporting entity does not respond within the time frame.
Section E indicates the status of the dispute:
- If the subject has disputed the report.
- If the Secretary of Health and Human Services is currently reviewing the dispute.
- If the Secretary of Health and Human Services has reached a decision about the dispute. When the review is completed, the Secretary of HHS can decide if the report is accurate or not.
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