National Practitioner Data Bank

Healthcare Integrity and Protection Data Bank

1. Do Healthcare Integrity and Protection Data Bank (HIPDB) mandated reporters, who also report to the National Practitioner Data Bank (NPDB), have to report the same action separately to the two Data Banks?

   Generally, no. The HIPDB is implemented in a manner that avoids the duplication of the reporting requirements established for the NPDB. Therefore, organizations that must report actions to both the Data Bank(s) will submit the report once and the system will automatically route the report to the appropriate Data Bank(s).

   However, health plans may have to submit one report to the NPDB and a separate report to the HIPDB. If two separate but related actions are taken, then a report for each action must be filed. For example, a health plan takes a formal or official contract termination that meets the definition of an "other adjudicated action." The health plan also takes a professional review action against the practitioner's panel membership based on the same facts. The two actions must be reported separately: the contract termination to the HIPDB as a Health Plan Action and the panel membership action to the NPDB as a clinical privileges action.

2. Once I logged into the Integrated Querying and Reporting Service (IQRS) I received an error message when I tried to view my query or report. What should I do?

   To view query or report output from the IQRS, you must have a current version of Adobe Acrobat Reader installed.

   For current versions of Acrobat Reader, see the Data Banks home page or access www.adobe.com/products/acrobat/readstep2.html. (Also in Error Message FAQ, Querying FAQ and Integrated Querying and Reporting Service [IQRS] FAQ.)

3. How do I correct a report that I previously submitted to the Data Bank(s) through the Integrated Querying and Reporting Service (IQRS)?

   To correct a previously submitted report, log in to the IQRS located on the Data Banks home page and select Report on the Options screen. Enter the Data Bank Control Number (DCN) of the report and select Correct or Modify a Report on the Report Type screen. Make the corrections to the report and submit the changes. (Also in Integrated Querying and Reporting Service [IQRS] FAQ.)

4. Are practitioners notified of a Data Banks report concerning them?

   Yes. Whenever the Data Banks receives a new, revised, corrected, or voided report, it sends a Subject Notification Document (SND) to the subject named in the report using the address supplied by the reporting organization. If an SND is returned to the Data Banks by the post office as undeliverable, that information is added to the report, along with the address to which the subject's report was sent, the date it was sent, and an explanation that the subject did not receive a copy of the report because it was returned as undeliverable. If a non-delivered report is not returned to the Data Banks by the post office, the Data Banks are unable to add the non-deliverable notice. (Also in General Information FAQ and Dispute Process and Secretarial Review FAQ.)
   

5. How long does a report remain on file in the Data Banks? Is it ever removed?

   A report remains on file with the Data Banks permanently unless it is voided by the reporting organization or the Secretary of the U.S. Department of Health and Human Services. A report may only be voided if it was erroneously submitted, if it was not a reportable action, or the action was overturned on appeal.
   

6. What is the difference between a Revision-to-Action Report and a Correction Report?

   The difference between a Revision-to-Action Report and a Correction Report is that a Revision-to-Action Report modifies a previously reported action; while a Correction Report corrects an error or omission in a previously reported action. A Revision-to-Action Report is stored as a separate report, which is linked to the previously submitted report. A Correction Report replaces the current version of a previously submitted report. Examples of Revision-to-Action Reports include reinstatement of a license or restoration of clinical privilege or professional society membership.
   

7. Can I correct a Revision-to-Action Report?

   Yes. The reporting organization may correct a Revision-to-Action Report. Log in to the IQRS, located on the Data Banks home page, and select Report on the Options screen. Enter the Data Bank Control Number (DCN) of the report to correct and select Correct or Modify a Report on the Report Type screen. Make the corrections to the report and submit the changes. A Revision-to-Action Report may also be corrected using the Querying and Reporting XML Service (QRXS). Refer to the appropriate QRXS File Format Specifications for additional information. (Also in Integrated Querying and Reporting Service [IQRS] FAQ and Querying and Reporting XML Service [QRXS] FAQ.)

8. Where can I find information regarding querying, reporting, and rejection codes?

   You can locate rejection and other reporting codes for all Data Banks transactions on the Data Banks home page. On the left side of the home page screen under General Information, click on Reporting Codes.

9. What is the deadline for submitting a Medical Malpractice Payment Reports (MMPR)?

   Medical malpractice payers, including self-insured organizations, are required to report a payment within 30 days from the date the payment was made. Missing the deadline does not excuse the reporter from filing a required payment report. The penalty for not reporting a medical malpractice payment is up to $11,000 dollars per occurrence. The reporting organization must also send a copy of the final report to the State licensure board.(Also in NPDB Query and Report FAQ.)

10. What is the deadline for reporting adverse licensure actions?

    Generally, State licensure boards must submit reports within 30 days from the date the adverse licensure action was taken. Please review the specific requirements for the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB) in the NPDB Guidebook and the HIPDB Guidebook that can be found under the Publications category on the Data Banks home page.

11. What is the deadline for submitting clinical privileges action reports?

    Hospitals and other healthcare organizations are required to report adverse clinical privilege or panel membership actions that are in effect for more than 30 days. A clinical privilege or panel membership action for a definite or specific time period, lasting 30 days or more, should be submitted within 30 days of the date that the action was taken. A clinical privilege or panel membership action in place for an indefinite period becomes reportable on the 31st day the action is in effect. For example, an adverse action was taken on May 1st and it is in effect indefinitely; on June 1st the action is now in effect for more than 30 days. As a result, the action must be reported within 30 days of June 1st or, in other words, by July 1st. Missing the deadline does not excuse the reporter from filing a required report. The reporting organization must send a copy of the final report to the State licensure board. (Also in NPDB Query and Report FAQ.)
    

12. What is the deadline for reporting adverse licensure actions to the National Practitioner Data Bank (NPDB)?

    State licensure boards must submit reports within 30 days from the date the adverse licensure action was taken. Missing the deadline does not excuse the reporter from filing the required report. (Also in NPDB Query and Report FAQ.)

13. What is the deadline for reporting adverse licensure actions, health plan other adjudicated actions, and Judgments or Convictions to the Healthcare Integrity and Protection Data Bank (HIPDB)?

    All reportable actions must be reported to the Healthcare Integrity and Protection Data Bank (HIPDB) within 30 calendar days of the date the final adverse licensure action was taken, or the date when the reporting organization became aware of the final action, or by the close of the organization’s next monthly reporting cycle, whichever is latest. The general guidance is within 30 days of the date of the action. (Also in HIPDB Query and Report FAQ.)

14. If a State licensing board reports the suspension of the practitioner’s license for 90 days, and the suspension is later reduced to 45 days, what type of report should the board submit for this new action?

    The State licensure board should submit a Revision-to-Action Report to reflect the subsequent reduction in the number of suspension days.
    

15. I am with a State dental board, and we suspended an oral surgeon's license until the practitioner completed additional training. The State dental board reinstated the dentist's license 28 days after the date of the suspension. Is this a reportable action?

    Yes, this is a reportable action because State licensure suspensions must be reported regardless of the duration of the suspension. Therefore, the board must submit an Initial Report for the suspension and a Revision-to-Action Report for the reinstatement of the license, since the Initial Report did not specify a definite time period for the suspension.

    Reinstatements and other types of revisions, to previously reported licensure actions, must be reported to the Data Banks. However, there is no need to report a routine reinstatement at the end of a fixed period of suspension specified in an Initial Report.
    

16. How do I know if my adverse action narrative description is factually sufficient to meet the statutory reporting requirements?

    To meet the statutory reporting requirements, the description must have enough detailed information so that a knowledgeable reviewer can determine clearly the circumstances of the action or surrender. In other words, you must provide a clear understanding of what the subject/practitioner is alleged to have done and the nature and reasons for the action taken. Merely repeating the adverse action or basis for action code is not factually sufficient. Do not reference personal identifying information about patients, other health care practitioners, plaintiffs, and/or witnesses (e.g., names). The narrative may be up to 4,000 characters in length. Examples of factually sufficient narratives are available on the Fact Sheet on Fact Sheet on Submitting A Factually Sufficient Narrative Description. (Also in Narrative Descriptions FAQ.)
    

17. How do I report an action taken against a nurse who is licensed in another State but is authorized to practice in our State under the Nurse Licensure Compact (NLC)?

    The Multi-State Privilege Adverse Action Classification codes were developed to allow the reporting of actions taken against a nurse's privilege to practice under the NLC. The State that issues the license to practice (the nurse's home State or State of residency) should use the Licensure Adverse Action Classification codes to report an action it takes against the nurse's license. If the remote State (the State that did not issue the license) also takes an action against the nurse's Multi-State Privilege to Practice, it should also file a separate report of that action using the Multi-State Privilege Adverse Action Classification codes. The Multi-State Privilege Adverse Action Classification codes, along with the Licensure Adverse Action Classification codes, and other Adverse Action Classification codes, are available under Reporting Codes under the General Information category on the Data Banks home page. (Also in HIPDB Query and Report FAQ.)

18. How do I make changes to a narrative description after I submit the report?

    To change a narrative description in a previously filed report, submit a correction to that report. A correction is a change to the report resulting from the discovery of an error or omission in an Initial Report. Please do not submit a Revision-to-Action Report or a Void Report. A Revision to Action Report is submitted to communicate a subsequent action that modifies an adverse action previously reported to the Data Bank(s). A Void Report should be done only if the action was erroneously submitted, if it was not a reportable action, or the action was overturned on appeal.

    Finally, when submitting a report to the Data Bank(s), you are required to provide a narrative description, with enough detailed information, so that a knowledgeable reviewer can determine clearly the circumstances of the action or surrender. Do not reference personal identifying information about patients, other health care practitioners, plaintiffs, and/or witnesses (e.g., names). Examples of factually sufficient narratives are available on the Fact Sheet on Fact Sheet on Submitting A Factually Sufficient Narrative Description. (Also in Narrative Descriptions FAQ.)

19. My organization, which requires its physicians to be board certified, denied a physician's application for surgical privileges because the physician was not board certified in a particular clinical specialty or subspecialty. Is this action reportable to the National Practitioner Data Bank (NPDB)?

    No, it is not reportable. If the healthcare organization's medical staff policy requires board certification, the automatic or administrative denial of medical staff membership or of a clinical privilege, is not reportable. Adverse medical staff membership or clinical privileges actions, reportable to the NPDB, result from professional review actions relating to the practitioner’s professional competence or professional conduct. (Also in NPDB Query and Report FAQ.)

20. A hospital suspends a podiatrist's clinical privileges for more than 30 days. Should the hospital report the adverse action to the National Practitioner Data Bank (NPDB)?

    Hospitals may, but are not required to, report adverse actions taken against the clinical privileges of "other health care practitioners" such as podiatrists. Hospitals must report adverse actions taken against the clinical privileges of only physicians and dentists. (The reporting requirement differs from the querying requirement; hospitals are required to query the NPDB at the time a physician, dentist, or other healthcare practitioner [e.g., podiatrist, chiropractor, nurse practitioner] applies for medical staff appointment or for clinical privileges and every two years thereafter at the time of reappointment.)

21. What is a report change notice?

    A report change notice is a notification detailing a change to a report you have previously queried on and received in the past 3 years. Actions that generate a report change notice include a correction, a subject statement addition, or a notice of appeal. Electronic versions of report change notices can be viewed on the Integrated Querying and Reporting Service (IQRS) by selecting Report Change Notices on the Options screen. Querying and Reporting XML Service (QRXS) users may elect to receive report change notices via the QRXS. By default, paper versions of report change notices are also mailed to your organization's address. Your Entity Data Bank Administrator can opt out of receiving the paper version, and/or indicate to receive notifications via QRXS on the Notification Preferences screen within the IQRS. (Also in Querying FAQ.)

22. In a medical malpractice lawsuit against a treating dentist and anesthesiologist, if the dentist is dismissed from the lawsuit before the settlement is made for the anesthesiologist, who should be reported to the National Practitioner Data Bank (NPDB)?

    The medical malpractice payment made for the benefit of the anesthesiologist is reportable. As to the dentist, if the dentist was dismissed from the lawsuit because a payment was made to settle the claim against him, the payment is reportable. However, no report is due, if the dentist was dismissed from the action independently without making a payment. (Also in NPDB Query and Report FAQ.)

23. We are a medical malpractice payer that is making a payment based on claimant expenses only. Are claimant expenses reportable to the NPDB?

    Claimant expenses, referred to in the NPDB Guidebook as loss adjustment expenses (LAEs), are payments made for expenses other than those in compensation of injuries, such as attorney's fees, billable hours, expert witness fees, etc. Claimant expenses should be reported to the NPDB only if they are included in the medical malpractice payment. In which case, the expenses should be itemized in the description section of the Medical Malpractice Payment Report. If the claimant expenses are not included in the medical malpractice payment, or if a payment is only for claimant expenses, then they are not reportable to the NPDB. Please note: reporting requirements specify that the total amount of a medical malpractice payment and a description and amount of the judgment or settlement and any conditions, including terms of payment should be reported to the NPDB. (Also in NPDB Query and Report FAQ.)