Medical Practice Management
Apr 17

National Practitioner Data Bank reporting requirements

The National Practitioner Data Bank (NPDB) is an electronic repository of all payments made on behalf of physicians in connection with medical liability settlements or judgments as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other health care practitioners.

The NPDB collects and disseminates certain information, including:

– Professional liability payments made on behalf of a physician or other health care practitioners.

– Adverse action reports based on a physician or other health care practitioner’s professional competence or conduct that adversely affects privileges for more than 30 days. These actions include reducing, restricting, suspending, revoking, or denying privileges, and also include an entity's decision not to renew a physician's or other health care professional’s privileges if the decision was based on competence or professional misconduct. It also includes voluntary surrender of license or restriction of privileges either while under investigation or in lieu of an investigation.

– Voluntary surrenders relating to retirement, nonpayment of licensure renewal fees, and change to inactive status, if there is not an investigation in progress, are not reportable.

– Disciplinary actions related to competence or professional misconduct taken against a physician's license, including revocation, suspension, censure, reprimand, probation, and licensure surrender.

– Professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the professional society.

– Medicare and Medicaid exclusion reports containing sanctions against a practitioner from the Medicare program or the Medicaid program due to fraud and abuse.

A complete list of reportable information is maintained in the NPDB.

http://www.ama-assn.org/resources/doc/washington/npdb-hipdb-comparison-chart.pdf

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →