Synergy - January/February 2014 - 14
bank on it
Accessing Information:
Three Ways to Query the Data Bank
By Donald Illich
T
Donald Illich is a writer-editor for
the Division of Practitioner Data
Banks, which is part of the Health
Resources and Services
Administration, Bureau of Health
Professions. He has written
several articles for both internal
and external audiences
concerning the policies and
operations of the Data Bank. He
is a member of the Division's
Policy and Disputes Branch. He
lives and works in Rockville, Md.
he National Practitioner Data Bank
(NPDB) allows authorized users to
obtain Data Bank reports through a
process called querying. The NPDB is
primarily an alert or flagging system intended
to facilitate a comprehensive review of the
professional credentials of health care
practitioners, providers, and suppliers; the
information from the Data Bank should be
used in conjunction with, not in replacement
of, information from other sources.
There are three querying methods:
one-time queries, continuous queries,
and self-queries. All allow users to receive
information they need while ensuring
that the users are authorized to receive
the information for specific purposes.
Queries result in a report revealing whether
practitioners or organizations have adverse
licensure actions, adverse clinical privilege
actions, Medicare or Medicaid exclusions,
civil judgments, criminal convictions, or
medical malpractice payments on file with
the NPDB.
The first thing to understand about querying
is that hospitals and other eligible entities
have certain querying requirements and
permissions. Hospitals are required to
query in three specific situations: (1) when
14
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SYNERGY JANUARY/FEBR UARY 2014
a physician, dentist, or other health care
practitioner applies for a medical staff
position (courtesy or otherwise) or for
hospital clinical privileges; (2) every two
years (biennially) on all physicians, dentists,
and other health care practitioners on
medical staff (courtesy or otherwise) or
who hold clinical privileges; and (3) when
a practitioner wishes to add to or expand
existing privileges or submits an application
for temporary privileges. Hospitals and
other eligible entities may query for various
reasons, including:
*
Employment
*
Professional review
*
Licensing or certification
*
Fraud or abuse investigation
*
Certification to participate in a
government program
*
Claims processing
Queries Performed By
Eligible Entities
In the past 3.5 years alone, reporting
entities have added nearly 400,000 reports
on practitioners, providers, and suppliers,
including 12,000 pharmacists, 175,000
professional nurses, and 1,900 respiratory
Synergy - January/February 2014
Table of Contents for the Digital Edition of Synergy - January/February 2014
Synergy - January/February 2014
Contents
Editor’s Column
President’s Column
Dealing with the Disruptive Practitioner
Accessing Information: Three Ways to Query the Data Bank
Managed Care Credentialing: Compliance, Challenges and Changes
NAMSS Dashboard
NAMSS PASS™: Changing Healthcare Today – One MSP at a Time!
Meet the NAMSS 2014 Board of Directors
AMSS News
Happenings
Consultants Directory
Synergy - January/February 2014 - Synergy - January/February 2014
Synergy - January/February 2014 - Cover2
Synergy - January/February 2014 - 1
Synergy - January/February 2014 - Contents
Synergy - January/February 2014 - 3
Synergy - January/February 2014 - 4
Synergy - January/February 2014 - 5
Synergy - January/February 2014 - Editor’s Column
Synergy - January/February 2014 - 7
Synergy - January/February 2014 - President’s Column
Synergy - January/February 2014 - 9
Synergy - January/February 2014 - Dealing with the Disruptive Practitioner
Synergy - January/February 2014 - 11
Synergy - January/February 2014 - 12
Synergy - January/February 2014 - 13
Synergy - January/February 2014 - Accessing Information: Three Ways to Query the Data Bank
Synergy - January/February 2014 - 15
Synergy - January/February 2014 - Managed Care Credentialing: Compliance, Challenges and Changes
Synergy - January/February 2014 - 17
Synergy - January/February 2014 - 18
Synergy - January/February 2014 - 19
Synergy - January/February 2014 - NAMSS Dashboard
Synergy - January/February 2014 - 21
Synergy - January/February 2014 - NAMSS PASS™: Changing Healthcare Today – One MSP at a Time!
Synergy - January/February 2014 - 23
Synergy - January/February 2014 - Meet the NAMSS 2014 Board of Directors
Synergy - January/February 2014 - 25
Synergy - January/February 2014 - AMSS News
Synergy - January/February 2014 - 27
Synergy - January/February 2014 - 28
Synergy - January/February 2014 - Happenings
Synergy - January/February 2014 - Consultants Directory
Synergy - January/February 2014 - Cover4
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