CPCS CPCS National Practitioner Data Bank (NPDB) Querying and Reporting 1 — Questions and Answers
Question 1: Which federal agency oversees the National Practitioner Data Bank (NPDB)?
- The Joint Commission
- Health Resources and Services Administration (HRSA) (Correct answer)
- Centers for Medicare & Medicaid Services (CMS)
- Office of Inspector General (OIG)
Correct answer: Health Resources and Services Administration (HRSA)
The NPDB is overseen by the Health Resources and Services Administration (HRSA), a division of the U.S. Department of Health and Human Services.
Question 2: A hospital is required to query the NPDB when a practitioner applies for initial medical staff membership. How long is the NPDB response valid for credentialing purposes?
- 30 days
- 60 days
- 90 days (Correct answer)
- 180 days
Correct answer: 90 days
NPDB query responses are considered current for 90 days from the date of the response and must be used within that window.
Question 3: Which of the following events MUST be reported to the NPDB by a hospital?
- A practitioner voluntarily resigns before an investigation begins
- A clinical privilege reduction of more than 30 days based on professional competence (Correct answer)
- A malpractice settlement paid on behalf of a licensed practical nurse
- A verbal warning issued to a physician for tardiness
Correct answer: A clinical privilege reduction of more than 30 days based on professional competence
Hospitals must report adverse actions taken against clinical privileges for more than 30 days when related to professional competence or conduct.
Question 4: Which practitioner type is NOT subject to mandatory NPDB reporting by hospitals for adverse privilege actions?
- Physicians
- Dentists
- Advanced practice registered nurses
- Pharmacists (Correct answer)
Correct answer: Pharmacists
NPDB reporting for adverse privilege actions covers physicians, dentists, and other health care practitioners who hold clinical privileges, but pharmacists typically do not hold clinical privileges at hospitals.
Question 5: A credentialing specialist discovers that a malpractice payment was made on behalf of a practitioner but was never reported to the NPDB. Who is responsible for submitting this report?
- The hospital credentialing department
- The malpractice insurance entity that made the payment (Correct answer)
- The state licensing board
- The practitioner themselves
Correct answer: The malpractice insurance entity that made the payment
Under the NPDB regulations, the medical malpractice payer (the entity that made the payment) is responsible for reporting the payment to the NPDB.
Question 6: Under NPDB regulations, what is the timeframe within which an adverse action must be reported after the final decision is made?
- 15 days
- 30 days (Correct answer)
- 45 days
- 60 days
Correct answer: 30 days
Hospitals must submit NPDB adverse action reports within 30 days of the date the final action is taken.
CPCS CPCS National Practitioner Data Bank (NPDB) Querying and Reporting 1
Which federal agency oversees the National Practitioner Data Bank (NPDB)?