CPCS National Practitioner Data Bank (NPDB) Querying and Reporting Flashcards

Which federal agency oversees the National Practitioner Data Bank (NPDB)?

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.

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?

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.

Which of the following events MUST be reported to the NPDB by a hospital?

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.

Which practitioner type is NOT subject to mandatory NPDB reporting by hospitals for adverse privilege actions?

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.

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?

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.

Under NPDB regulations, what is the timeframe within which an adverse action must be reported after the final decision is made?

Answer: 30 days

Hospitals must submit NPDB adverse action reports within 30 days of the date the final action is taken.