National Practitioner Data Bank NPDB

Question 1

The Joint Commission
NPDB

Answer 1

Query of NPDB is required when clinical privileges are initially granted, on renewal, and when new privileges are requested (including temporary privileges).
Subsequent to the initial query, us of continuous query is acceptable for ongoing information

Question 2

NCQA Health Plan with CVO
NPDB

Answer 2

Organizations are responsible for the ongoing monitoring of Medicare/Medicaid sanctions between recredentialing cycles.
Information must be reviewed within 30 days of release by the reporting entity.
If reports are not published on a regular basis, organization must query the source at least every 6 months.
If reports are not published, the organization must query the source within 12-18 months from the last credentialing cycle.
Query of the NPDB is not required. The NPDB is an acceptable source for sanctions or limitations on licensure, Medicare/Medicaid sanctions, and malpractice history.
Use of continuous Query is acceptable for verification of these elements and for ongoing monitoring of license sanctions and Medicare/Medicaid sanctions

Question 3

ACHC (HFAP) Acute Care Hospitals
NPDB

Answer 3

Query of NPDB is required on initial and reappointment. The application requests information on actions listed on the NPDB report

Question 4

DNV NIAHO for Hospitals
NPDB

Answer 4

MS 6 SR 4(e) & 5(d)
Query of NPDB is required on initial and reappointment and granting of temporary privilelges

Question 5

URAC Health Plan
NPDB

Answer 5

Not required to query the NPDB, but can use to verify malpractice history, licensure sanctions, Medicare/Medicaid sanctions, hospital and other healthcare entity actions, and professional society actions if the organization is eligible to query the NPDB. Us of continuous query is acceptable.

Question 6

AAAHC for Ambulatory Health Care
NPDB

Answer 6

NPDB query required at initial and reappointment.
Use of continuous query is acceptable

Question 7

Medicare Hospital COPS and Interp Guidelines
NPDB

Answer 7

Interpretive Guidelines 482.22(a)(1)
…whenever a practitioner’s privileges are limited, revoked, or in any way constrained, the hospital must, in accordance with State, and/or federal laws or regulations, report those constraints to the appropriate State and Federal authorities, registries, and/or databases. Such as the National Practitioner Data Base