CPCS CPCS National Practitioner Data Bank (NPDB) Querying and Reporting 2 — Questions and Answers
Question 1: What is a 'self-query' in the context of the NPDB?
- A query submitted by a hospital on behalf of a practitioner without consent
- A query submitted by a practitioner to review their own NPDB report (Correct answer)
- A query used during a Joint Commission survey
- A query submitted by a state licensing board to investigate a complaint
Correct answer: A query submitted by a practitioner to review their own NPDB report
A self-query allows practitioners to access their own NPDB records to review what information has been reported about them.
Question 2: Which entities are authorized to query the NPDB as part of the credentialing process?
- Only hospitals and group practices
- Hospitals, other health care entities, and state licensing boards (Correct answer)
- The general public and malpractice attorneys
- Insurance companies and pharmaceutical firms
Correct answer: Hospitals, other health care entities, and state licensing boards
Authorized queriers include hospitals, other health care entities that engage in formal peer review, and state licensing boards, among others.
Question 3: A report in the NPDB is disputed by a practitioner. What is the correct process for disputing a report?
- The practitioner contacts the hospital's credentialing department to remove the report
- The practitioner files a dispute with the NPDB, which notifies the reporting entity to review it (Correct answer)
- The practitioner requests a state court order to expunge the record
- The practitioner submits a rebuttal directly to The Joint Commission
Correct answer: The practitioner files a dispute with the NPDB, which notifies the reporting entity to review it
To dispute an NPDB report, the practitioner submits a dispute directly to the NPDB, which then contacts the reporting entity to review the accuracy of the report.
Question 4: Which of the following is a permissible use of NPDB information by a hospital?
- Sharing NPDB query results with the public to inform patients
- Using NPDB data to make credentialing and privileging decisions (Correct answer)
- Providing NPDB results to a competing hospital for staff sharing
- Publishing NPDB findings in a medical journal
Correct answer: Using NPDB data to make credentialing and privileging decisions
NPDB information is confidential and may only be used by hospitals to make credentialing and privileging decisions for medical staff membership.
Question 5: What category of NPDB report is generated when a state licensing board takes an adverse action against a practitioner's license?
- Medical Malpractice Payment Report
- Adverse Action Report (Correct answer)
- Medicare/Medicaid Exclusion Report
- Federal Licensure Action Report
Correct answer: Adverse Action Report
State licensing boards submit Adverse Action Reports to the NPDB when they take formal disciplinary or adverse actions against a practitioner's license.
Question 6: A practitioner leaves a hospital while under investigation for quality concerns. What NPDB reporting obligation does the hospital have?
- No obligation if the investigation was not completed
- The hospital must report if privileges would have been reduced or revoked had the practitioner stayed (Correct answer)
- The hospital must wait for the state board to initiate reporting
- The hospital must report only if a malpractice suit was filed
Correct answer: The hospital must report if privileges would have been reduced or revoked had the practitioner stayed
Hospitals must report to the NPDB when a practitioner resigns or surrenders privileges while under investigation for quality or competence issues, to prevent circumvention of the reporting requirement.
CPCS CPCS National Practitioner Data Bank (NPDB) Querying and Reporting 2
What is a 'self-query' in the context of the NPDB?