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NPDB Insights - December 2023

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Is It Reportable?

A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. The hospital took a professional review action to deny his renewal application, which the Medical Executive Committee (MEC) considered to be related to the practitioner's professional conduct, even though there was no actual patient harm. Should this be reported to the NPDB?

It depends. A clinical privileges action must be reported to the NPDB if it is the result of a professional review action that relates to professional competence or conduct that adversely affects, or could adversely affect, the health or welfare of a patient and lasts more than 30 days. Whether an action affects or could affect patient health or welfare is generally a determination that must be made by the entity taking the action. If, in the opinion of the MEC, the practitioner's falsification of his application could adversely affect the health or welfare of a patient, and the action is the result of a professional review, the action must be reported to the NPDB.

How to Keep Your NPDB Account Running Smoothly

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Now is the perfect time to make sure your NPDB account is ready for the new year! Keeping your NPDB account information accurate and up to date is a great way to ensure your organization's operations can continue to run smoothly. To help, we've compiled a list of things you should review before 2024:

  • Continuous Query enrollments. Review and update your Continuous Query enrollments. Make sure to cancel enrollments for practitioners who are no longer employed or otherwise affiliated with your organization. For practitioners still working in your organization, you must update their enrollments with any new information (e.g., update their names, mailing addresses, or additional licenses).
  • Payments. Review your payment methods. Do you want to store a new credit card or set up an electronic funds transfer account? Visit our Billing & Fees FAQ page for more information. You can also retrieve any receipts to reconcile NPDB charges on credit cards or bank statements. To do so, select View Billing History.
  • Query Credits. Check your query credit balance. If your organization uses query credits, you can add more to ensure there is no disruption to your ability to query. If you want to start using query credits, visit our How To Use Query Credits page to get started today.
  • Subject Database. If you use a subject database, verify that its information is current and accurate. You can use your subject database to prepopulate
    • query forms
    • report forms, and
    • Continuous Query enrollments
  • Registration profile. Update your entity's registration if any of the information shown below has changed. You can update it at any time. Visit our How to Update Profile Information page to learn how.
    • Entity Name
    • Address
    • Tax ID number
    • Email address
    • Phone number
    • Point of contact
    • Certifying official
  • Data Bank Administrators. Did you know you can have more than one NPDB account administrator? With multiple Data Bank administrators you will be able to seamlessly maintain your NPDB operations, even in the event that one of your administrators is out of the office or no longer working for your organization. Visit our How to Become the New Administrator for your Registered Organization page to set up multiple administrators for your organization today.
  • User accounts. Review your organization's user accounts. You must delete accounts for employees who no longer work at your organization, or whose jobs have changed and for whom access to the NPDB is no longer authorized. You can also add roles to your user accounts, like querying, reporting, and billing.

Now is also a good time to start using multi-factor authentication (MFA). MFA streamlines your sign-in experience and provides additional protection for your account. After enabling MFA, you can sign in to your account without entering a DBID or user ID. Getting started with MFA is easy. Check out our Multi-Factor Authentication Help page, or take a look at our new video walking you through how to set up your MFA account today!

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Management Services Organizations vs. Managed Care Organizations

Management services organizations and managed care organizations are two distinct types of entities working in the health care field. Knowing in which category your organization fits impacts how you interact with the NPDB. Your entity type affects whether or not you can register, query, or report.

Is My Organization a Management Services Organization or a Managed Care Organization?

Management Services Organization Managed Care Organization

A management services organization is a company that provides non-clinical services to a medical organization. These services may include billing and collection, accounts payable, revenue management, or even IT services and marketing.

Management services organizations do not provide health care services and cannot register with the NPDB except as an authorized agent.

Managed care organizations are health care delivery systems which are organized to manage multiple aspects of health care. For example, cost, utilization, and quality.

Each of the following may be considered a managed care organization:

  • Health maintenance organizations
  • Preferred provider organizations
  • Provider-sponsored organizations
  • Religious/fraternal benefit society plans

Managed care organizations are not often considered professional societies.

A managed care organization that provides health care services and follows a formal peer review process for the purpose of furthering quality health care may register with the NPDB.

Please visit the Defining Eligible Entities section of the NPDB Guidebook for more information.

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