NPDB Insights - March 2021

Is It Reportable?

A health care entity terminated a physician's contract for cause relating to poor patient care, which in turn resulted in loss of network participation. Should this be reported to the NPDB using one or two reports?

Depending on the circumstances, the health care entity may be required to submit two different reports. The loss of the practitioner's network participation that resulted from the termination of the contract for reasons relating to professional competence or professional conduct must be reported as a clinical privileges action only if it is considered to be a professional review action by the health care entity.

The termination of the practitioner's contract with the health care entity, in itself, does not meet NPDB reporting criteria for a clinical privileges action. However, if the contract termination meets the definition of an "other adjudicated action or decision," the contract termination should be reported separately to the NPDB.

Updated 2020 Data and Resources

The following NPDB resources have been updated with 2020 data:

• Public Data File and Data Analysis Tool. We continue to update the PUF and DAT quarterly. Sign up on the PUF or DAT page to be notified when updates are posted to the website.
• Infographics. In 2020 we provided more than 10 million query responses, and the NPDB now contains more than 1.6 million reports. For more information on querying and reporting, check out our infographics.
• Timeline. Visit the NPDB timeline for highlights of important events from 2020, including the NPDB's temporary query fee waiver.

For even more helpful resources, visit the NPDB Help Center.

Step-by-Step: Reporting State Licensure Actions

State licensing boards must report any action taken against a practitioner, provider, or supplier (individual or organization) that is a result of a formal proceeding (such as a formal hearing, settlement agreement, consent order, etc.) that results in one or more of the following:

• An adverse action, including revocation, suspension, reprimand, censure, or probation
• Any other loss of a license or right to apply for or renew a license by operation of law, voluntary surrender, nonrenewal, or otherwise (excluding nonpayment of fees, retirement, and inactive status)
• A dismissal or closure of a formal proceeding because the practitioner surrendered a license or left the jurisdiction
• Any publicly available negative action or finding (including a health care-related administrative fine or citation)

How to Submit a State Licensure Action for Individuals

To report a state licensure action, you must submit an initial adverse action report within 30 days of when the action was taken.

1. Sign in to the NPDB and select Report on the Select an Option page.
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   Select an Option

   
2. On the Identify the Subject page, select that the subject is an individual, then enter the practitioner's name.
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   Identify the Subject

   
3. Select the type of action on the following page.
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   Select Action

   
4. Complete the Subject Information section. Be sure to fill out as much information on the subject as possible to help querying organizations find your report.
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   Subject Information

   
   1. Enter the practitioner's personal information, such as name, gender, and birth date.
   2. Enter the practitioner's home and work address and organization name.
   3. Enter the type of license against which the action was taken.
   4. Enter the schools or institutions the practitioner attended for their professional degree, training, or certification.
   5. Enter the practitioner's known identification numbers, which could include the Social Security Number, National Provider Identifier, or Drug Enforcement Administration Number.
   6. Enter all of the practitioner's health care entity affiliations.
5. Complete the Action Information section.
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   Action Information

   
   1. Select the adverse actions you have taken against the practitioner's license (you can select up to five adverse actions). Select the basis for these actions. Enter the name of the agency or program that took the action. Enter the date the action was taken, the date the action went into effect, and how long the action will remain in effect. Then include a narrative description.
      Note: In the narrative description, provide background information and explain the circumstances of the action that led to the report. This description provides future queriers with a more complete understanding of what the subject did or is alleged to have done.
6. Review the information you provided to ensure it is correct, then complete the certification section.
7. Save or print a copy of the report on the Report Submission Complete page for your records.

As noted in the NPDB Guidebook, entities are not excused from reporting simply because they missed a reporting deadline. Reports should still be submitted as soon as possible when a deadline is missed.

For more comprehensive instructions and requirements for reporting state licensure actions, see the NPDB regulations and the NPDB Guidebook.

Looking for information on how to submit state licensure actions against organizations or other report types? Check out our Introduction to Reporting and Reporting Clinical Privileges Actions articles, and keep an eye on NPDB Insights for upcoming articles on how to report medical malpractice payments, health care-related criminal convictions, and other adjudicated actions or decisions.

Dear NPDB

How do I know if my organization is eligible to register with the NPDB?

Registering with the NPDB allows your organization to report to and query the NPDB. Your organization is responsible for determining its eligibility and must certify that it is eligible when registering with the NPDB.

Your organization must certify eligibility based on the most appropriate eligible entity category. However, if your organization meets the definition of multiple eligibility categories, you must comply with all applicable querying, reporting, and other requirements. For example, if you are registered as a hospital but are also a self-insured medical malpractice payer, you are responsible for reporting any medical malpractice payments made for the benefit of a practitioner in addition to your querying and reporting responsibilities as a hospital.

For a list of eligible entities and requirements, visit Chapter B of the NPDB Guidebook.

How Do I Register my Organization with the NPDB?

If your organization is not already registered and you have verified your eligibility using the NPDB Guidebook, then you may begin the registration process by going to the Register Your Organization page and selecting Start a New Registration.

For detailed instructions on how to register, see our How to Register as a Health Care Organization or How to Register as an Authorized Agent pages.