Reporting

Why Report?

Reporting certain adverse information is required by law, fosters quality in health care, and assists the health care community in making sound employment, credentialing, and licensing decisions. Report information received by organizations is used in conjunction with a comprehensive review of professional credentials.

Who Reports?

Federal statutes require certain health care organizations to report specific actions to one or both of the Data Banks. To report you must determine your eligibility and be registered with the Data Bank.

Organizations that must report to the NPDB include:

• Hospitals and other health care entities that follow a formal peer review
• Medical and dental State licensing boards
• State health care practitioner and health care entity licensing boards
• Medical malpractice payers
• Professional societies that follow a formal peer review
• Private accreditation organizations
• Peer review organizations
• HHS Office of Inspector General
• U. S. Drug Enforcement Administration

Note: For hospitals and other health care organizations reporting adverse actions to the NPDB and for medical malpractice insurers (including self-insured organizations) reporting payments to the NPDB, a printed copy of the Report Verification Document (RVD) must be mailed to the appropriate State licensing board.

Organizations that must report to the HIPDB (Healthcare Integrity and Protection Data Bank) include:

• Federal and State government agencies
• Health plans

Reportable Actions

Table 1 briefly summarizes the major categories of reports that must be made to the Data Bank (NPDB or HIPDB). (See What Must You Report to the Data Bank? for more information.)

Note: While some reporting requirements of the NPDB and the HIPDB overlap, they differ in focus, detail, and scope. Consult the FAQs for examples, questions and answers, and detailed reporting policy issues.

Table 1. Reportable Actions

	Data Bank
Report Category	NPDB	HIPDB
MMPRs (Medical Malpractice Payment Reports)	Yes	No
AARs (Adverse Action Reports)
Adverse clinical privilege or panel membership actions	Yes	No
Adverse professional society membership actions	Yes	No
Adverse licensure actions	Yes	Yes
Other Adjudicated Actions	No	Yes
Other negative actions or findings	Yes	No
Medicare/Medicaid exclusions	Yes	Yes
JOCRs (Judgment or Conviction Reports)
Health care-related civil judgments	No	Yes
Health care-related criminal convictions	No	Yes
Health care-related injunctions	No	Yes
Health care-related nolo contendere (no contest) pleas	No	Yes

Using the Data Bank to Report

There are two ways you can submit reports to the Data Bank:

• Web-based reporting
• Reporting through an external application

Web-Based Reporting

Most reports submitted to the Data Bank by registered health care organizations are processed through the Data Bank Web site. The Web-application through which reporting (and querying) takes place is called the Integrated Querying and Reporting Service (IQRS).

The IQRS makes it easy for you to submit legally required reports within time limits, to the appropriate Data Bank (NPDB or HIPDB) whether you are submitting a Medical Malpractice Payment Report (MMPR), an Adverse Action Report (AAR), or a Judgment or Conviction Report (JOCR).The IQRS also guides you through reporting corrections, revisions, or voiding reports.

How to Get Started

First, verify that you are an eligible and registered organization. Then, sign in to the Data Bank and follow the steps in How to Submit a Report. Online instructions and Help are provided to guide you through the reporting process.

Types of Reports (NPDB)

There are four types of reports accepted by NPDB:

• • Initial Report – An initial report is the first record of a medical malpractice payment, an adverse action or a judgment or conviction submitted and processed by the Data Bank. It stays in the Data Bank as the current report unless a correction, void or revision-to-action is submitted. A copy is sent to the practitioner named in the report. Reporters must print and mail a copy of the processed Report Verification Document (RVD) to the appropriate State licensing board.
  • Correction Report – A correction report supersedes the contents of a current report. If a report contains an error, then the reporting organization must submit a correction report immediately. Correction reports are processed and mailed to the subject (practitioner) named in the report and all queriers who received the report within the last 3 years. The reporting organization also must print and mail a copy of the RVD to the appropriate State licensing board.

• • Void Report – A report is voided when the reporting organization wants to retract, in its entirety, a previously processed report that was submitted in error. The three reasons for which you may void a report are; the report contains incorrect information, the action that was reported was not reportable, or the action was overturned on appeal. A voided report is removed from a practitioner’s record. The Data Bank mails an RVD to the practitioner named in the report as well as to all queriers who received the report in the last 3 years. The reporting organization must also print and mail a copy of the RVD to the appropriate State licensing board.

• Revision-to-Action Report – A revision-to-action report describes an action that relates to and/or modifies an adverse action previously reported. It is treated as a second and separate action but does not negate the action previously reported. Some reasons why an organization may submit a revision-to-action are if additional sanctions are taken against the practitioner based on a previously reported incident, the length of action is extended or reduced, the original suspension or probationary period has ended, or if the licensure, clinical privileges, or membership/program participation is reinstated. The reporting organization must also print and mail a copy of the RVD to the appropriate State licensing board.

What Happens Next

Upon submitting a report to the Data Bank, you will receive a Temporary Record of Submission with a confirmation number, which you can use to verify that you submitted the report. Within 4 to 6 hours of receipt, the Data Bank sends you an official RVD. You must verify the report data on the RVD.

The Data Bank mails a copy of the processed report to the practitioner named in the report. Both the reporter and the practitioner named in the report should review for accuracy.

Note: Each NPDB reporter must mail a printed copy of the initial, correction, revision, or void RVD to the appropriate State licensing board.

What happens if you are reported to the NPDB? See Has a Report Been Filed on You?