By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawWhen faced with an issue or question about the National Practitioner Data Bank (NPDB), most health care practitioners rely on the Data Bank Guidebook. Since September 2001, this Guidebook has been a reliable source to turn to for answers regarding reporting to and querying the NPDB. However, after twelve years, a new Guidebook will soon be released. In November 2013, the Health Resources and Services Administration (HRSA) division of the U.S. Department of Health and Human Services (HHS) announced a limited released of the draft NPDB Guidebook. The new Guidebook incorporates information on Section 1921 of the Social Security Act, the merger of the NPDB and the Healthcare Integrity and Protection Data Bank (HIPDB), and other useful information.The new, expanded Guidebook will be published soon. Until then, the 2001 NPDB Guidebook is the book health care practitioners should use for reference.
HIPDB-NPDB Merger.One of the most important regulatory changes included in the revised Guidebook is the merger of the NPDB and the HIPDB which happened as a result of the Patient Protection and Affordable Care Act. In May 2013, the HIPDB was merged with the NPDB. Previously, the HIPDB had its own procedures and its own HIPDB Guidebook. They will now be merged into this new Guidebook. Click here to read my previous blog on the merger.Specifics Included in the Revised NPDB Guidebook.To improve functionality, the revised Guidebook includes expanded and improved examples about reporting to and querying the NPBD, live links to relevant statutes and regulations, and useful tables explaining NPDB policies. Also included in the Guidebook are legislative and regulatory changes adopted since the last edition.Back in November 2013, the NPDB executive committee held a meeting to discuss the progress of the Guidebook and initiatives that will be included. To see the minutes from that meeting, click here. To review an analysis of NPDB reports and queries from 1990 to 2012, click here.Medical staff professionals, and anyone involved in reporting to the NPDB, and those that might be reported to the NPDB should review the draft version of the Guidebook, and the final version when it is released.What is the NPDB?The NPDB was established under the Health Care Quality Improvement Act (HCQIA). It is a confidential information clearinghouse of information serving primarily as a national flagging system and intended to facilitate a comprehensive review of the professional credentials of health care practitioners, health care entities, providers and suppliers. Reporting is required to the NPDB for a variety of reasons, including medical malpractice payments, some adverse reactions resulting from professional review actions and licensure actions, and Medicare and Medicaid exclusions. It is Extremely Important to Defend Yourself in Data Bank Actions.If you receive a notice that a report has been made to the NPDB, it is extremely important that you hire an attorney to dispute it, submit a rebuttal and appeal it. If you receive notice from the Office of the Inspector General (OIG) that you are being considered for exclusion from the Medicare Program, it is extremely important that you retain an experienced attorney to challenge that decision for you. Such reports and exclusion from Medicare can have devastating effects on your ability to obtain employment. Click here to read a related blog.Contact Experienced Health Law Attorneys. The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, NPDB actions, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.Comments?How do you think the new Guidebook will help you? Please leave any thoughtful comments below.About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620. Tag Words: Health Resources and Services Administration (HRSA), Healthcare Integrity and Protection Data Bank (HIPDB), National Practitioner Data Bank (NPDB), Health Care Quality Improvement Act (HCQIA), Department of Health and Human Services (HHS), reporting to the NPDB, querying the NPDB, NPDB self query, NPDB report, NPDB reporting, NPDB guidebook, new NPDB guidebook, revised NPDB guidebook, healthcare provider, healthcare professional, doctor, physician, nurse, dentist, Affordable Care Act, exclusion against physicians, exclusion against healthcare providers, licensure, medical staff privileging, professional liability claims, healthcare fraud, healthcare abuse, Patient Protection and Affordable Care Act (PPACA), defense attorney, defense lawyer, NPDB attorney, NPDB lawyer, The Health Law Firm
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