Reporting
Frequently Asked Questions (FAQ)

See also:
  1. Do Healthcare Integrity and Protection Data Bank (HIPDB) mandated reporters, who also report to the National Practitioner Data Bank (NPDB), have to report the same action separately to the two Data Banks?

    Generally, no. The HIPDB is implemented in a manner that avoids the duplication of the reporting requirements established for the NPDB. Therefore, entities that must report actions to both the Data Bank(s) will submit the report once and the system will automatically route the report to the appropriate Data Bank(s).

    However, health plans may have to submit one report to the NPDB and a separate report to the HIPDB. If two separate but related actions are taken, then a report for each action must be filed. For example, a health plan takes a formal or official contract termination that meets the definition of an "other adjudicated action." The health plan also takes a professional review action against the practitioner's panel membership based on the same facts. The two actions must be reported separately: the contract termination to the HIPDB as a Health Plan Action and the panel membership action to the NPDB as a clinical privileges action.

  2. I receive an error message when I try to view my query or report output from the Integrated Querying and Reporting Service (IQRS). What do I do?

    To view query or report output from the IQRS, located on the Data Banks home page, you must have a current version of Adobe Acrobat Reader installed.

    For current versions of Acrobat Reader, see the Data Banks home page, or access www.adobe.com/products/acrobat/readstep2.html. (Also in Querying FAQ and Integrated Querying and Reporting Service [IQRS] FAQ.)

  3. How do I correct a report that I previously submitted to the Data Bank(s) through the Integrated Querying and Reporting Service (IQRS)?

    To correct a previously filed report, log in to the IQRS located on the Data Banks home page, and select Report on the Options screen. Enter the Data Bank Control Number (DCN) of the report to correct and select Correct or Modify a Report on the Report Type screen. Make the corrections to the report and submit the changes. (Also in Integrated Querying and Reporting Service [IQRS] FAQ.)

  4. Are practitioners notified of a Data Banks report concerning them?

    Yes. Whenever the Data Banks receives a new report, or a revised, corrected, or voided report, the Data Banks send a Subject Notification Document (SND) to the subject of the report using the address supplied by the reporting entity. If an SND is returned to the Data Banks by the post office as undeliverable, that information is added to the report, along with the address to which the subject's report was sent, the date it was sent, and an explanation that the subject did not receive a copy of the report because it was returned as undeliverable. If a non-delivered report is not returned to the Data Banks by the post office, the Data Banks are unable to add the non-deliverable notice. (Also in General Information FAQ and Dispute Process and Secretarial Review FAQ.)

  5. How long does a report remain on file in the Data Banks? Does it ever get removed?

    A report remains on file with the Data Banks permanently unless it is voided or corrected by the reporting entity or the Secretary of the U.S. Department of Health and Human Services. When a report is corrected, the original report is no longer available; however, the corrected report is available to queriers. A report may only be voided if it was erroneously submitted, if it was not required to be filed, or the action is reversed because the original action should never have been taken (e.g., overturned on appeal).

  6. What is the difference between a Revision-to-Action Report and a Correction Report?

    The difference between a Revision-to-Action Report and a Correction Report is that a Revision-to-Action Report relates to, and modifies, a previously reported action, while a Correction Report corrects an error or omission in an existing report. A Revision-to-Action Report is stored as a separate report, linked to the previously submitted report, in the Data Banks, while a Correction Report replaces the current version of a report. Examples of Revision-to-Action Reports include reinstatement of a license or restoration of clinical privilege or professional society membership.

  7. Can I correct a Revision-to-Action Report?

    Yes. The reporting entity may correct a Revision-to-Action Report. Log in to the IQRS, located on the Data Banks home page, and select Report on the Options screen. Enter the Data Bank Control Number (DCN) of the report to correct and select Correct or Modify a Report on the Report Type screen. Make the corrections to the report and submit the changes. A Revision-to-Action Report may also be corrected using the Querying and Reporting XML Service (QRXS). Refer to the appropriate QRXS File Format Specifications for additional information. (Also in Integrated Querying and Reporting Service [IQRS] FAQ and Querying and Reporting XML Service [QRXS] FAQ.)

  8. Where can I find information regarding querying, reporting and rejection codes?

    You can locate rejection and other reporting codes for all Data Banks transactions on the Data Banks home page. On the home page, scroll to the left side of your screen to the General Information category.

  9. What is the deadline for submitting a Medical Malpractice Payment Reports (MMPR)?

    Medical malpractice payers are required to report a payment within 30 days from the date the payment was made. However, missing the deadline does not excuse the reporter from filing a required report. The reporting entity must also send a copy of the final report to the State licensure board.(Also in NPDB Query and Report FAQ.)

  10. What is the deadline for reporting adverse licensure actions?

    Generally, state licensure boards must submit reports within 30 days from the date the adverse licensure action was taken. Please review the specific requirements for the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB) in the NPDB Guidebook and the HIPDB Guidebook that can be found under the Publications category on the Data Banks home page.

  11. What is the deadline for reporting clinical privileges actions?

    Hospitals, others health care entities, and professional societies are required to report adverse clinical privilege actions that are in effect for more than 30 days. The report should be submitted within 30 days of the date that the action was taken. A Clinical Privileges action, for an indefinite period becomes reportable on the 31st day the action is in effect. For example, an adverse action was taken on May 1 and it is in effect indefinitely; on June 1 the action is now in effect for more than 30 days. As a result, the action must be reported within 30 days of June 1 or, in other words, by July 1. However, missing the deadline does not excuse the reporter from filing a required report. The reporting entity must send a copy of the final report to the State licensure board. (Also in NPDB Query and Report FAQ.)

  12. What is the deadline for reporting adverse licensure actions, health plan other adjudicated actions, and Judgments or Convictions to the Healthcare Integrity and Protection Data Bank (HIPDB)?

    All reportable actions must be reported to the Healthcare Integrity and Protection Data Bank (HIPDB) within 30 calendar days of the date the final adverse licensure action was taken, or the date when the reporting entity became aware of the final action, or by the close of the entity’s next monthly reporting cycle, whichever is later. The general guidance is within 30 days of the date of the action. (Also in HIPDB Query and Report FAQ.)

  13. If a State licensing board reports the suspension of the practitioner’s license for 90 days, and the suspension is later reduced to 45 days, what type of report should the board submit for this new action?

    The State licensure board should submit a Revision-to-Action Report to reflect the subsequent reduction in the number of suspension days.

  14. I am with a State dental board, and we suspended an oral surgeon's license until the practitioner completed additional training. The State dental board reinstated the dentist's license 28 days after the date of the suspension. Is this a reportable action?

    Yes, this is a reportable action because State licensure suspensions must be reported regardless of the duration of the suspension. Therefore, the board must submit an Initial Report for the suspension, and submit a Revision-to-Action Report for the reinstatement of the license, since the Initial Report did not specify a definite time period for the suspension.

    Reinstatements and other types of revisions, to previously reported licensure actions, must be reported to the NPDB-HIPDB. However, there is no need to report a routine reinstatement at the end of a fixed period of suspension specified in an Initial Report.

  15. How do I know if my adverse action narrative description is factually sufficient, and if I meet the statutory reporting requirements?

    To meet the statutory reporting requirements, the description must have enough detailed information so that a knowledgeable reviewer can determine clearly the circumstances of the action or surrender. In other words, you must provide a clear understanding of what the subject practitioner is alleged to have done, the nature of the action taken, and the reasons for the report. Merely repeating the adverse action or basis for action code is not factually sufficient. Do not reference personal identifying information about patients, other health care practitioners, plaintiffs, and/or witnesses (e.g., names). The narrative may be up to 4,000 characters in length. (Also in Narrative Descriptions FAQ.)

  16. How do I report an action taken against a nurse who is licensed in another State but is authorized to practice in our State under the Nurse Licensure Compact (NLC)?

    The Multi-State Privilege Adverse Action Classification codes were developed to allow the reporting of actions taken against a nurse's privilege to practice under the NLC. The State that issues the license to practice (the nurse's home State or State of residency) should use the Licensure Adverse Action Classification codes to report an action it takes against the nurse's license. If the remote State (the State that did not issue the license) also takes an action against the nurse's Multi-State Privilege to Practice, it should also file a separate report of that action using the Multi-State Privilege Adverse Action Classification codes. The Multi-State Privilege Adverse Action Classification codes, along with the Licensure Adverse Action Classification codes, and other Adverse Action Classification codes, are available under Reporting Codes under the General Information category on the Data Banks home page. (Also in HIPDB Query and Report FAQ.)

  17. How do I make changes to a narrative description after I submit the report?

    To change a narrative description in a previously filed report, you must submit a correction to that report. A correction is a change to the report resulting from the discovery of an error or omission in an Initial Report. Please do not submit a Revision-to-Action Report, which is a report that relates to and/or modifies an adverse action previously reported to the Data Bank(s). Nor should you void the report, which should be done only if it was erroneously submitted, if it was not required to be filed, or the action is reversed because the original action should never have been taken (e.g., overturned on appeal).

    Finally, when submitting a report to the Data Bank(s), you are required to provide a narrative description, with enough detailed information, so that a knowledgeable reviewer can determine clearly the circumstances of the action or surrender. Do not reference personal identifying information about patients, other health care practitioners, plaintiffs, and/or witnesses (e.g., names). (Also in Narrative Descriptions FAQ).

  18. My organization (entity), which requires that physicians be board certified, denied a physician's application for surgical privileges because the physician was not board certified in a particular clinical specialty or subspecialty. Is this action reportable to the National Practitioner Data Bank (NPDB)?

    No, if the entity has a medical staff policy that all practitioners must be board certified to be eligible for medical staff membership, the automatic denial of a given type of clinical privileges is not reportable.

    However, if the committee weighs whether board certification is required on an individual basis, then a report would be required if privileges were denied to a particular practitioner because the practitioner was not board certified. (Also in NPDB Query and Report FAQ.)

  19. A hospital suspends a podiatrist's clinical privileges for more than 30 days. Should the hospital report the adverse action to the National Practitioner Data Bank (NPDB)?

    Hospitals may, but are not required to, report adverse actions taken against the clinical privileges of "other health care practitioners" such as podiatrists. Hospitals must report adverse actions taken against the clinical privileges of only physicians and dentists. (The reporting requirement differs from the querying requirement; hospitals are required to query the NPDB at the time a physician, dentist, or other healthcare practitioner [e.g., podiatrist, chiropractor, nurse practitioner] applies for medical staff appointment or for clinical privileges and every two years thereafter at the time of reappointment.)

  20. What is a report change notice?

    A report change notice is a notification detailing a change to a report on a practitioner whom you have previously queried on and received in the past 3 years. Actions that generate a report change notice include a correction, a subject statement addition, or a notice of appeal. Electronic versions of report change notices can be viewed on the Integrated Querying and Reporting Service (IQRS) by selecting Report Change Notices on the Options screen. Querying and Reporting XML Service (QRXS) users may elect to receive report change notices via the QRXS. By default, paper versions of report change notices are also mailed to your entity's address. Your Entity Data Bank Administrator can opt out of receiving the paper version, and/or indicate to receive notifications via QRXS on the Notification Preferences screen within the IQRS. (Also in Querying FAQ.)

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Last revised June 2008