Credentialing Corner

# The Role of the National Practitioner Data Bank (NPDB) in Credentialing

- May 28, 2024
- Posted by Kristen Edwards

29 Sep

The healthcare field is a complex one, where a lot of people are working in different positions. The main objective and end goal is the provision of quality healthcare to patients. All healthcare systems overseeing this process also have this goal as the basis of their work models. Healthcare practitioner database systems and data banks are also constructed on this principle of maintaining quality patient healthcare. The National Practitioner Data Bank (NPDB) is one such system.

The National Practitioner Data Bank (NPDB) system was created to contain information about all the practicing healthcare workers, including doctors, nurses, paramedical staff, and other hospital workers coming in contact with the patient in one way or another. This data bank contains the complete record of the work history of these healthcare practitioners, including any malpractice history and unsatisfactory work action reports. Also, the data bank is accessible by only authorized institutions so that they can see the status of the healthcare professionals they employ. Let us dive more into knowing NPDB and why physicians need to get in contact with them.

## What is NPDB?

The National Practitioner Data Bank (NPDB) is a confidential and secretive data bank and informational clearinghouse containing important data of healthcare professionals, including their malpractice history, history of personal conduct, and unprofessional conduct reports. The main objective of this data bank is to ensure the safety of the patients, increase the quality of healthcare, and reduce the chances of frauds/forgeries within the healthcare system by preventing any fraudulent or unrespected professionals from getting within the system.

NPDB comes into play whenever a new healthcare professional wishes to join the healthcare field. It acts as an information storehouse and checklist for the authorities to check the professional history of the practitioners. In addition to the employment process, NPDB serves as a checking authority for credentialing, monitoring, and licensing processes of the whole healthcare field. Thus, it is a complete information database of the whole healthcare field within the US and is one of the main authorities overlooking the safety and security of patients.

## NPDB’s impact on the Medical Credentialing Process

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Medical credentialing is an essential part of the employment of healthcare professionals, especially doctors. By ensuring that the concerned practitioner meets the standards set by the healthcare facility or any overlooking authority, credentialing ensures that the facility chooses the best person available for the job. NPDB plays an important part in this process, as it generally adds to the validity of the information used in the credentialing process.

Here’s how NPDB can be very significant for credentialing of healthcare practitioners:

### 1. Background Check

NPDB acts as a complete data system to do background checks on the practitioners the healthcare facility will employ. The facility can check the whole work history of the practitioner using this system. All information about malpractice or adverse actions taken against the practitioner is also contained within this database. Thus, hospitals and other authorities can check the practitioner they will employ and decide based on their performance within the NPDB system.

### 2. Credential Verification

The whole system also allows healthcare facilities to check the credentials provided by the practitioners. They can use this system to cross-check the data provided by the doctor they will hire and see if there are any discrepancies/forgeries in the information provided by the doctor. This allows the hospitals to cross out chances of any fraudulent activity by the practitioners and select the most qualified person among the bunch.

### 3. Quality Assurance

By keeping the whole work history of practitioners within a single system, the NPDB allows healthcare facilities to maintain the quality of care being provided to the patients. Practitioners themselves are careful about their jobs since all of their case management data will be stored. The hospitals also put thought into improving the care procedures to maintain a flourishing doctor record within the system. This allows the authorities to maintain the quality of care being provided to the patients.

This quality then translates into a better credentialing profile for the practitioner, which helps him in the long run.

### 4. Making Credentialing Decisions

Using data from the NPDB, hospitals, and healthcare authorities can make important credentialing decisions about their practitioners. These decisions generally relate to the employment of the said practitioner but can also be about their clinical privileges and licenses. A shining record on the NPDB system means that these decisions can favor the practitioner and help them make the most of their professional career.

### 5. Regulation Compliance

Using the NPDB system to check the practitioner’s data before employing them is a requirement made essential by federal law in the US. Healthcare authorities have to comply with this regulation and use the NPDB to check the status of their healthcare staff. By doing this, they are complying with federal law and the Health Care Quality Improvement Act (HCQIA), which makes it necessary for healthcare facilities to check the NPDB data and report any data of malfunction or adverse action to the database.

## How does NPDB aid in Healthcare Credentialing?

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NPDB collects data from healthcare authorities, stores it, and dispatches it to the relevant authorities on request. It aids in the healthcare credentialing process by storing the following information about healthcare practitioners:

- Medical malpractice history
- Malpractice payment history
- Exclusions from the state healthcare programs or initiatives
- Adverse action reports filed by the healthcare facility or any peer review authorities
- Criminal convictions related to healthcare malpractice
- Civil convictions related to healthcare malpractice
- civil/criminal judgments against the practitioner for any adverse action
- Federal and state-level licenses
- Federal and state-level certifications
- Certificates issued by medical boards
- License issues by medical boards
- Healthcare work eligibility decisions for the practitioner
- Any other professional history/data`

## Using NPDB for Medical Background Check

As we already said, NPDB is a complete storage of the professional data of practitioners. Healthcare authorities can, thus, use this system to check the data provided by the doctors they employ. This allows them to see the complete previous record of the doctor, including their employment history, work experience, malpractice issues, adverse action reports, and any civil/criminal judgments passed on to the doctor. Thus, the doctor’s whole personality and professional conduct are present within a centralized data system that the healthcare facilities can use to perform background checks on the doctors they are going to employ.

## Who can access the NPDB data?

Since the NPDB is a complete data storehouse for the whole healthcare history of a practitioner, it serves as a standard for almost all healthcare facilities to conduct background checks of these practitioners before employing them. However, the use of NPDB data is limited as it only allows the facilities authorized to check data to access the database.

These authorities include:

- Healthcare facilities, including hospitals and clinics
- Medical billing companies
- Medical malpractice payers
- Medical examiners boards
- Medical peer review boards
- State licensure and certification authorities
- Law enforcement agencies
- Medicaid authorities
- Doctors/healthcare workers
- Federal licensure authorities

Thus, you won’t be able to access the data if you don’t belong to one of these. Thus, the data is only available to some of the public. Healthcare workers, including doctors, can check their status within the database using the systems available within hospitals. Questions regarding the data can also be only asked by certain qualified persons.

Compliance with the disclosure guidelines is mandatory by law. Any person found misusing or not disclosing this data to improper authorities is liable to be fined. Fines associated with such mishandling of data are also very hefty. If any healthcare professional is found in connection with these leakages, their licenses are liable to get canceled as well.

## Conclusion

The National Practitioner Data Bank (NPDB) is a centralized data bank containing important information about healthcare professionals. This confidential data storage is under the provision of the US government and is used by healthcare facilities to cross-check the data of their practitioners before hiring them. This data bank contains information regarding the work history of the practitioners, including their malpractice history, adverse action reports, peer review comments, medical board recommendations, and licensure/certification information. Using this data, healthcare authorities can perform background checks on their practitioners, verify their credentials, make credentialing decisions regarding the doctors, and maintain the quality of the care being provided to the patients. Owing to the sensitivity of the data, it is only accessible by relevant authorities and by those with express permission from them. The NPDB data bank allows only the most qualified and professional healthcare workers to gain jobs within the healthcare system and ensures that the quality of the care being provided to the patients by these workers is up to the mark and the best in the world.

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