When healthcare practitioners apply for clinical privileges or medical staff appointments

When they are engaging in profes- sional review activity Registered ASCs can submit a query

on any healthcare practitioner, provider or supplier, not just those given privi- leges at the ASC. ASCs receive the following types of information in response to their queries: ■

Medical malpractice payment infor- mation

■ ■ ■

Licensure actions by boards of medical examiners

Licensure and certification actions taken by states

Adverse actions taken by healthcare entities against

clinical ■ privileges,

including professional review actions taken by professional societies

Negative actions or findings by peer review organizations or private accreditation entities

Healthcare-related criminal convic- tions when reported by federal agen- cies or health plans

Healthcare-related civil judgments when reported by federal agencies or health plans

Exclusions from participating in fed- eral or state healthcare programs when reported by federal agencies or health plans

Other healthcare-related adjudicated actions or decisions when reported by federal agencies or health plans.

How to Query Registered ASCs can request either of the following query types though the NPDB website: ■

Continuous Query allows enti- ties

to receive a query response

for an individual or organization, as well as any new or updated report notifications during the year- long enrollment.

One-Time Query allows entities to receive a query response for an indi- vidual or organization. Those entities will not be notified of any new reports submitted to the NPDB after the ini- tial query date.


Email: for technical questions related to billing, registration and submitting a report; and for policy questions

Call: 800.767.6732 Monday through Thursday 8:30 am to 6:00 pm and Friday 8:30 am to 5:30 pm ET, except federal holidays.

The cost for a single one-time query response or one-year enrollment in con- tinuous query is $2.00.

Your ASC Could Be Reported to the NPDB

Federal licensing and certification agencies must report final adverse licensure and certification actions taken against ASCs to the NPDB, regardless of whether the final adverse action is the subject of a pending appeal. These reports include formal or official actions such as revocation or suspension of a license, certification agreement or contract for participation in government healthcare programs; reprimand; censure; or probation. State licensing and certification authorities also must report to the NPDB certain actions—referred to as state licensure and certification actions—taken against ASCs. Certain actions include, but are not limited to, revocation or suspension of a license, certification agreement or contract for participation in a government health- care program; reprimand; censure; or probation. Reported actions must be as a result of formal proceedings. A formal proceeding is one that is con- ducted by a state licensing or certifica- tion authority that maintains defined rules, policies or procedures for such a proceeding. Private accreditation organiza- tions, too, are required to report to the NPDB certain negative actions or findings against ASCs. These nega-

tive actions or findings are defined in NPDB regulations as a final deter- mination of denial or termination of an accreditation status that indicates a risk to the safety of a patient or to the quality of healthcare services. The actions taken must be as a result of formal proceedings.

Last, federal and state attorneys and health plans also must report civil judgments related to the delivery of a healthcare item or service against ASCs, regardless of whether the civil judgment is the subject of a pending appeal. NPDB regulations define civil judgment as “a court-ordered action rendered in a federal or state court pro- ceeding, other than a criminal proceed- ing. This reporting requirement does not include consent judgments that have been agreed upon and entered to provide security for civil settlements in which there was no finding or admis- sion of liability.”

What Is Attestation, How Do ASCs Participate? In August, the NPDB began encourag- ing ASCs to participate in its national attestation program. This education and outreach effort aims to ensure that all organizations registered with the NPDB are aware of and in compliance with the reporting and confidentiality require- ments that apply to them. During attestation, organizations,

such as ASCs, confirm that they have submitted all reportable actions and medical

malpractice the NPDB.

ASCs that register with the NPDB will be asked to complete attestation every two years on the renewal anni- versary date for their registration. To find their renewal date, the ASC should sign into the NPDB website and check the Entity Registration Confirmation page. An organization must be regis- tered for at least two years before it will need to attest.

Donald Illich is a technical writer with the National Practitioner Data Bank in Fairfax, Virginia. Write him at

ASC FOCUS JANUARY 2020 | 25 payments to

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