Run Your own NPDR Inquiry – See What You Find

Lurking behind every privileging, licensing and credentialing decision is an inquiry by your hosp8tial, health plans, and nearly any certificating body is a search of the National Practitioner Data Bank (NPDB).  The NPDB is a data base run by the US Department of Health and Human Services. It is mandatory for hospitals, state licensing boards, and even health plans and credentialing arms of physician organizations to submit actions of a negative nature to the NPDB.  And it is in many cases mandatory that test organizaiton do a search of the NPDB when considering a physician’s application for privileges or crediting and licensing.

Reported to the NPDB are suspensions, terminations, or any restitutions on clinical privileges at a hospital, actions that could impact your license from a state agency (OPMC), malpractice awards, or investigations done by hospitals into any patient care or other matters.

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What’s in the NPDB can impact your ability to be employed, granted privileges at a hospital, or even retain your participating contracts with health plans. What’s there, like a financial credit report, can come back to bite you.

And similar to a financial credit report, what is in the report can be commented upon.  Not that the negative finding will be expunged at with the credit report when disputed, but the NPDB does allow physicians to file a statement towards explain the circumstances, or defending one’s reputation.

Sometimes the situations reported are technical violation, and physicians think that unless patient care is involved, the NPDB is of no concern.  Not so.  For example, the physician that choose to resign from a hospital to take another position was flagged because at the time he was being investigated for an issue related to by-laws of the hospital.  No patient care issue, but it was reported and found on a NPDB report because the rule is that resignations during investigations are reportable, regardless of the reason. (The rule supposes that physicians resign to stop an investigation as to avoid negative findings)

What is in your NPDB report follows you, and impacts our reputation. Filing a comment, which must be well worded is important to rehabilitating your reputation as others see it, explaining the circumstances, or otherwise writing to mitigate the damages of a correct finding against you.

Here is where you know what happened, the potential unfairness of the events, the circumstances.  Your response has to be carefully structed, and unemotional.  A good healthcare lawyer needs to do the wordsmithing with you. The wording has to be just right. Don’t let the drama of the situation get in the way.  This should not be a do it yourself response, there is too much riding on it.  Once filed, it stays on the NPDB, so words will matter.  The last thing you want is to slam your former employer, or come across as a future problem for a future employer.

It is always preferable to have a response to a NPDB filing filed at the time the report to the NPDB is filed. Once a reported has bene filed, whenever you are renewing or applying for certification, license or privileges, the NPDB is going to be queried.  Have your response, your side of the issue there as well.


Top 20 EMR Providers

CureMD has been servicing practices across the US for over twenty years now and has received numerous accolades during that time. With an easy-to-use interface and amazing customer service, CureMD’s Electronic Medical Records (EMR) software caters to 32 specialties and helps physicians and office staff efficiently manage their daily operations. The company has also been providing exemplary service to mental health professionals, making their practices substantially more organized and better coordinated; and we’re not the only ones saying this! Continue

How Can Better Documentation Lead to Better Revenue Cycles?

Revenue cycle management has grown to be increasingly tricky to handle, largely due to the ever-growing healthcare reforms and policies. With the implementation of ICD-10, practices, as well as hospitals, have started to arm themselves with as many supplies and tools as they can to help them manage their revenue cycles efficiently.

One technique that has shown tremendous promise is clinical documentation improvement (CDI). CDI helps physicians and coders increase coding accuracy and properly depict the quality of care delivered. CDI aids in communication as well as identifies those areas of the documentation process that could use some improvement and greater specificity. With proper implementation, CDI offers both procedural and financial benefits.

If your practice has been struggling to improve patient outcomes, smooth clinical workflows and streamline your revenue cycle, here are more ways better clinical documentation can help: Read more

How PMS Systems Save Physicians Time

Medical practice management software for private practices has a medical station, with access through a single screen to the most usual data of their daily tasks, from where a clinical history is accessed that collects in a comprehensive way all the information of care of the Patients.

With this software for clinics can manage requests and results, generate reports based on templates, prescribe traditional recipes on paper, as well as electronic prescriptions integrated into the public health system. In addition, medical practice management software has an excellent billing system for private patients and with health insurance. Read more 

Can we ever move towards patient friendly medical billing?

Medicine has advanced tremendously in the last 50 years. I mean we’ve come up with antibiotics and image scanning and angioplasty, so why is it we haven’t been able to come up with a bill that doesn’t royally confuse the patients?

If patients are going to be billed high prices for medical procedures, they had better well be able to understand everything they are being billed for!

After many focus groups revealed patient frustration with their medical bills, the Patient Friendly Billing project was born.

Today’s Consumers Demand More
The costs of healthcare are rising, and it’s the consumers’ savings account that’s taking the biggest hit. Today’s consumers expect to wholly participate in their medical care and demand pricing transparency and documentation that is understandable.

The Healthcare Financial Management Association (HFMA) began the Patient Friendly Billing project to promote clear, concise, and correct patient-friendly financial communications.

The project is founded on the following tenets:
• When designing administrative processes and communications, the needs of patients and their families should be the primary focus.
• It should be the responsibility of providers and insurers to coordinate the gathering of patient information in an efficient and private way, and without any unnecessary duplication.
• If at all possible, communication regarding financial matters should not happen during the medical visit.
• The language and format of communications should be understandable to the average reader.
• Better practices should be a goal of all providers and should incorporate patient feedback.
• Billing statements should be easy to understand, accurate, provide comprehensive details, and designed so the information is logical to read. Continue reading

5 Ways to Protect Yourself from the EHR Heartbreak

Out-dated EHR bringing your practice down? Or maybe just thinking of switching your practice management software? Look no further. Brining you a basic, 5-step guide to buying the right EHR, this info-graphic is bound to help you choose better and shop smarter. Remember, 59% more buyers are replacing existing EHR Software this year and you most definitely can’t afford staying behind in the race. Analyze, research, consult and go for it! Get the EHR your practice deserves and spend time managing your patients, and not the software. Happy shopping this year! Read more