Physician's Coding Strategist-Feds open data bank to help boost quality

The public can't access the information

The Department of Health and Human Services' Office of the Inspector General has launched another tool to help ensure health care quality and fight health care fraud and abuse.

The Healthcare Integrity and Protection Data Bank (HIPDB), mandated by the Health Insurance Portability and Accountability Act of 1996, is expected to begin accepting requests for reports early this year. The final rule implementing the data bank was published in the Oct. 26 Federal Register and took effect upon publication.1

The new data bank contains the following types of information:

o civil judgments, with the exception of malpractice judgments, against health care providers, suppliers, and practitioners in federal or state courts related to the delivery of a health care item or service;

o federal or state criminal convictions against health care providers, suppliers, and practitioners related to the delivery of a health care item or service;

o actions by federal or state agencies responsible for the licensing and certification of health care providers, suppliers, and practitioners;

o exclusion of health care providers, suppliers, and practitioners from participation in federal or state health care programs.

Overpayment determinations by Health Care Financing Administration contractors are not reportable, according to the final rule.

HIPDB will complement the 10-year-old National Practitioner Data Bank (NPDB). The NPDB contains reports of medical malpractice payments, adverse licensing actions, adverse clinical privileges actions, and adverse professional society membership actions against more than 133,000 physicians, dentists, and other health care practitioners.

Day-to-day operation of HIPDB will be managed by the Office of the Inspector General in the Department of Health and Human Services' Health Resources and Services Administration, which also operates the NPDB.

Because health organizations may find some overlap in the data banks, a single NPDB-HIPDB Integrated Querying and Reporting Service (IQRS) will be used to report to and query both of them over the World Wide Web. Based on the action being reported and the applicable laws, the IQRS will submit the report automatically to the NPDB, the HIPDB, or both.

Users first must register and certify eligibil - ity to report or submit queries to the data banks before access will be authorized. Access to HIPDB reports is strictly limited by statute, and, as required by law, the general public will not have access to data bank information. The statute provides that only the government agencies and private health plans required to report to the data bank will be authorized to obtain data bank information. Subjects of reports may obtain access to their own reports.

Information reported to the data bank is confidential. HIPDB information may be requested for privileging and employment, professional review, licensing, certification or registration, fraud and abuse investigation, certification to participate in a government program, and civil and administrative sanctions.

As required by law, the operating cost of the data bank will be covered by a fee for each information search requested by a nonfederal entity authorized to use the data bank. It is estimated that the HIPDB will process in excess of 1 million requests during its inaugural year.

[Editor's note: The combined Web site can be accessed at http://www.npdb-hipdb.com, and additional information on the data banks can be obtained by calling (800) 767-6732.]

Reference

1. 99 Fed Reg 57,739 (Oct. 26, 1999).