Vendor Credentialing

Jon Morales

VP of Operations

VCS - Vendor Credentialing Service

jmorales@VCSdatabase.com

Vendor Credentialing? Definitions: The process of obtaining and reviewing the

documentation (licensure, certifications, insurance, etc.) of health professionals. Generally, this includes reviewing information given by the professional and verifying that the information is correct and complete.missourifamilies.org/features/healtharticles/health40.htm

A generic term for licensure, certification, and registration. Can also be used as a term for a voluntary process under the auspices of private sector associations. (Shimberg and Roederer, 1994.)www.dshs.state.tx.us/chs/hprc/glosterm.shtm

What is vendor credentialing

HOSPITAL: The process of obtaining, reviewing and tracking submitted documents from suppliers and their representatives (HCIR’s).Suppliers: insurance, diversity, media scans, financial info, supplier risk scores, business info, Gov’t exclusions, etc.Representatives: Gov’t exclusions, background checks, immunizations, hospital policies, vendor orientation, etc.

SUPPLIER: Online database to track all company and representative credentialing documentation including internal training and internal policies.

What Does It Mean To Healthcare?

Vendor Management = Risk Management

Managing Risk to patients healthcare-associated infections account for an

estimated 1.7 million infections and 99,000 associated deaths each year

13,779 TB cases (a rate of 4.6 cases per 100,000 persons) were reported in the United States in 2006.

Patient Privacy and Patient Rights Security of the hospital and hospital

property Managing Conflict of Interest Cost controls with proper device and

medication approval processes

The problem…

Challenges Facing A Facility

Vendor Company Financials

Bankruptcies Liens Judgments

Legal Standing Involved with Anti-

Kickback Legislation Liability Insurance HUB’s Conflict of Interest

Vendor Representatives Immunizations

MMR TB Varicella Influenza

Cold Calling Background Check Conflict of Interest Contact Information Proper Training

OIG / GSA Excluded Parties List

“No payment will be made by any Federal health care program for any items or services furnished, ordered, or prescribed by an excluded individual or entity.”

http://oig.hhs.gov/fraud/exclusions.asp

In a case of false or fraudulent claims, the OIG may seek a penalty of up to $10,000 for each item or service improperly claimed, and an assessment of up to three times the amount improperly claimed. 42 U.S.C. § 1320a-7a(a). http://oig.hhs.gov/fraud/enforcement/cmp/index.asp

False & Fraudulent Claims23K, 15K, 100K, 260K, 500K, 18K, 28K…….http://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp

What Vendor Credentialing (VC) can do for you…

Reduce liability Reduce cost Increase compliance Increase safety Increase organization of supplier & rep data Increase communication with suppliers & reps

HOW?

How VC can do it for you… Guarantee Credentialing

database Confirmed

Appointments Detailed Badges Required credentials Required policies Background/sex off

checks Supplier data & risk

score Rep data & Notes Deny Access

Supplier & rep training

Community Notes Conflicts of interest Diversity Product / Service

searches Communication Supplier review GPO contracted

suppliers Track expenses Track gifts

Market trend

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Hospitals with a vendor credentialing program: 3rd party or their own

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3 year forecast for vendor credentialing

3 year forecast for vendor credentialing

Suppliers pushing a “preferred” credentialing provider

Consolidation of credentialing companies!

Vendor Credentialing Standard????

Questions?