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Vendor Credentialing Jon Morales VP of Operations VCS - Vendor Credentialing Service [email protected]

Vendor Credentialing

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Vendor Credentialing. Jon Morales VP of Operations VCS - Vendor Credentialing Service. [email protected]. Vendor Credentialing?. Definitions: - PowerPoint PPT Presentation

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Page 1: Vendor  Credentialing

Vendor Credentialing

Jon MoralesVP of OperationsVCS - Vendor Credentialing Service

[email protected]

Page 2: Vendor  Credentialing

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

Page 3: Vendor  Credentialing

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.

Page 4: Vendor  Credentialing
Page 5: Vendor  Credentialing

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

Page 6: Vendor  Credentialing

The problem…

Page 7: Vendor  Credentialing

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

Page 8: Vendor  Credentialing
Page 9: Vendor  Credentialing

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

Page 10: Vendor  Credentialing

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?

Page 11: Vendor  Credentialing

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

Page 12: Vendor  Credentialing

Market trend

0%5%

10%15%20%25%30%35%40%

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

200420052006200720082009

Page 13: Vendor  Credentialing

3 year forecast for vendor credentialing

Page 14: Vendor  Credentialing

3 year forecast for vendor credentialing

Suppliers pushing a “preferred” credentialing provider

Consolidation of credentialing companies!

Vendor Credentialing Standard????

Page 15: Vendor  Credentialing

Questions?