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Vendor Credentialing Jon Morales VP of Operations VCS - Vendor Credentialing Service jmorales@VCSdatabase.com
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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 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 www.dshs.state.tx.us/chs/hprc/glosterm.shtm
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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.
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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
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The problem…
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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
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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 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 http://oig.hhs.gov/fraud/enforcement/cmp/index.asp False & Fraudulent Claims 23K, 15K, 100K, 260K, 500K, 18K, 28K……. http://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp
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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?
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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
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Market trend
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3 year forecast for vendor credentialing
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Suppliers pushing a “preferred” credentialing provider Consolidation of credentialing companies! Vendor Credentialing Standard????
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Questions?
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