vendor credentialing jon morales vp of operations vcs - vendor credentialing service...
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Vendor Credentialing
Jon Morales
VP of Operations
VCS - Vendor Credentialing Service
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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
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
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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
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
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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
0%
5%
10%
15%
20%
25%
30%
35%
40%
Hospitals with a vendor credentialing program: 3rd party or their own
2004
2005
2006
2007
2008
2009
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3 year forecast for vendor credentialing
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3 year forecast for vendor credentialing
Suppliers pushing a “preferred” credentialing provider
Consolidation of credentialing companies!
Vendor Credentialing Standard????
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Questions?