Vendor Credentialing

1. Vendor Credentialing Jon Morales VP of Operations VCS - Vendor Credentialing Service jmorales@VCSdatabase.com

2. 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

3. 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.

5. 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

6. The problem…

7. 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

9. 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 Claims 23K, 15K, 100K, 260K, 500K, 18K, 28K……. http://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp

10. 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?

11. 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

12. Market trend

13. 3 year forecast for vendor credentialing

14. 3 year forecast for vendor credentialing • Suppliers pushing a “preferred” credentialing provider • Consolidation of credentialing companies! • Vendor Credentialing Standard????

15. Questions?