Transcript Vendor Management

Vendor Credentialing
Jon Morales
VP of Operations
VCS - Vendor Credentialing Service
[email protected]
Vendor Credentialing?
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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
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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.
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SUPPLIER:
Online database to track all company and representative
credentialing documentation including internal training and
internal policies.
What Does It Mean To Healthcare?
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Vendor Management = Risk Management
Managing Risk to patients
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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
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Vendor Company
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Financials
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Vendor Representatives
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Bankruptcies
Liens
Judgments
Involved with AntiKickback Legislation
Liability Insurance
HUB’s
Conflict of Interest
Immunizations
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Legal Standing
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MMR
TB
Varicella
Influenza
Cold Calling
Background Check
Conflict of Interest
Contact Information
Proper Training
OIG / GSA Excluded Parties List
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“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
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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
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False & Fraudulent Claims
23K, 15K, 100K, 260K, 500K, 18K, 28K…….
http://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp
What Vendor Credentialing (VC) can
do for you…
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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…
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Guarantee
Credentialing database
Confirmed Appointments
Detailed Badges
Required credentials
Required policies
Background/sex off checks
Supplier data & risk score
Rep data & Notes
Deny Access
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Supplier & rep training
Community Notes
Conflicts of interest
Diversity
Product / Service searches
Communication
Supplier review
GPO contracted suppliers
Track expenses
Track gifts
Market trend
40%
35%
30%
2004
25%
2005
20%
2006
15%
2007
10%
2008
5%
2009
0%
Hospitals with a vendor credentialing
program: 3rd party or their own
3 year forecast for vendor credentialing
3 year forecast for vendor credentialing
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Suppliers pushing a “preferred” credentialing provider
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Consolidation of credentialing companies!
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Vendor Credentialing Standard????
Questions?