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Audit-Ready Compliance Through Data Automation and Technology

May 15, 2019

Sustaining consistent health care compliance is becoming more complex and challenging as the health care industry grows and evolves.

THE PROBLEM:

Health care employment in the U.S. has reached historical highs, now exceeding that of manufacturing and retail. With an overall 20% growth rate (higher for nurse practitioners and physician assistants) there are currently 2.2 million health care workers and an additional 8 million licensed providers.

Health care spending continues to grow at a staggering rate with the baby boom population entering Medicare age. The spend for 2018 was more than $2.5 trillion, with more than $90 billion spent on improper payments. Waste, fraud and abuse accounts for 10 percent, or some $350 billion annually. Only one in six dollars lost to fraud is recovered following additional spending on investigations, task forces, audits, and prosecution.

On average, it is estimated that one in every 20 health care providers will have an impaired license due to any number of infractions ranging from unpaid student loans, to patient abuse or neglect, to a criminal conviction.

Federal regulations change frequently, and more are added as health care evolves. Telemedicine, Medicaid expansion, and the likely dissolution of the Affordable Care Act are just a few examples of why sustaining compliance to State and Federal standards require a high level of expertise and constant attention.

Additionally, adhering to standards to qualify for certifications and accreditations adds a layer of detail and annual rigor to pass scheduled and surprise audits.

THE PROCESS:

Many Human Resources, Medical Staff Services and Compliance Departments are siloed and still use paper filing and antiquated spreadsheet systems. Verisys Corporation built CheckMedic®, a powerful data and technology SaaS platform that manages each employee, provider and affiliate of an organization by issuing an individual MedPass® for each individual or entity.

The MedPass® is a secure, digital profile that is created by screening and verifying each individual or entity against more than 3000+ primary sources and arrives at identity matching with 99.9 percent accuracy.

Once static data is verified, it is locked and continuously monitored based on the type of data required for compliance.

Licensed providers are monitored against FACIS® (Fraud Abuse Control Information System) for sanctions, debarments, disciplinary actions and exclusions, giving a heads up of possible red flags and the opportunity to act sooner rather than later.

THE SOLUTION:

Setting policies and procedures that integrate departments and implement automation and technology mitigates risk exposure, protects patients, ensures alignment with quality measures, and reduces administrative burden.

Full implementation of CheckMedic® and the MedPass® positively impacts your organization’s bottom line by reducing risk of fines, penalties and legal entanglements. Because of the speed, accuracy and integration of departments, CheckMedic® dramatically cuts the time from practitioner onboarding to full credentialing and billing for reimbursement. Only allowing properly licensed providers to address patient needs ultimately builds high star ratings and quality measures that increase the ratio of reimbursement.

With our primary objective being quality patient care, Verisys’ CheckMedic® MedPass® system keeps an entire enterprise in compliance thus protecting health care consumers by enforcing competency and patient safety through full transparency.