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Why Close the 5 Critical Gaps in Health Care Compliance?

January 10, 2019

Closing the 5 critical gaps in health care compliance is the best way to deliver the highest level of care and quality while protecting patients. This is vitally important to achieving and sustaining your reputation as a health care organization.

It is crucial to have complete transparency into every member of your workforce and service providers—particularly those who serve patients. This is the key to patient safety and regulatory compliance and why transparency is a tangible competitive advantage with a definable return on your investment.

How much transparency do you have into your workforce, partners and suppliers?

Do you know everything you need to know?

All too common is news such as this from Nexstar Broadcasting reporting of a woman posing as a nurse with a forged license who pleaded guilty of prescription fraud. Health care providers and their credentials (or lack thereof) have been a hot topic in the news as of late and it is a scary reality. An article written by John Fauber and Matt Wynn published in USA Today in November 2018 found in their year-long investigation that 73 physicians nationwide still maintained active medical licenses in spite of receiving FDA warning letters over a five-year period. Only one of the 73 received disciplinary action from his state medical board.

With demand rising among all health care stakeholders for information access and disclosure, the processes and technologies you apply to screening, verification and monitoring for credentialing and hiring can protect your organization and—most importantly—your patients. 

Screening, primary-source credentials verification and monitoring of clinical health care practitioners and the teams supporting them, in addition to new hires, current staff, affiliates, and third-party vendors are important functions of the HR, compliance and medical affairs/staff services teams at every hospital system, acute, post-acute, long-term, and home care facility.

With the proliferation of telehealth as it provides broader access, more patients are receiving care from providers outside of a familiar on-site clinical practice environment. Screening, verification and continuous monitoring is ever more important to assure that no matter the way a patient accesses care from a provider, that provider’s credentials are in good standing from license status, proper training, to a clean criminal and abuse record.

Proper due diligence is more vital than ever as expectations for transparency rise in order to meet standards and regulatory compliance. The ramifications for oversights and mistakes have greater exposure as the press has taken focus on medical errors due to abuse or incompetency causing harm to patients. In addition, federal program task forces are stepping up enforcement to reduce fraud, waste and abuse.

The Value of a 360-Degree View of all Parties

Aside from mandated compliance requirements, there are critically important business reasons to ensure complete and thorough screening, verification and continuous monitoring as the core of the credentialing process as well as performed across the workforce and external individuals and entities that serve the organization. Now, more than ever, administration and leadership are due for standing true to the same level of transparency as providers.

All Information is Power—It’s Not Only the Adverse Information That’s Important

While it is essential to uncover adverse information about a potential or existing member of your workforce or partner, there is also a tremendous benefit to obtaining and maintaining non-adverse data. Knowing the full scope of education, experience, certifications and specialties throughout an enterprise can inform decisions on resource allocation. Information is power—a 360-degree view can help a health care organization better understand and manage talent across the workforce. Something as simple as knowing your range of foreign language fluency can add tremendous value for an organization.

Part 1 of “Achieving Transparency Through Closing 5 Critical Gaps in Credentialing”, is brought to you by Verisys Corporation, creator of the most powerful health care data platform delivered by cutting-edge technology providing full transparency that protects your reputation and your patients.

The e-book, “Closing the 5 Critical Gaps: A Guide to Understanding the Issues and Using Data Technology to Improve Provider Transparency to Protect Patients and Reduce Risk” is available to download here.

As an NCQA Certified and URAC Accredited Credentials Verification Organization, Verisys manages all data reports as a Consumer Reporting Agency abiding by federal law set forth in the Fair Credit Reporting Act. Verisys stores and exchanges data from a Tier 3+ secure environment, assures 99.9+% identity resolution accuracy 99.9+% of the time and assures its promises with full indemnification.

Verisys earned and sustains compliance with two international quality standards, ISO 9001:2015, certified for quality of credentialing software and background screening; and, ISO 27001, certified for highest standards of information security and data protection.

The sum of these certifications and accreditations ensures that promises made are promises kept to the world’s highest standards.

Verisys is the leading choice to help you assure patient safety and positively contribute the future of U.S. health care through the mitigation of fraud, waste and abuse by providing full transparency on those in the health care system.

Call for a conversation about full implementation, or a staged roll-out of screening, verifying and monitoring your health care workforce. 888-837-4797.