Health Care License and Certification Verification and Monitoring
Why should I verify and monitor licenses and certifications?
Recently the Florida Attorney General and the Medicaid Fraud Control unit filed charges against a Florida dentist for employing a person to perform duties outside the scope of their license. And, in January of 2013, after self-disclosing, a health care organization in New Jersey agreed to pay $100,000 for violating the Civil Monetary Penalties Law by providing services furnished by an unlicensed and unregistered physician.
Both of these situations highlight the importance of license and certification monitoring as a key factor in meeting current compliance requirements. The Office of Inspector General (OIG) can now fine a health care organization for submitting claims from an unlicensed health care provider. In order to avoid these negative penalties and fines, including license and certification verifications is now key to a successful OIG Exclusion List Monitoring program.
In order for health care organizations to better protect themselves and prevent the employment of unlicensed or sanctioned individuals, continual license and certification verification and monitoring is vital. Failing to verify or monitor licenses and certifications often leads to organizational errors, non-compliance, penalties, and staff shortages. By adopting or maintaining a license and certification verification process as well as implementing continual monitoring, health care organizations are significantly better equipped to remain compliant.
Utilizing a manual monitoring and verification process, while better than nothing, can often develop inconsistencies and quickly grow unmanageable. An inconsistent and unreliable verification and monitoring system can create legal and safety risks as well potentially lead to fines and other penalties. To avoid these negative consequences as well as save your organization the time and energy of maintaining a manual verification and monitoring process, follow these basic best practices for license and certification verification and monitoring:
- Go above and beyond: Instead of getting by with just doing the bare minimum, adopt measures that will make it easy to stay on top of verifying and monitoring licenses. Even if this takes some work on the front end, having a high quality verification and monitoring process in place minimizes risks for missing licenses and certificatations, as well as help identify sanctions and other vital information that could make an individual ineligible for employment.
- Consider using an automated system service: Manual verification and monitoring systems are often inconsistent, unreliable, and just unmanageable. Consider purchasing an automated system to manage the tasks of verifying and monitoring licenses and certifications. A professional and high quality service with an established process can help you minimize the risks that result from employee turnover and manually reviewing batch data. A trustworthy vendor with a credentialing and license monitoring system can help streamline these processes and ensure compliance.
- Develop and utilize notifications: An automated system can track the status of both medical licenses and certifications and provide alerts regarding expirations, renewals, testing, and continuing education requirements. These notifications will be helpful tools as your organization works to stay on top of various requirements and help you remain compliant.
- Ongoing monitoring: By continually monitoring individual and vendor licenses and certifications, health care organizations can maintain trust in their providers and staff caring for patients. At the very least, organizations should consider implementing a quarterly license and certification monitoring system. Ideally, organization should develop a monthly system to minimize risk in meeting compliance regulations.