healthcare compliance and credentialing

The phrase time well-spent is a cliché for a reason, and nowhere is that idea more relevant than in the business of healthcare. Every single minute matters to a patient's well-being and to a hospital or healthcare organization’s ability to serve its community. But when healthcare organizations rely on outdated methods of employee scheduling and time tracking, like using paper schedules or piecemeal technology and software, it's easy to mismanage that valuable time. Undisciplined time and task oversight allows for inefficiencies to creep in, leading to problems such as: Scheduling holes and mistakes Skyrocketing premium pay, such as overtime or contract labor Reduced productivity and profitability Burned-out staff

Workforce management plays a pivotal role in any organization’s success, but in healthcare, the stakes of employee optimization couldn’t be higher. Not only does poor workforce management pose a risk to the organization and its staff, it also negatively impacts patients’ health outcomes and the overall patient experience. Staffing across healthcare systems is complex. Facilities must maintain sufficient staffing levels to manage their patients, but it’s equally important that they have the right staff for their patients’ needs, and at the right times and locations.

Some 2,400 years after the Hippocratic Oath addressed protecting the sick from harm and injustice—and decades after healthcare regulations made patient safety a central mission—we’re still asking: Why is achieving and maintaining a safe, reliable patient care environment so difficult? The pursuit of continuous improvement is why we have a highly regulated healthcare industry today, focused on safety, and with steep penalties for noncompliance. 

Vendors and vendor management play a significant role in the operation of healthcare facilities. Healthcare organizations use third-party vendors to handle a number of functions, from providing service for capital equipment to delivering devices for surgeries, helping to ensure the facility’s day-to-day operations run as planned. By partnering with third-party vendors, staff members and administrators stay focused on providing care to patients. However, before third-party businesses can provide supplies or services, their vendor representatives must go through the organization’s vendor credentialing process. One question in particular comes up often whenever vendor credentialing is discussed: Does vendor credentialing vary by state? The answer, broadly speaking, is no: States don’t have regulatory requirements for vendor credentialing. That said, even though states don’t set vendor credentialing policies, those policies can still vary depending on what state(s) the vendor is in.

Ongoing Professional Practice Evaluation and Focused Professional Practice Evaluation (OPPE and FPPE) are standard protocols in healthcare organizations today. They bring together compliance, quality, and safety initiatives in their focus on provider performance improvement. While OPPE and FPPE are The Joint Commission’s (TJC) terms, the ideas they represent are universal. All hospitals and healthcare organizations must evaluate and validate providers’ performance at regular intervals, and under certain circumstances, according to their healthcare accreditation and/or regulatory body’s standards.

No matter what type of healthcare facility you work in, hiring a credentialing verification organization (CVO) is a tried-and-true way to achieve fast, accurate medical provider credentialing and payer enrollment. Organizations of all sizes use CVO credentialing to handle rapid growth and busy times, increase customer satisfaction, and better manage resource capacity. CVOs exist to help healthcare organizations verify licensed medical practitioners’ qualifications (i.e., credential) and enroll them into payers' health plans, in order for the provider organization to be reimbursed for services. CVOs do so by accepting delegated responsibility to gather information on clinicians’ backgrounds, identify gaps or red flags in large volumes of data, and report the findings. They don’t typically make credentialing decisions on behalf of your organization, unless that role is specified in your contract.