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February 15, 2019

Continuous Monitoring Gap – Gap 4 of the 5 Critical Gaps in Health Care Compliance.

Continuous Data Monitoring is Key to Patient Safety

Better outcomes are derived from quality providers. And better outcomes affect your bottom line in many ways: patient safety and satisfaction, higher reimbursement rates, reputational supremacy, and physician attraction/retention. Maintaining a dedicated staff of quality providers and support staff and assuring you are contracting with reputable suppliers of goods and services requires continuous data monitoring of all individuals, licensed and unlicensed, as well as partners, investors, contingent workers, agents, and contractors you do business with.

Rigorous and continuous data monitoring checks against everything from license status, state hopping, criminal activity, unpaid loans, patient abuse, and fraud. When a provider joins a new practice or moves to a new state, the entire credentialing process needs to take place to ensure full compliance and to reduce risk to the new organization. Ongoing credential monitoring is then critical once a provider is enrolled in order to be properly reimbursed and to further mitigate risk to patients or to the organization. Without ongoing credential monitoring your organization is subject to fines and penalties if a provider or other support staff falls out of compliance while continuing to see patients.

Verisys provides mission-critical information around two key areas. First, determining if a provider’s relevant credentials are current, active, and unimpaired. Second, determining the veracity of the information provided by an applicant (such as education, work history, medical training). At Verisys, we do not rely on self-reported data, all credentialing requires primary source verification.

CheckMedic Makes Ongoing Credential Monitoring Easy

With Verisys’ enterprise-wide platform, CheckMedic®, each monitored individual and entity is issued a MedPass®, a secure, portable, comprehensive profile complete with pre-set notifications of license expiration, educational requirements, and alerts regarding infractions. CheckMedic is an online medical credentialing and management tool that uses trusted data to protect your patients, ensure compliance, and speed provider enrollment. A CheckMedic MedPass takes care of the ongoing credential monitoring for all of the providers on your staff.

With CheckMedic you will receive expiration notifications, as well as monitoring against exclusions, debarments, sanctions, and other adverse actions. This continuous monitoring program gives you peace of mind knowing that you will be alerted of any activity that could put your organization at risk.

Knowing with absolute assurance day after day that your entire staff and all associates and affiliates are compliant to Federal and state laws, as well as your best-practice guidelines, keeps not only your patients safe, but the entire workforce will have the assurance of working alongside a top-quality team. This greatly reduces the chances of fines or penalties to your organization due to noncompliance. 

Monitoring Patient Safety Will Improve the Quality of Health Care

Focus on the patient experience is paramount in delivering quality health care. A well-designed screening, verification, and continuous monitoring program for your entire workforce, affiliates, and vendors protect an organization by minimizing risk, improving patient safety and satisfaction, and ultimately gives you a competitive advantage.

The safety of your patients depends on making sound hiring decisions and ensuring that the licenses of your staff are current. Backed by FACIS® (Fraud Abuse Control Information System), the most comprehensive data platform in the health care industry, the accuracy of Verisys’ screening, verification, and monitoring services exceeds OIG standards. With CheckMedic as your trusted credentialing partner, you will eliminate the blind spots and guesswork, ensuring your patients come first and your organization avoids reputational risk and steep fines.

Credential Monitoring Requires the Highest Quality and Most Current Data

As with the initial screening, the continuous data monitoring process should utilize the highest quality and most current data on a continuous basis. For most hospitals, health systems, practice groups, acute care facilities, and surgical centers this is a daunting task with seemingly small payoff compared to the amount of effort required to keep the records up-to-date—until there is a fine, civil monetary penalty, or very public lawsuit regarding patient negligence or fraud.

Verisys was created 25 years ago to address this very issue. With its robust data set of more than eight million records cumulative since 1992, FACIS® grows by 75,000 records a month. Through technology, Verisys systematically gathers, verifies, and aggregates data daily from some 3,500 primary sources and 5,000 total sources and delivers results in near real-time via API or SaaS based platforms.  

Implementing CheckMedic® as the enterprise-wide SaaS platform and issuing a MedPass® to the individuals and entities you are monitoring gives secure, permissive access to any department in your organization. Data can be viewed visually on a dashboard, through data reports, or via each MedPass® as a comprehensive, individual digital profile that auto populates with the most current data. Each record is identity matched with 99.9% accuracy to the proper individual or entity.

Verisys will perform verifications and due diligence on all possible matches identified through the screening process in order to determine true and correct matches. Any discrepancies or possible matched data points identified are investigated and resolved with the primary source, eliminating any false positives. Supporting documentation and communications are documented and attached to each verification element, as required by standard-setting organizations (NCQA, The Joint Commission, URAC).

Closing Data Gaps in Your Credentialing Process

This automated approach that assures full compliance is the answer to the Continuous Data Monitoring Gap. Utilizing technology and the most comprehensive database in the industry assists your organization in closing this data gap and mitigating the risks associated with having gaps in your credentialing process. A continuous data monitoring program such as this is necessary to meet and exceed Federal and state requirements for participation in government-funded programs.

Gap 4 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 in the industry 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 backs up 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 monitoring; 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 in health care credentialing.

Contact us for a demo of FACIS®, and discuss a staged rollout of screening, verifying, and monitoring your entire workforce through CheckMedic® and the MedPass®.

Susen Sawatzki Written by Susen Sawatzki Healthcare Industry Expert Muse. Writer. Publisher. Producer. Creator of Inspiring Narratives. Connect with Susen on LinkedIn