5 Best Practices for Effective Healthcare License Verification and Monitoring
An effective license verification and management process can not only ensure patient safety for healthcare organizations, but it can also ensure compliance with accreditation standards and minimize the risk of overpayments. The following are five best practices for effective healthcare license verification and monitoring.
Following the Rules of License Maintenance
An exhaustive license management process is a crucial part of hospital audits performed by The Joint Commission, DNV, and Health and Human Services. The laws and standards of these hospital overseers require proof and documentation of the timely renewal of required licenses and/or certifications for healthcare workers. The TJC standard, HR.01.02.05, also calls for organizations to have processes in place "to ensure that a person's qualifications are consistent with his or her job responsibilities." The intent of the standard is to lower the risk of fraudulent credentials while ensuring that an individual has the correct qualifications for the duties they perform.
Beyond the Basics
Professional healthcare license monitoring software such as LicenseManager Pro supports hospitals with the task of ensuring license renewals are documented appropriately, while additionally checking them monthly for new or changed board actions. PreCheck's LicenseManager Pro solution can help a healthcare facility transform their license management process instantly and create a quick success for Human Resources. Within a hospital setting, the use of LicenseManager Pro can boost the performance measurement of not only Human Resources but Ethical Conduct/Regulatory Compliance as well. In the healthcare compliance arena, there are existing requirements for hospitals to regularly check the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) for excluded individuals that may be working at a facility. What may be overlooked is that fact that many of the actions that led to the exclusion began at the level of the state licensing board. Because solutions like LicenseManager Pro monitor state licensing boards on a monthly basis, the system can identify an employee who could eventually be excluded because of an event that began with a board action.
The Problem of Overpayments
Recent news regarding Medicare overpayments has bombarded the healthcare industry. The issue of overpayments, as it pertains to practitioners working with expired licenses, has heightened the need for improved processes. If a practitioner with an expired license peforms a procedure for which Medicare/Medicaid is billed, an overpayment event has occurred. The Patient Protection and Affordable Care Act (PPACA) requires that healthcare providers return overpayment within 60 days before a Civil Monetary Penalty (CMP) could be involved.
The Centralized Process
A centralized process brings oversight, control, and accountability. While processes vary from one hospital to the next, methods currently used involve spreadsheets, folders, payroll systems, HRIS systems, etc. If the hospital is Joint Commission accredited, Human Resources will ultimately get the hit for any lapse in the process. Healthcare license monitoring software such as LicenseManager Pro allows for managers to access the system while still giving Human Resources, or any other applicable users, the ability to oversee an entire hospital system. Many of PreCheck's healthcare clients have included LicenseManager Pro in their policies pertaining to the practitioner's responsibility for maintaining current licensure.
Third Party Participation
Many healthcare organizations use third party credentialing experts to assist with the overwhelming task of managing professional licenses and certifications for their staff. There are several critical factors any healthcare organization should consider when selecting a third party organization.
- It is important to consider the current hospital policies pertaining to licenses, and how the third party participation will be intertwined with those policies.
- The flexibility of the third party to understand the current licensure compliance pain points, needs, and goals of the hospital system is also important to the success of the partnership.
- A growing number of healthcare organizations are upgrading and changing their current payroll and HRIS systems. Any third party provider of license management services needs to be able to accomodate these changes in the hospital's technology in order to ensure continuity of service.
- Technical experience and familiarity with integrations will be an important factor for hospitals using payroll, time and attendance, or other systems to store license information.
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