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Wednesday, November 30, 2022

The GHX 5 Part Framework: Document and Policy Level Vendor Credentialing Compliance

Remaining familiar with healthcare’s ever-changing regulatory scheme is a daunting task for today’s healthcare leaders. Hospitals and health systems must comply with no fewer than 629 discrete regulatory requirements across nine domains, and data shows organizations spend nearly $39 billion a year solely on the administrative activities related to regulatory compliance in these nine domains, according to the American Hospital Association’s Regulatory Overload Report. Vendor credentialing is an important subset of broader compliance regulations for healthcare.

At the document and policy level of the GHX 5 Part Framework, health systems should require full compliance with their administrative rules, hospital policies and procedures, as well as local, state and national regulations and documentation requirements. Requirements may include the following vendor information: sanction checks, criminal background checks, federal tax identification numbers, immunization/vaccination records, educational training documents, and any additional documents required to meet health system, local, state, and national mandates.

With this in mind, compliance professionals need to stay current on the regulations applicable to their system and how they apply. By integrating new laws, regulations, or standards into its vendor credentialing compliance program, a health system can craft more detailed policies and guidance, develop targeted training, and promote other aspects to help institutionalize knowledge across the organization.

 

The Document and Policy-Level best practices checklist includes:

  • Review document requirements and make sure they are always applicable to your health system. Your vendor credentialing organization may be able to provide documents concerning recommendations/best practices for your specific departments.
  • Require representatives to review and electronically acknowledge policies through your vendor credentialing organization’s platform.
  • Deliver current policy information and maintain updates for any new policies with your vendor credentialing organization.
  • Provide an up-to-date list of whom should be receiving sanction notifications. Research any representatives or vendors who are flagged for sanctions and reach out to your vendor credentialing organization for best practices.
  • Work with your vendor credentialing organization to tailor your document requirements to different types of representatives (i.e., contractors, off-site vendors, etc.)

Compliance standards and procedures are established to prevent and detect deviations and to help ensure your organization remains compliant. In other words, the policies must be an integral part of the vendor credentialing compliance program. Leading by example and keeping up with change is imperative for a robust and up-to-date vendor credentialing compliance program.

1GHX Commissioned Provider Medical Credentialing Survey by Orbees July 2020

See how our team can assist you in optimizing vendor credentialing compliance. Schedule a review with us today.

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John Rodgers

Vendormate Compliance Associate
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