The High Cost of a Low-Quality License Verification Process

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Verifying healthcare licenses can be extremely complex and time-consuming, especially if it’s done through manual processes. Is your organization’s license monitoring process a manual one or does it involve multiple systems that don’t talk to each other? Read on to learn more about what a low-quality license verification process could be costing your organization.

License Verification is Extremely Complex

For healthcare organizations, verifying and managing provider licenses is critical to maintaining compliance and to ensuring up-to-date credentialing and accreditation, accurate billing, and patient safety. However, license verification is often time-consuming due to the ambiguous license and credentialing landscape:

  • Healthcare license verification typically occurs upon hire and at the time of recredentialing or renewal, but this baseline two-touch approach can leave critical gaps in your assurance of properly credentialed providers.
    • State healthcare licensure boards are unique and have their own terms and points of reference for various credentials and license status types. They each make changes at varying points throughout the year. Even verifying licenses every quarter can still result in hundreds of patient encounters under an invalid or expired license.
  • There are more than 80 disciplines in healthcare that require a license or certification.
  • There are many license status types to be familiar with to conduct proper license verification and ongoing monitoring. Comparable statuses are often referred to differently across boards. This can be a challenge for many automated solutions.
  • The COVID-19 pandemic made license verification schedules even more challenging when many boards decided to pause or shift batch expirations.
  • While license board data is published at varying intervals and in multiple formats, many boards are increasing their security by adding CAPTCHA and other verification techniques, which adds more time to manual processes and can significantly handicap many automated solutions.

Broken License Monitoring Processes Can Expose Your Organization to Risk

Many of our large health system clients came to us after their previous license monitoring solution could no longer keep up with their needs, creating an unsustainable administrative burden. The two scenarios that we hear most often include:

  1. We built our own solution and it can’t keep up with state board changes and our growing organization.
  2. Our vendor keeps sending us more and more unverifiable licenses.

Did you know 43% of all HHS OIG exclusions can be tied to licensure action such as a revocation, disciplinary or administrative action from a medical board? The HHS OIG has the authority to impose fines and penalties for inadequate credentials or false claims billed. In 2020 alone, the OIG assessed total penalties in the amount of $680k for licensure issues, amounting to an average of almost $85k per unlicensed individual.

Hospitals, health systems, and other providers should be confident that the frequency at which they are verifying licenses, certifications, and registrations is sufficient to ensure that no individual with a renewal lapse or an administrative action against their license is providing care.

Smarter License Verification Could Save You Time and Money

Despite the complexity of the license and credentialing landscape, in order to ensure audit and survey readiness and patient safety, it’s vital for license verification technology to: 

  • Automate primary source verification of all license, credential, and registration statuses up to daily, without requiring manual intervention from users.
  • Track and monitor for upcoming expirations and renewals for certifications and registrations that can’t be verified from the primary source.
  • Provide digital, configurable, comprehensive, and on-demand reports that are audit ready and reflect a single source of truth.

ProviderTrust’s timely and accurate healthcare license verification ensures that every employee or provider has the required credentials to serve your patients. We are passionate about making healthcare smarter and safer. That’s why we deliver best-in-class license verification and monitoring services via a  license solution that provides the most comprehensive end-to-end holistic monitoring with the lowest cost of ownership.

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