Contract Therapy Compliance
Credentialing Risk

OIG DaabaseHaving proper credentials in place is an essential requirement New Window to bill Federal and State Healthcare Programs. With the limited supply of therapists and the new professional faces routinely showing up to cover in any facility, how can a facility be sure that the proper credentials are always in place for the contract staff?

Skilled nursing facilities generally rely on their contract therapy vendor to ensure that credentials of the treating staff are in place and in compliance. But, more importantly, facilities rely on their vendor to identify and rectify any problems with credentials before too much time passes. Scrambling for credentials during survey is not the optimum time to uncover a problem.

This multi-faceted reliance comes with the risk that an unlicensed or otherwise ineligible person may provide services to facility patients if credentials are allowed to lapse or have not been properly reviewed. If non-licensed or otherwise ineligible service is delivered, then that service and all related services are non-billable and must be refunded. That means, for example, the RUGs rate may be adjusted for all patients who received treatments, and that can quickly add to the hundreds of thousands of dollars. Moreover, malpractice insurance and general liability insurance does not cover treatments by unlicensed or ineligible staff. One non-licensed or ineligible therapist for just a few months can cost any facility significant and painful losses in revenue and reputation.

At Marden, our credentialing systems are designed to make certain that you have qualified staff at all times. For assistance in managing credentialing risk, click here, or simply contact Marden.

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