Vendor Credentialing in Hospitals: A Guide for Healthcare Industry Representatives (HCIRs)

• Kara L. Nadeau, Healthcare Industry Contributor

Hospital vendor credentialing requirements have grown in scope and complexity, making it more difficult for vendors and their healthcare industry representatives (HCIRs) to attain and maintain compliance with health system credentialing requirements.

Requirements can vary broadly from healthcare facility to facility, even within the same health system, and can frequently change based on shifting policies and procedures. With no standard set of credentialing requirements, it can be challenging for vendors and their representatives to navigate the complex web of various solutions providers, their user interfaces and processes.

Who should be credentialed? Essentially anyone not employed by the hospital or health system that is representing an outside organization. We refer to these individuals as “reps” or “healthcare industry representatives”. Some obvious roles that would need to be credentialed are those that promote products on behalf of pharmaceutical or medical supplies/equipment companies. More, not so obvious positions include service technicians, retail vendors, orthotics and prosthesis reps, IT consultants and remote access contractors.

The consequences of noncompliance can potentially have a negative impact on a company when denial of access to healthcare facilities or healthcare providers occurs and can result in potential loss of business opportunities and revenue.

Learn about the importance of vendor credentialing for healthcare facilities and organizations, and discover some best practices for managing credentialing requirements and maintaining compliance.

What is healthcare vendor credentialing?

Healthcare organizations conduct business with a broad range of vendors supplying products and services that are critical to effective, efficient patient safety and care delivery. Representatives for these companies often meet face-to-face with clinicians and other hospital staff members to sell their solutions and then provide training, education and support after the sale.

National, state and local compliance regulations require healthcare organizations to screen and track both vendors and their representatives (reps) with whom they do business. All vendors and reps that hospitals do business with should be credentialed, whether or not they are entering patient care facilities to assist in creating the safest environment possible for the hospital’s patients, employees, and visitors.

Key components for vendor credentialing

Vendor credentialing is a multi-pronged process used by healthcare organizations to help ensure that vendors and their representatives meet the necessary credentialing compliance requirements for credentialing. These requirements may include training and certifications for safety practices, HIPAA compliance, and immunization verification. By implementing this process, healthcare organizations can enhance the quality and standardization of vendor services while prioritizing patient safety and regulatory compliance.

The vendor credentialing process may also include written acknowledgment of policies around conflicts of interest and requests to provide identifying information like tax IDs for verification against federal and state sanctions lists. Credentialing is a continual process involving healthcare organizations and their vendors and representatives to keep requirements up to date.

Common healthcare vendor credentialing requirements

Compliance requirements for vendor management and vendor credentialing may vary between healthcare facilities, at both the vendor entity and vendor representative levels. There are also a variety of vendor credentialing organizations (VCOs) for hospitals to choose from, each with their own credentialing software and processes.

Due to the lack of standardization of vendor credentialing compliance requirements or national credentialing database, it can be challenging for a vendor and its representatives to keep track of healthcare facilities' requirements, stay updated on changes to policy and procedure changes, and learn how to use the various VCO platforms for submitting and managing necessary documentation.

A credentialing best practice that can help vendors streamline their obligations is to make credentialing part of their representatives onboarding process, performing the necessary background checks and verifications.

Vendor organizations can stress the importance of credentialing compliance internally and for customer relationships, educate them on federal, state and industry requirements, and describe the potential consequences and cost of noncompliance.

Because hospital vendor credentialing is an ongoing process, and not a one-time project, a vendor must conduct consistent monitoring of its representatives to stay up-to-date on any exclusions or sanctions. Establishing and tracking key performance indicators (KPIs) is important to meeting performance goals.

KPIs can include metrics on representatives’ badge history (e.g., when allowed or denied access to a facility), credentialing reports (e.g., missing, soon to be expired credentials), and logged customer support calls. Ongoing monitoring is a key component of vendor risk management and an important credentialing best practice.

💡 Read more: Common Credentialing Requirements

Credentialing vendors: the benefits

Credentialing compliance supports improved vendor performance. Vendor credentialing is important because it helps boost efficiency by facilitating access to customer sites, reducing the risk that a representative will miss an appointment or lose a sale by helping ensure they have met customer requirements.

With increased competition for hospitals’ limited capital , supply and service budgets, demonstrating commitment to a customer’s vendor and representative credentialing requirements can also serve as a competitive advantage. Trust is a crucial element in building strong customer relationships, and your customers trust you with their facilities, their staff and proximity to patients. By adhering to the necessary training and education, you can understand and follow safety protocols, adhere to HIPAA regulations, and maintain appropriate infection control practices. Such practices and procedures ultimately contribute to a safer environment for patients, staff, and visitors and help build a positive reputation for your company.

5 steps to overcoming credentialing challenges

While varied hospital vendor credentialing requirements and VCO platforms can present significant challenges to vendors and their representatives when trying to stay compliant, there are steps your company can take to ease the burden and bridge the gaps.

1. Develop a centralized vendor credentialing process: Assign a single point of contact for credentialing in your organization and clearly define their role and responsibilities as your credentialing administrator. Work with them to define and build a structure to centralize the credentialing process and drive credentialing best practices.

2. Establish a centralized document repository where your credentialing administrator can easily monitor, manage and track all healthcare facility required vendor credentialing documents. Choose a repository that features standardized workflows and automated alerts to when documents are set to expire. That way, your administrator can upload and proactively identify missing documentation to fill credentialing compliance gaps in support of vendor risk management strategies.

3. Take a risk-based approach to credentialing compliance requirements: Stratify hospital vendor credentialing requirements by risk and educate representatives on which requirements are appropriate for them to sign off on without company review/approval and those they should escalate to management for review prior to sign off.

4. Reinforce credentialing compliance: Take steps to enforce registration and sign-in credentialing compliance at customer facilities. Task your company’s credentialing administrator with proactively reaching out to noncompliant representatives as they see program deviation, not wait until the monthly meeting.

5. Regularly update policies and procedures: Ensure your company and credentialing administrator stay informed of changes to hospital credentialing requirements. Changes in hospital vendor credentialing management should be matched against your company’s current program and necessary adjustments made to representatives credentialing compliance criteria.

The future of vendor credentialing in healthcare

Vendors to the healthcare market are faced with competing priorities and limited budgets. To be successful today, they must focus their resources on those factors most critical to their businesses.

While the vendor credentialing process has potentially become one of these critical components of med-device and pharmaceutical sales, it is not a traditional function of a vendor’s operations and many companies lack internal expertise to manage it efficiently or effectively.

However today, credentialing program administration is a full-time job in many organizations. An average med-device company spends a cumulative 21,358 hours per year on credentialing across administrative, human resource, and sales departments, according to 2021 GHX internal data.

As a result, many organizations are turning to Credentialing Managed Service, complete with a dedicated team knowledgeable about the complexities of vendor credentialing for hospitals and healthcare facilities. This expertise can help companies expedite and streamline administrative requirements.

Conclusion

The growing scope and complexity of hospital vendor credentialing requirements can pose significant challenges for vendors and their representatives in attaining and maintaining compliance. Many vendor representatives struggle with navigating the broad range of vendor credentialing solutions and credentialing software platforms that hospitals employ today.

Centralizing vendor credentialing processes can help a company drive greater vendor credentialing compliance, streamline the process, standardize on credentialing best practices, and support effective vendor risk management.

Given the success HCIRs have had in leveraging GHX Vendormate’s Credentialing Managed Service, it is likely more will turn to outsourcing their healthcare and hospital vendor credentialing activities to this dedicated team of experts in some of the credentialing best practices. In doing so, they ease the administrative burden on their internal resources, most notably their sales teams, so they can focus on activities that help drive revenues and growth.

Kara L. Nadeau

Healthcare Industry Contributor

Kara L. Nadeau has more than 20 years of experience as a writer for the healthcare industry, working for clients in fields including medical device/supply manufacturers and distributors; software, solution and service providers; hospitals and health systems; and industry associations.