Nursing Licensure Verification & Credentialing

Posted by Frank Strafford on January 24, 2017 in Credentialing, nursing licensure,

It goes without saying that nursing licensure verification is a benefit to all stakeholders in our healthcare ecosystem.  Our licensing system allows patients to be satisfied that nursing professionals have the skills and knowledge to provide care as determined by individual state boards’ of nursing and offers standards providers can rely on to fulfill their staffing needs.

Our licensing system requires nurses to be listed on a registered nurse registry and registration renewal requirements ensure nurses receive continuing education and as new information becomes available, allow all patients to enjoy the benefits of quality care best practices.

The Pitfalls of Nursing Licensure

If a nurse fails to renew their license, they are legally barred from providing care as a registered nurse.  Failure to renew is just one scenario by which a nurse can lose their license.

Other scenarios include, but are not limited to:nurse license revoke

  • Exceeding the scope-of-care parameters
  • Violating specific facility policies and procedures
  • Medication errors
  • Inaccurate charting

Providers may conclude that remaining compliant with the law in regards to their nursing staff’s licensure is a relatively simple task, one that requires no more than having an individual in personnel responsible for keeping track of the nurses’ licensure end date. That assumption is false.

Remaining compliant can be a particularly daunting task especially in practices with a large number of licensed staff members all who have different annual license expiration dates.

In some states such as, New Jersey, for example, providers and MCOs are responsible for verifying that current or prospective employees (regular or temporary), contractors or subcontractors are not excluded, unlicensed or uncertified by searching the several databases on a monthly basis.

Not All Licenses are Created Equal

Licensing requirements also vary depending on the type of nursing specialization. Certified registered nurse anesthetists (CRNAs), anesthesiologist assistants (AAs), nurse practitioners (NPs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs), all have different qualification requirements required by the Department of Health and Human Services Centers for Medicare & Medicaid Services. Compliance with these requirements helps ensure a high quality of care while non-compliance can lead to serious consequences.

Consequences

The consequences for failing to verify a nursing license can be devastating for providers.  New Jersey law states, “Knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any cost study, claim form, or any document necessary to apply for or receive any benefit or payment under this act P.L.1968, c. 41”.  In this law, the terms knowingly and willfully can be interpreted as failing to put systems in place to ensure compliance with the law.  Ignorantia juris non excusat or ignorantia legis neminem excusat (Latin for “ignorance of the law excuses not” and “ignorance of law excuses no one”, respectively) is a legal principle holding that a person who is unaware of a law may not escape liability for violating that law merely because one was unaware of its content. Following this same principle, being unaware that a caregiver does not meet licensure requirements and receiving compensation for care provided by the unlicensed caregiver would be punishable because providers are required to be aware of nurses’ licensure status at all times.

OIG Making It A Priority

Finally, the OIG has made fostering economic payment policies a priority by reducing improper payments with future planning efforts to include, “oversight of certification surveys and hospice-worker licensure requirements.”  This priority includes prosecution for services provided by unlicensed and unqualified individuals.  Recently, Dr. Labib Riachi, a New Jersey OB/GYN, was excluded from participating in Federal healthcare programs for several violations including operating with an unlicensed practitioner.  While the OIG plan specifies hospice-work licensure only, it is clear that license verification in general is becoming more of a priority.  

The Solution

To help providers remain compliant and ensure their nursing license lookup system goes beyond a registered nurse registry, Streamline Verify now offers license verification. Our application serves as Streamline Verifyyour primary source of verification, checking licenses monthly and storing a digital version of the licensing agency page for your records.  You will receive monthly license verification audits with the status of each licensed provider on your staff and have the ability to generate up-to-date reports on demand.  You will also receive semi-monthly reports for licenses due to expire within 30 days, and our system checks those licenses daily, so you know when a license has been updated as renewed within 24 hours. All of these searches are saved and serve as evidence of compliance should your company have to defend itself against unlicensed provider allegations. Contact us today to find out how we can set up your nursing licensure verification and give you the peace of mind of knowing you are 100% compliant with licensure requirements.

About Frank Strafford

About Frank Strafford

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