Establishing and Understanding a CVO Cheryl Cisneros, RN, BSN, CPCS, CPMSM Client Success Manager and Consultant

Objectives What it takes to develop a CVO Services provided by a CVO Define what is a Credentials Verification Organization (CVO), types of CVOs and history What it takes to develop a CVO Services provided by a CVO Benefits of CVO NCQA Certification

What is a Credentials Verification Organization (CVO)? A CVO is an organization which gathers data and verifies the credentials of health care practitioners. Typically it includes physicians, dentists, advanced practice nurses, physicians assistants, psychologists, and other practitioners who are members of a health care organization or health plan. Provides credentialing services Provides supportive services Overcomes obstacles Opportune efficiencies Improves onboarding timeframes

What is the History of CVOs? CVOs have evolved over time with a consistent focus to create streamlined workflow processes. Over 30+ years ago medical societies centralized credentialing As managed care organizations (health plans) increased, so did CVOs Today CVOs support organizations to provide services which meet increased demands. How? Developing Internal CVOs Enterprise Credentialing

Credentialing and Payor Enrollment: What is the difference? Credentialing is the process of obtaining, reviewing and verifying the documentation provided by a licensed professional for granting hospital membership and/or privileges or for payor enrollment. Payor Enrollment is the process to request participation in a Commercial health insurance network, Medicare and/or Medicaid. It also includes when you add, change, term a practitioner or group office practice location. Confirmation is completed to insure timely and optimal reimbursement of submitted claims for services provided by practitioners to enrollees and patients.

Are there different types of CVOs? Health Care Organization CVO Regulatory Body Requirements Organization Requirements Not for Profit Payer Delegation Requirements Certified / Accredited Independent CVO Customer Requirements For Profit Contracted

What does it take to start a CVO? Shared vision of the future state which includes a plan with goals, target dates and accountabilities. Endorsement and Ongoing Collaborative Support: Health System Leadership Medical Staff Office Leaders Health Plan, PHO, IPA CVO Leaders Staff

Developing a CVO What do you need to consider?

Initial Assessment – Value & Cost What is the cost to credential a practitioner? Baseline Metrics Time to Credential Volume Data Practitioner Satisfaction Develop Budget Staff – work with human resources Office Space Software Equipment

Documents - Collect, Review, Standardize Request for Application Applications (organization, state mandated, addendum) Attestation / Release of Information Privileges Bylaws, Rules and Regulations, Credentialing Plan Application & Reappointment Packets Practitioner Enrollment Packet Payer Applications Policy and Procedures, etc.

Credentialing Process Review - Tasks, Timeframe, Accountability Application Request Send Application & Privileges Application & Privilege Review Verification Approval Process Handoffs Communication Update Database(s)

What Services are Provided by a CVO?

Process Applications Initial Application Recredentialing Locum Tenens Request for Additional Privileges Privileges Case Logs NPDB CQ Enrollment Criminal Background Check

Primary Source Verifications Education and Training Medical School Residency/ Internship Graduate Education Fellowship Licensure DEA , Controlled Substance Work History Malpractice and Sanction History Board Certification

Ongoing Monitoring Professional Licensure Office of Inspector General (OIG) Medicare / Medicaid Sanction List Medicare Opt Out Social Security Master Death File

Expirables Professional License DEA Controlled Substance (as required by state) Insurance Board Certification

Quality Audit(s) Database Maintenance Initial and Locum - Verifications and Database Reappointment - Verifications and Database Database Maintenance Offices University(s) Graduate Educational Programs Hospitals Board Certification Etc.

Other Services Reports Expirables Payer rosters AdHoc – i.e. Business Development, Marketing Metrics Application Verification TAT Onboarding TAT Total Applications Completed Health Information – i.e. Flu, Immunization Compliance

Benefits - CVO NCQA Certification Recognized by Commercial Health Plans Health Plan Credentialing Delegation Agreements Reduce burden of organization’s need to submit payer credentialing applications for employed practitioners Improved onboarding timeframes Decreased onboarding timeframe impacts your Organization’s Bottom Line!

Cheryl Cisneros, RN, BSN, CPMSM, CPCS Client Success Manager and Consultant Morrisey, A HealthStream Company Cheryl.Cisneros@HealthStream.com