Compliance with Law CVO/Delegation NAMSS Standards Compliance with Law CVO/Delegation

Compliance with Law Hospitals A governance standard holds the hospital’s governing body responsible to comply with applicable law and regulation. Leaders are responsible to be aware of and comply with local, State, and Federal regulations related to credentialing and privileging of practitioners. Managed Care The administrative policies and procedures indicate that organizations providing managed care services must comply with applicable Federal, State, and local laws and regulations, including requirements for licensure. Thus, the organization’s leaders are responsible for any regulations relating to credentialing.

CVO/Delegation Hospitals Organizations that use information from a CVO should have confidence in the completeness, accuracy, and timeliness of that information and outlines nine principles to evaluate such an agency. Among the necessary aspects are disclosure of data and information available, processes utilized, limitations of information available, identification of primary source information versus information obtained from a secondary source, overview of quality control measures related to data integrity, security, transmission accuracy, etc.

Managed Care CVOs are allowed to be used and credentialing policies and procedures include the process used to delegate credentialing and recredentialing, what can be delegated, how the decision to delegate is made. The organization maintains the right to approve/terminate practitioners, and has responsibility for oversight of the delegated agency. There must be a mutually agreed upon document describing each organizations’ responsibilities, the delegated activities, the process for evaluation and outcome if obligations are not fulfilled. There must be, at least, semiannual reporting by the delegated entity to the organization. If the CVO achieves NCQA certification this oversight responsibility is waived. For Medicare deeming, the delegation agreement must include a statement requiring the delegate to adhere to Medicare regulations.