UNCOVERING THE FAQs OF CVOs: Credentialing Verification Organizations Tuesday, May 21, 2019 Donna Goestenkors, CPMSM - President Stephanie Russell, BS, CPCS, CPMSM Team Med Global Healthcare Consulting

Donna Goestenkors, CPMSM PRESENTER Donna Goestenkors, CPMSM 43 Years of Service

Stephanie Russell, BS,CPCS, CPMSM PRESENTER Stephanie Russell, BS,CPCS, CPMSM 34 Years of Service

WORKING TOGETHER…

OBJECTIVES Describe the primary benefits of CVOs. Distinguish between internal (system) CVOs and external (commercial) CVOs. Track the top 10 CVO challenges and solutions.

PREPARE YOURSELF

MSP COMPETENCY FORMULA

MSP CORE COMPETENCY

MSP CORE COMPETENCY SKILLS Efficiency Core: ~Credentialing Management CAREER Power PERSONAL Effectiveness SKILLS Efficiency Core: ~Credentialing Management ~Privileging Management ~Practitioner Competence Mgmt. {privileging, FPPE, OPPE} ~Compliance Management ~Enrollment Management ~Healthcare Quality Data Management ~Practice Management ~Managed Care Management ~On/Off-Boarding Management ~Office Management ~Consulting Management ~Document Management ~Merger/Acquisition Management ~Lean Management ~Technology Management ~Relationship Management ~Development Management

WHAT DOES CVO MEAN? Credentials Verification Organization/ Office

WHAT IS A CVO? “A CVO is defined as any organization that provides information on an individual’s professional credentials.” Sometimes called CVS – Centralized Verification Services Source: https://www.jointcommission.org/assets/1/6/AHC_who_what_when_and_ where_credentialing_booklet.pdf

TYPES OF CVOs Internal External System Regional National Local Medical Society Others?

POLL QUESTION #1 Are you a CVO? Yes No

POLL QUESTION #2 Do you use a CVO? Yes No

POLL QUESTION #3 Do you wish you used a CVO? Yes No

CVO RATIONALE

ADVANTAGES Cost Reduction Increased Efficiencies Centralized Resources Standardized Process Faster Turnaround Time Culture Objectivity Focus on Privileges vs. PSV

DISADVANTAGES Loss of MSP Control Lack of Respect for Facility Culture Increased Bureaucracy - Sometimes

TOP 10 CVO CHALLENGES

STAFFING CHALLENGES C-Suite “Believes” Full Time Equivalent (FTE) Neutral Determination of Who will Do What? To Be Determined #1

#1 STAFFING SOLUTIONS Educate C-Suite Regarding Responsibilities Efficiencies Need to be Identified Not Less Staff – Better Use of Resources #1

#2 CONTROL CHALLENGES Define Responsibilities/Work Flow MSP Paradigm Shift ”Doing It All” to Shared Lack of Control - Fallacy #2

#2 CONTROL SOLUTIONS Collaborate – Especially During Set-Up MSPs Remain the Expert Validate Decisions *Resources *CMS/TJC/HFAP/DNV/NCQA, etc. #2

#3 QUALITY CHALLENGES Document ”Ownership” Process “Ownership” Auditing Process Turn Around Times (TATs) #3

#3 QUALITY SOLUTIONS Auditing Process – by BOTH Parties TATs Defined/Acceptable Process Defined that is Acceptable to BOTH Parties #3

PRIVILEGES CHALLENGES Ensuring Delineation of Privileges (DOPs) Converted Properly Maintenance of DOPs Compliance with Privilege Criteria #4

#4 PRIVILEGES SOLUTIONS DOPs Defined/Set by MSSD not CVO MSPs Remain the Experts on the Criteria Determine Who Collects Criteria – CVO or MSSD? #4

#5 POLICIES CHALLENGES CVO Needs MSSD Needs Stakeholder Needs Regulatory/Accreditation Compliance #5

#5 POLICIES SOLUTIONS Write Policies Together – MSSD & CVO REMEMBER: The MSSD is the Customer! Collaborate/Negotiate Practices that Both Parties Can Live With #5

COMPLIANCE CHALLENGES Keeping Polices/Forms Updated Survey Process – Who Does What? Efficiency vs. Compliance – Don’t Cut Corners. #6

#6 COMPLIANCE SOLUTIONS Educate CVO/MSSD Process to Maintain Compliance Team Work!!!!! #6

EVALUATION, RECOMMENDATION & ACTION CHALLENGES TATs Medical Staff Review Process ”Complete” Application Definition – CVO? MSSD? #7

EVALUATION, RECOMMENDATION & ACTION SOLUTIONS Set Realistic Time Frames Educate C-Suite – PTB Define Parameters – CVO/MSSD #7 PTB = Powers that Be

COMMUNICATION CHALLENGES CVO ”Way” vs MSSD “Way” C-Suite & Medical Staff Leaders Applicants #8

COMMUNICATION SOLUTIONS TALK – Don’t Email  – Verify in Writing Educate – Educate – Educate Define Instructions – Process Not Always “Intuitive” #8

STANDARDIZING/CENTRALIZING CHALLENGES CVO vs MSSD “Way” Time Sensitive “Needs” Maintenance – Everything! #9

STANDARDIZING/CENTRALIZING SOLUTIONS Understand Each Other’s “Worlds” Take Time to Make Time – Especially During Setup Keep Current! #9

AUTOMATION CHALLENGES Testing Rollout/Implementation #10

AUTOMATION SOLUTIONS How to Review Documents – No Assumptions! Test at All Levels: CVO, MSSD, Medical Staff, Office Beta Sites Allow Extra Time During Rollout to Address “Issues” #10

TIPS FOR A SUCCESSFUL CVO Communication Audits Evaluation Quality

TIPS FOR A SUCCESSFUL CVO - COMMUNICATION Customers Client C-Suite Practitioners Other

TIPS FOR A SUCCESSFUL CVO - COMMUNICATION Set Expectations Theirs Yours C-Suite

TIPS FOR A SUCCESSFUL CVO - COMMUNICATION Policies/Processes In Writing Available for Reference Keep Current Other

TIPS FOR A SUCCESSFUL CVO - COMMUNICATION Continuous Communications Completed Files Issues Meetings

TIPS FOR A SUCCESSFUL CVO - AUDITS At the CVO With the Client Practitioner

TIPS FOR A SUCCESSFUL CVO - EVALUATIONS Process Team Practitioner Level C-Suite Surveys Other

TIPS FOR A SUCCESSFUL CVO - QUALITY Audits Will Reflect Your Performance Surveys Will Provide Feedback From Client/Providers Continuous Review of Processes Take Time to Make Time Software System Keep it Current An IT Department that KNOWS Credentialing Interfaces that Make Sense

SUMMARY FOR SUCCESS Communications Audits Evaluations Assessments Quality

SUMMARY FOR SUCCESS This Photo by Unknown Author is licensed under CC BY-NC-ND

POWER THOUGHT

“Your Roadmap for Managed Care” Next MARK YOUR CALENDAR! “Your Roadmap for Managed Care” Tuesday, June 18, 2019 Noon – 1:00 p.m. CST Next MARK YOU CALENDAR!

Donna Goestenkors, CPMSM SPEAKER CONTACT INFORMATION Donna Goestenkors, CPMSM Team Med Global Consulting, LLC Email: Donna@TeamMedGlobal.com Phone: (618) 830-0057 Website: TeamMedGlobal.com facebook.com/TeamMedGlobal linkedin.com/DonnaGoestenkors twitter.com/TeamMedGlobal

SPEAKER CONTACT INFORMATION Stephanie Russell, BS, CPMSM, CPCS Team Med Global Consulting, LLC Email: stephanie.russell1@uchealth.org Phone: (719) 365-8670 Website: TeamMedGlobal.com Regional Director Medical Staff Services and Credentialing UCHealth Colorado Springs Southern Region

THE MSP YOU ARE MEANT TO BE! 5/28/2019

SERVICE LINE 5/28/2019

COMMUNITY 5/28/2019

COMMUNITY 5/28/2019

SERVICE LINE 5/28/2019

RESOURCES Team Med Global Healthcare Consulting Lisa Deterding 5/28/2019 Team Med Global Healthcare Consulting CVO Team Industry Interviews Research Lisa Deterding PowerPoint Design Consultant

CAREER DEVELOPMENT RESOURCE Features include: Frequently asked questions by MSPs Sample job descriptions, systematic Assessment tools, planning techniques & strategies for effective performance Real-life stories to illustrate specific points Order your copy: donna@teammedglobal.com

CREDENTIALING TOOL Order: www.teammedglobal.com

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