Making healthcare remarkable CVO – Functions, Audits, and More Dwaina Humphries, CPMSM, CPCS Assistant Director, Novant Health Central Verifications Office NCAMSS Quarterly Meeting - February 12, 2016

Objectives Definition of types of CVOs Review of Novant Health CVO processes Overview of Audit process Best practices for a CVO 2 02/12/2016 Novant Health:

Introduction Native of North Carolina Raised in Lenoir One of first jobs at Caldwell Memorial Wilkes Regional, Carolinas Medical Center, Novant Health Presbyterian Medical Center, Novant Health 02/12/2016 Novant Health: 3

Introductions Where are you from? MSO One person office Multiple people CVO Managed Care Locums Company Other 02/12/2016 Novant Health: 4

Types of CVOs CVO – Central Verification Office Internal/external Hospitals Ambulatory Surgery Centers Office Practices Managed Care/enrollment/delegated Locums company CCO – Central Credentialing Office Hospitals Other types? “Center for Practitioner Information” – Advocate Healthcare in Chicago 02/12/2016 Novant Health: 5

History of Novant Health CVO Developed in October 2008, with purpose of providing uniform applications and credentialing processes across all Novant facilities. Designated Senior Director of NH Credentialing and CVO to lead process. Credentialing Council developed in 2008 with leadership of CVO and Novant MSOs. Met in July of 2008 for 2 day retreat to develop policies and procedures. Continue to meet on monthly basis with at least annual retreats. Started with Initial Application processing in October Branched out to process Reappointments in August Became NCQA Certified in 2010 Took over Practitioner Support Staff (PSS) in For practitioners such as scrub nurses, dental assistants, etc needing to come into the hospital to assist their physicians. Using HR Equivalent Developed Streamlined application process in 2012 for practitioners already on staff at one Novant facility and needing privileges in an additional Novant facility. Electronic application process for Practitioner Support Staff in 2015 Work in progress to target go live for electronic reappointments in Spring 2016 Plan to have electronic app process for all applicants in /12/2016 Novant Health: 6

Novant Health CVO Process 02/12/2016 Novant Health: 7 Internal CVO doing primary source verification for 12 hospitals, 2 ASCs, 3 Joint Venture ASCs Follow TJC, NCQA, DNV, AAAHC, CMS Standards Credentialing Council – MSO/CVO membership to develop processes Teams: Initial App/Reap/PSS/Management Files assigned on rotating basis Reaps on Specialty cycle Audits done when files are released. No outside audits other than NCQA and internal Corporate Compliance. Privileging, Bylaws revisions/enforcement, Credentialing meetings among many other things handled in MSO

Novant Health CVO Process Initial Application Online initial application requests – goes to each MSO requested Approved by each MSO, reviewing criteria, noting which privilege forms are sent Once all have approved, app and forms indicated are ed to applicant Link to electronic app sent to PSS with instructions Applications submitted to CVO by fax or , attached in database. Credentialing Manager reviews for completeness to begin processing Assigns to Credentialing Coordinator to process 02/12/2016 Novant Health: 8

Documents gathered: Uniform application (includes NCDOI) Photo (included with verification forms) Current Certificate of Insurance Copy of Drivers License Federation of State Medical Boards query NPDB (enrolled in Continuous Query) Delineation of Privileges (DOP) for each requested facility Procedure log if required by DOP Hep B, PPD, Flu Vaccine Criminal Background check (includes OIG, GSA) Novant required Safety Training Novant Health CVO Process Initial Application (Continued) Verifications of : All current and prior licenses, certifications Most recent Education ECFMG if Foreign Medical grad Training 7 years of affiliations/work history 3 peer references NPI Number 02/12/2016 Novant Health: 9

Novant Health CVO Process Initial Application (Continued) If any issues of concern are found during verification process, coordinator flags record and database sends MSOs notifying them. When Coordinator thinks he/she has everything, file is given back to Credentialing Manager for review and release to MSO MSO adds any additional documentation/forms needed, assures orientation is done, and puts through their Approval processes. 02/12/2016 Novant Health: 10

Quarterly cycles – per quarter depending upon specialties Pre-populated applications printed and mailed to practitioner at primary office. Letter also sent to office manager as a “heads up.” Come back by fax or , attached in database Credentialing Manager assigns to Coordinator Novant Health CVO Process Reappointment Applications Documents gathered: Reappointment application Novant Safety training Criminal Background Check Verifications: Primary current licenses and certifications Peer reference Sponsor evaluation if Advanced Practice Clinician Once Coordinator thinks everything is there, is given to Credentialing Manager to review and release to MSO MSO adds OPPE/FPPE, other documents, confirms Reappointment education, and puts through approval process. 02/12/2016 Novant Health: 11

Novant Health CVO Process Streamlined Applications Currently on staff at one facility and now wants membership/privileges at another Novant facility Prevents them from having to complete full application, when across Novant we know them already. Shortened app is pre-populated with what we currently have on them. Documents gathered: Delineation of privileges form as approved by new facility MSO Verifications of Primary Current licenses and certifications Enrolled in NPDB continuous query for new facility Confirm training completion from previous credentialing (or AMA) Obtain competency evaluation from current Novant facility Reviewed by Manager Released to new facility MSO for normal approval process for new applicants 02/12/2016 Novant Health: 12

For physician support staff such as rounding nurses, scrub techs, etc who want to come into the hospital to assist their physician. Follows TJC HR standards; Does not go through MSO approval process Uniform Electronic application. Job descriptions are uniform. Given to manager, who grants permission to practice If any issues or concerns of competency, Senior Director and Chief Medical Officer reviews and provides approval or denial Novant Health CVO Process Practitioner Support Staff Documents gathered: Electronic application Criminal Background check Safety training and Novant orientation Verifications: Education Clinical affiliations/work history for last 7 years License and certifications as required by job description Sponsor and peer evaluations Annual Evaluations done Electronic application submitted Verifications of current license, certifications sponsor eval 02/12/2016 Novant Health: 13

Audits Done as files are released Checklist in computer system of items required Manager enters audit findings in checklist Monthly Excel Reports/Statistics based off this checklist All possible errors in a file x number of files processed to get number of elements reviewed. Number of errors / number of elements reviewed to get rate Done for all types of applications Managers use this information in process improvement with coordinators Value-added? In process of total revision for 2016 Developing manager review checklist with items tracked. 02/12/2016 Novant Health: 14

Best Practices for a CVO 02/12/2016 Novant Health: 15 Get by-in from administration and medical staff leadership Plan ahead Meet with key stakeholders Know what is required by each accrediting body The more uniform, the better Be ready to grow/change Meet regularly with your team – get their input Every so often, “reinvent the wheel” – Risk vs. Value vs. Return on Investment (ROI)

What’s ahead Uniform Bylaws – in process of being approved at facilities early 2016 Uniform privilege forms Fully electronic New facilities VIA (Value and Integration Acceleration) Credentialing Improvement project Millions of dollars in lost revenue due to delay in credentialing with payers Multiple complaints from employed providers during the on-boarding process – confusion, multiple people asking for the same information Revenue Cycle was tagged to take the lead and brought in Consulting firm to assist in getting all depts involved in the on-boarding process on the same computer system, one source of truth, working together Phase 1 (all using ECHO database system) of project scheduled to be completed in April. In an effort to improve satisfaction, Leadership has developed the One Point of Contact system, where all communication with the employed provider goes through Novant Health Medical Group Recruiting. Major changes occurring for all involved 02/12/2016 Novant Health: 16

Multiple Touchpoint Model 17 Applicant CVO MSO Corporate Insurance Provider Enrollment Choice Health H.R. 02/12/2016 Novant Health:

One Point of Contact Model 02/12/2016 Novant Health: 18 Navigator CVO MSO Enrollment Corporate Insurance Choice Health H.R. Applicant

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