1. Evolution of a system wide cvo
WAMSS Meeting – walla walla, wa – april 26, 2017

2. objectives
Understand the set-up and organization of a Health System CVO
Understand how a CVO benefits your hospital/health system
Understand how bringing Provider Enrollment into your Credentialing world is a beneficial
Understand the importance of having a single source of truth database
Understand how to set-up and implement quality monitoring, matrix and reporting in your credentialing and provider enrollment processes

3. St. Luke’s health system
8 Hospitals (9th opening 10/2017)
1 Rehab Hospital
5 Surgery Centers
2 Urgent Care Centers
5 Tumor Institute sites
280+ Clinics
2 Managed/Partner Hospitals
Statewide Provider Network
5,589 Providers
St. Luke’s health system
Idaho’s Largest Locally Owned Health System

4. Why centralize & standardize?
Credentialing is expensive
Credentialing is time consuming
Lots of duplication
Long & varying turnaround times
Frustrated providers, physician services, administration

5. benefits TO FACILITIES TO PROVIDERS TO MSSPs More time to ..
Update Bylaws & documents
Develop policies
Improve meeting preparation & follow-up
Assist Medical Staff Leadership
Increased efficiency
Increased regulatory compliance
Audit Ready Files
Cost savings
Increased productivity
Elimination of duplication
Streamlined processes
Increased efficiency
Increased accuracy
Increased regulatory compliance
ONE application & forms
Standardized requirements
Shorter processing times
One source of truth – record documentation
Dedicated coordinator
Provider Enrollment & Credentialing done simultaneously

6. Cvo creation CVO was created in 2010 Expanded Services Rapidly grew
2,472 providers
5 staff members
4 Hospitals
Credentialing Only
Expanded Services
Provider Enrollment (2011)
Database Management and Single Source of Truth (2012)
Rapidly grew

7. CVO Current day & Organization
14 Employees
Numerous Facilities
3 Services Lines:
Credentialing (5,589 providers)
Database Management (14,646)
Provider Enrollment (1,376 providers)

8. credentialing Initial Appointment Reappointment
Sending the application through verification
Reappointment
Specialty cycle alignment
Expirable Management (10,372 annually)
Notices 60 days prior & Follow-up
Ongoing Monthly Monitoring
Privilege Maintenance
Delegated Credentialing Audits
Audit Help & Assistance

9. PROVIDER ENROLLMENT What is Provider Enrollment?
The overall process of gathering credentials information, completing payer applications, obtaining signatures, submitting applications to payers, verifying enrollment effective dates and maintaining the enrollments.
Why doing it well matters
Faster enrollments mean faster reimbursement
Less denials & write-offs mean more money
Benefits of including it in your credentialing process
One stop shopping
Seemless process
Less ‘hands in the pot’
Initial Enrollment
Recredentialing
Out-of State Medicaid, Railroad Medicare, Workers Comp Enrollments
Maintenance: Changes
Claim Resolution
Terms

10. Database management - SINGLE SOURCE OF TRUTH
Maintains a complete provider database
Credentialed, referring, ordering
Provides system-wide reports, directories, exports
Exports to all downstream systems including EPIC
Credentialing database support
Automated forms, letters, reports, s, faxes, processes
Standard workflows
Provides Software Training
Troubleshooting
Builds reports, letters, forms, modules
Prior to Single Source of Truth
Numerous provider databases
Data integrity was non-existent
Confusion & frustration
Benefits of being the single source of truth
Increased data integrity
One place to provide updates
One place to request data/reports
Happier customers all around

11. successes Improved Turnaround Times
Faster Enrollment with Payors – MORE $$
Less claim denials and deactivations
Audit Ready Files
Increased compliance with regulatory standards
Increased Provider & MSSP Satisfaction
Decreased costs
Zero expired documents
Online Application & Privileges
Paperless credentialing files
Aligned reappointments
Improved data integrity

13. OUR QUALITY PROGRAM Monthly Monitoring & Reporting 100% File Review
Activity Numbers
Turnaround Times
Credentialing & Provider Enrollment
Errors & Omissions
Provider Satisfaction
Initial & Recredentialing
Client Satisfaction
Billing Hold Dollars
Controllable Write-offs: Enrollment
100% File Review
Quality Reporting Tool
Database Audits
Written Standard Operating Policies
Individual Coordinator Feedback Reports
Quarterly & Yearly Quality Report
Sent out & shared throughout system

14. Sample of quality scorecards

15. System Peer Review/OPPE/FPPE Processes
What’s in our future
System Bylaws
System Privileges
System Peer Review/OPPE/FPPE Processes
One System Credentials Committee

16. Tawna Miles-Knight, CPCS. CVO Director st
Tawna Miles-Knight, CPCS CVO Director st. luke’s health system – Boise, ID
(208)