CVO – Functions, Audits, and More
Dwaina Humphries, CPMSM, CPCS
Assistant Director, Novant Health Central Verifications Office
NCAMSS Quarterly Meeting - February 12, 2016
Making healthcare remarkable
Objectives
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Definition of types of CVOs
•
Review of Novant Health CVO
processes
•
Overview of Audit process
•
Best practices for a CVO
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Novant Health:
02/12/2016
Introduction
Native of North Carolina
•
Raised in Lenoir
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One of first jobs at Caldwell Memorial
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Wilkes Regional, Carolinas Medical Center,
Novant Health Presbyterian Medical Center,
Novant Health
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Novant Health:
02/12/2016
Introductions
Where are you from?
MSO
One person office
Multiple people
CVO
Managed Care
Locums Company
Other
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Novant Health:
02/12/2016
Types of CVOs
CVO – Central Verification Office
•
Internal/external
•
Hospitals
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Ambulatory Surgery Centers
•
Office Practices
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Managed Care/enrollment/delegated
•
Locums company
CCO – Central Credentialing Office
•
Hospitals
Other types? “Center for Practitioner Information” – Advocate Healthcare in Chicago
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Novant Health:
02/12/2016
History of Novant Health CVO
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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 2008.
•
Branched out to process Reappointments in August 2009.
•
Became NCQA Certified in 2010
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Took over Practitioner Support Staff (PSS) in 2011. 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
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Work in progress to target go live for electronic reappointments in Spring 2016
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Plan to have electronic app process for all applicants in 2016
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Novant Health:
02/12/2016
Novant Health CVO Process
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Internal CVO doing primary source verification for 12 hospitals, 2 ASCs, 3 Joint
Venture ASCs
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Follow TJC, NCQA, DNV, AAAHC, CMS Standards
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Credentialing Council – MSO/CVO membership to develop processes
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Teams: Initial App/Reap/PSS/Management
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Files assigned on rotating basis
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Reaps on Specialty cycle
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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
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Novant Health:
02/12/2016
Novant Health CVO Process
Initial Application
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Online initial application requests – email goes to each MSO requested
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Approved by each MSO, reviewing criteria, noting which privilege forms are sent
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Once all have approved, app and forms indicated are emailed to applicant
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Link to electronic app sent to PSS with instructions
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Applications submitted to CVO by fax or email, attached in database.
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Credentialing Manager reviews for completeness to begin processing
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Assigns to Credentialing Coordinator to process
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Novant Health:
02/12/2016
Novant Health CVO Process
Initial Application (Continued)
Documents gathered:
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Uniform application (includes NCDOI)
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Photo (included with verification forms)
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Current Certificate of Insurance
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Copy of Drivers License
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Federation of State Medical Boards query
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NPDB (enrolled in Continuous Query)
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Delineation of Privileges (DOP) for each
requested facility
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Procedure log if required by DOP
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Hep B, PPD, Flu Vaccine
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Criminal Background check (includes OIG, GSA)
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Novant required Safety Training
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Novant Health:
02/12/2016
•
Verifications of :
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All current and prior licenses, certifications
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Most recent Education
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ECFMG if Foreign Medical grad
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Training
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7 years of affiliations/work history
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3 peer references
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NPI Number
Novant Health CVO Process
Initial Application (Continued)
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If any issues of concern are found during
verification process, coordinator flags
record and database sends MSOs email
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.
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Novant Health:
02/12/2016
Novant Health CVO Process
Reappointment Applications
•
•
•
•
Quarterly cycles – 600-1100 per quarter
depending upon specialties
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• Reappointment application
• Novant Safety training
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 email, attached in
database
• Criminal Background Check
• Verifications:
• Primary current licenses and certifications
• Peer reference
• Sponsor evaluation if Advanced Practice
Clinician
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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.
Credentialing Manager assigns to
Coordinator
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Novant Health:
02/12/2016
Documents gathered:
Novant Health CVO Process
Streamlined Applications
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Currently on staff at one facility and now wants membership/privileges at another
Novant facility
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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
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Reviewed by Manager
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Released to new facility MSO for normal approval process for new applicants
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Novant Health:
02/12/2016
Novant Health CVO Process
Practitioner Support Staff
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
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If any issues or concerns of
competency, Senior Director and Chief
Medical Officer reviews and provides
approval or denial
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Novant Health:
02/12/2016
•
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
Audits
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Done as files are released
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Checklist in computer system of items required
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Manager enters audit findings in checklist
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Monthly Excel Reports/Statistics based off this checklist
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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
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Done for all types of applications
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Managers use this information in process improvement with coordinators
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Value-added? In process of total revision for 2016
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Developing manager review checklist with items tracked.
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Novant Health:
02/12/2016
Best Practices for a CVO
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Get by-in from administration and medical staff leadership
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Plan ahead
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Meet with key stakeholders
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Know what is required by each accrediting body
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The more uniform, the better
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Be ready to grow/change
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Meet regularly with your team – get their input
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Every so often, “reinvent the wheel” – Risk vs. Value vs. Return on Investment (ROI)
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Novant Health:
02/12/2016
What’s ahead
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Uniform Bylaws – in process of being approved at facilities early 2016
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Uniform privilege forms
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Fully electronic
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New facilities
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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
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Novant Health:
02/12/2016
Multiple Touchpoint Model
Corporate
Insurance
Provider
Enrollment
Choice
Health
MSO
CVO
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Novant Health:
02/12/2016
Applicant
H.R.
One Point of Contact Model
CVO
Corporate
Insurance
Choice Health
H.R.
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Novant Health:
02/12/2016
Applicant
Enrollment
Navigator
MSO
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Novant Health:
02/12/2016