Centralized Credentialing: The Authoritative Guide to Efficient CVO Enactment and Operation

Leslie J. Cox, BS, MHA, CPMSM, CPCS

Streamline and standardize your credentialing process

As an increasing number of healthcare organizations transition from stand-alone facilities into integrated systems of continuing care, many are forming CVOs to reduce expenditures and standardize the credentialing process across member facilities.

Centralized Credentialing: The Authoritative Guide to Efficient CVO Enactment and Operation addresses the needs of the growing contingent of professionals responsible for (or about to get involved in) CVO operations. This book provides actionable guidance on building and managing a successful CVO, as well as credentialing best practices for sustaining strategies across an array of CVO management stages and roles.

Armed with this book’s practical advice and field-tested tools, readers will be able to:

• Create an actionable road map for getting new system CVOs up and running, as well as ensuring their continued success
• Streamline and standardize the credentialing process across growing provider/payer networks
• Accommodate higher application volumes while diversifying workflows to meet the needs of today’s fast-paced credentialing environment
• Ensure ongoing compliance with varied accreditation standards
• Expand a commercial or system CVO’s service scope and client base for increased revenue

About the Author

Leslie J. Cox, BS, MHA, CPMSM, CPCS, currently serves as senior director of Banner Health’s credentials verification office (CVO). Previously, she was director of medical staff services at Banner Estrella Medical Center in Phoenix. Cox has a BS in business administration, an MA in health administration, a dual certification in professional medical services management (CPMSM, CPCS), and over 30 years of field experience. She enjoys leading process improvement teams, with a focus on generating efficiency, customer service, and facilitating collaboration among various constituents. She is currently co-leading a health system CVO leadership forum in collaboration with Morrisey, A HealthStream Company. She is a member of the Credentialing Resource Center advisory board.

Published: May 2018

Page count: 88
Dimensions: 8.5x11
ISBN: 978-1-68308-727-4

Table of Contents

• Overview and Purpose of a Centralized Verification Office
  • Patient Safety
  • Risk Management
  • Organizational Efficiency
  • Regulatory Complianc

• CVO Operational Structure
  • Leadership
  • Communication
  • Staffing Plan
  • Position Descriptions/Qualifications
  • Remote Staff/Telecommuting
  • Staff Engagement (SAC, SSC, Pilots, Projects)

• Teams and Functions
  • Onboarding (Employed Practitioners)
  • Initial Applications
  • Reappointment Applications
  • Quality File Review
  • Technical Operations; Expirables

• Budget and Financial Reporting
  • Operating Expenses of a CVO
  • Operating Income, Fee Structure, Payment Options
  • Stewardship and Accountability

• Scope of Service
  • LIPs; Allied Health Practitioners
  • Hospitals; Ambulatory Surgery Centers
  • Delegated Health Plans
  • Managing Volume
  • Streamlining Efforts

• Delegation Agreements
  • Internal System Facilities
  • External Contracted Services
  • Delegated Health Plans
  • NCQA Certification for CVOs

• Customer Service
  • Internal Stakeholders
  • External Customers
  • Physician Engagement

• Key Policies and Procedures
  • General Departmental Policies
  • Data Standardization Guidelines
  • Verification Attempts Policy
  • “Red Flag” Criteria

• Application Processing
  • Confidentiality and Peer Review Statutes
  • Standardization—Consistency in Workflow Processes
  • Locum Tenens and Expedited Requests
  • Telemedicine Provider Applications
  • Start-to-Finish Processing in a Paperless Environment

• Online Forms
  • Request for Application
  • Electronic Applications
  • Peer Reference Form

• Metrics and Reporting
  • Application Processing Turnaround Time
  • Data Integrity, e.g. Data Entry Error Rates
  • Staff Productivity Report—Benchmarking

• The Challenges and Rewards of Leading a CVO