How do you gauge where your staff should spend most of their time when credentialing providers? Could their time be better spent on tasks other than provider applications, primary source verification (PSV), and payer enrollment? This is a dilemma that credentialing leaders face as volume increases, but staff size does not.
To foster a credentialing workforce that is ready to handle expanding core functions (i.e. quality, contract, and revenue cycle management), outsourcing time-consuming tasks of PSV, enrollment, and licensure services, to name a few, has become a successful business strategy for healthcare organizations.
Here are five needs that are solved by working with a full-service Credentials Verification Organization (CVO):
1. Ensuring patient safety and quality care at every step
Healthcare is heavily regulated to protect patients. To comply with state regulations, accreditation standards, and organizational policies, provider quality and patient safety must be measured and reported.
Partnering with a top-tier CVO serves as an insurance policy that supports your organization in making informed decisions about which practitioners can see patients, protecting all parties in the process.
Quality standards exist for patient safety, but they also protect practitioners and your organization from negligent credentialing, Medicare fraud, and other detrimental outcomes.
Partnering with an experienced CVO team who is NCQA Accredited and Certified and well-versed in the standards of The Joint Commission, CMS, DNV, NCQA, URAC, and others is critical to ensuring patient safety and protecting your organization.
2. Accelerating the Onboarding Process to Boost Revenue
All payments flow from enrollment contracts. Payers commit to offering networks where members are satisfied with the choices of primary care providers, specialists, and advanced practice professionals. Hospitals often operate on razor-thin margins, and hearing “no” from a payer that declines to enroll their practitioner can result in loss of revenue.
What’s more, enrollment processing delays of weeks or months cause revenue problems. A CVO who offers Payer Enrollment Services can expedite the overall process so you can realize revenue faster.
3. Enhancing the provider & patient experience
The nationwide shortage of physicians is well documented and felt more acutely as the population ages. As a result, healthcare organizations must attract and retain top physicians amidst a highly competitive environment.
Physicians are your internal customers and their satisfaction with onboarding, credentialing, and enrollment impacts their commitment to your organization. Patients, on the other hand, are your external customers and when they cannot access the care they need because physicians are stuck in the credentialing process, patient experience plummets.
Primary source verification is frequently cited as a pain point in the credentialing process for all parties involved. But employing the help of CVO credentialing experts can streamline and significantly shorten the time it takes to verify and credential practitioners.
4. Making technology work for you
While many organizations have well-established billing and clinical privileging processes, their payer enrollment procedures are inefficient or outdated. Further, most software used for credentialing and clinical privileging is not designed to handle the enrollment of providers into private and government insurance payers.
As a result, healthcare organizations of all sizes find themselves entangled in predominantly manual enrollment processes. A full-service CVO can offer hospitals, payers, group practices, and managed care organizations technology-enabled services to help address the inefficiencies of manual process.
5. Benefitting from one or more delegated relationships
For hospitals and payers, delegation is a successful partnership tactic that benefits hospitals and payers.
Delegation is where a healthcare organization or health plan formally contracts to turn over some function(s)—typically PSV—to another qualified organization. Most delegated relationships are for NCQA-certified organizations enrolling 150+ providers, but every payer/health plan sets its own standards for what is acceptable.
Delegated credentialing can help your organization achieve faster effective dates, so providers begin billing sooner. Depending on the payer and the arrangement, following the receipt of a roster, a new hire could potentially be considered as participating in a plan as early as the effective date they were approved by the committee.
Two benefits of partnering with an experienced CVO are expert-level oversight of high volumes of data (individual practitioner data, contracts, and rosters) and the ability to accommodate organizational growth as well as peak periods of credentialing or enrollment.
