Common Metrics in Centralized Verification Offices (CVOs)

Today you will find that it is the rare health system that does not already have a centralized credentialing service or verification office (CVO) or if one is not already present, those health systems are busy getting them started.

Health systems that have CVOs are closely examining their efficiency and effectiveness – credentialing has become important in today’s healthcare world because credentialing practitioners is inherently associated with the organization’s ability to get paid. Health Systems want benchmarks related to efficiency and effectiveness of the CVO operations.

This isn’t easy because health system CVOs are still in the process of evolving and provide such a varied scope of services – I always say that “if you have seen one CVO, you have seen one CVO.”

We can start by focusing on common services.

CVO Common Services

Most health system CVOs provide the following core services:

Application Management - This includes sending out the application and privileges to applicants for initial credentialing and reappointment, getting those applications back, identification of whether they are complete or incomplete and follow-up with applicants when they are incomplete.

Population of the Provider Database - This includes entry and oversight of information whether from an online application process or manual data entry.

Verification Services - This includes obtaining verification of education, training, licensure, DEA registration, professional liability insurance, peer references, etc. Typically, the verification services provided do NOT include verification of privileging criteria. For example, a practitioner may request the privilege of doing robotic surgery, which requires that the practitioner provide evidence of having completed the manufacturer’s training. This would be out of the scope of the verification services and obtained by the organization where that privilege was requested.

File Closure and Analysis - Evaluation of completed files against agreed-upon procedures (typically including identification of credentialing red flags).

Management of Expirables - This includes obtaining/verification of items that are subject to expiration, such as licensure, board certification, professional liability insurance, etc.

Additional services that health system CVOs often provide include:

• Obtaining/verification of privileging criteria (this usually occurs when there has been standardization of privileges across the participating facilities).
• Management of the evaluation and decision-making process at the participating facilities (this only works for organizations that have established completely electronic credentials files).
• Support for development of privileges and criteria (usually occurs when it is determined that there will be an effort to standardize at least some specialty privileges).
• Database administration for the credentialing and payer enrollment solution.
• Development of customized reports for all users of the database.
• Quality and compliance management for all participating facilities (i.e., making sure that all involved parties are using the database in accordance with data dictionary requirements, timely managing the evaluation and decision-making process, etc.).
• Managing the routine responses to hospital affiliation requests for participating facilities.
• Payer enrollment activities.

CVO Metrics

VerityStream’s CredentialStream solution provides health system CVOs the ability to not only understand their own benchmarks for common services but also compare them to peers nationwide. It’s not comparing apples to apples though in all cases.

When using the same key tasks in calculating turnaround times some CVOs might have additional tasks in their processes that impact the timeline. Even so there is value in these benchmarks. Knowing the range of measurements and how your organization compares can very well identify opportunities for improvement.