This blog post is based on a webinar - How to Prepare for the NCQA CVO Certification Process Including Virtual Surveys
For NCQA certification, CVOs can represent individual health systems or be commercial operations with a variety of clients. Why is a NCQA Certified CVO important? According to Renee Aird Dengler, RN, MS, CPMSM, CPCS, FMSP, Senior Consultant, VerityStream, who is also an NCQA Surveyor, “Any client of a CVO that's been certified by NCQA is not required to do pre-delegation evaluations. They're also not required to do an annual audit of credentialing files.” Certification eliminates the burden of annual evaluations and audits. Dengler adds, “If anybody's been through all the health plans’ yearly file review audits, they take significant time and it can be stressful—by using a certified CVO, the health plan isn't required to do those surveys or audits.”
CVO Certification veteran Dengler recommends beginning the process a year in, giving you adequate time to ensure eligibility and review evaluation standards. NCQA CVO Verification extends to 15 required and optional standards. Each standard has up to five elements, and each element can have as many as seven factors. Dengler offered, “About nine to 11 months before your desired survey date, you should purchase the standards and the interactive survey tool that you will use to submit your information to NCQA. The next important step, that you will want to start early, is to do a gap analysis.” Standards need to be in place at least six months for certification, supported by existing policies, procedures, and documentation.
Applicants submit their standards, a surveyor reviews them, and a conference call occurs to discuss initial findings. The client has five days to provide anything missing. Before the COVID-19 pandemic an onsite survey of 75 files followed. Now virtual surveys will occur, at least through December 2020. The file review must occur online, in whatever way client systems allow, followed by a building security assessment. To accommodate COVID-19, NCQA will rely on previous survey scores for recertifications and require new initial certifications to include a video of all security measures involved in building access and file storage. Once submitted, all information, including any client commentary, is sent by the surveyor to NCQA, where the review oversight committee (ROC) determines the result of the process and notifies the client.
Memorial Healthcare (MHS) of Fort Lauderdale is in the midst of its initial NCQA CVO Certification effort. According to Jennifer Kadis, RN, MSN, Administrative Director, Quality, Utilization and Medical Affairs, Credentialing, Memorial Healthcare, multiple health plans delegate credentials to Memorial, requiring long, intrusive site verification visits. These organizations are looking strictly at NCQA guidelines, making NCQA CVO Certification an obvious choice. They consulted with VerityStream about the appropriate CVO certification version for MHS. A gap analysis focused on infrastructure, documents, processes, governance, and maintenance tasks has guided Memorial Healthcare’s ongoing effort to develop policies and processes, readying them to complete their application in the near future.
VerityStream CVO clients range from stand-alone hospitals, integrated health systems, and health plans to surgery centers, federally qualified health centers (FQHCs) and medical groups. After we learned much during NCQA Certification Surveys in 2016 and 2018, the NCQA’s ROC passed our CVO in 2020 with 100% compliance in all 11 elements, including written policies and procedures, our internal quality improvement, and all NCQA verification elements. Interestingly, we converted our files designated for COVID-19 virtual survey to PDFs. Our download process saved significant time; we finished about three hours ahead of schedule. For this particular survey, we kept it simple and factual and separated the NCQA credentialing policies from our other operational credentialing policies and procedures—doing so made it easier to ensure that each NCQA standard was clearly written and re-numbered to match NCQA. We continue to streamline policies and procedures to make NCQA recertification even more efficient next time around.
Our experiences with certifying and recertifying VerityStream CVO, as well as with assisting myriad clients’ successful certification efforts, have given us great insight into the NCQA CVO Certification process. Here are six important guidelines for achieving success with the process:
These key takeaways will help ensure your organization is prepared for continued employment of virtual surveys as long as the COVID-19 Pandemic makes them necessary. They also will facilitate your understanding of and success with NCQA CVO certification when and if onsite surveys by NCQA again become the rule.