Sneak Peek of the 2022 Annual Report  on Medical Staff Credentialing

Sneak Peek of the 2022 Annual Report on Medical Staff Credentialing

Apr 7, 2022
  • Author:
    Vicki Searcy
    Former VP, Consulting
    Vicki has managed several credentialing and privileging practices, led a national healthcare accreditation and compliance consulting practice, was a surveyor for the NCQA, and a former president of NAMSS.

At VerityStream, we are frequently asked for benchmarks related to the efficiency and effectiveness of credentialing operations. The good news is that metrics related to credentialing and CVO operations is rapidly becoming more available. However, health system CVOs are still in the process of evolving and provide a varied scope of services. Some CVOs provide application management and verifications only, others are involved in privileging and still others are a merged department that provides credentialing and enrollment services.

A few health systems began the process of establishing a CVO approximately 25-30 years ago. Prior to the mid-1990’s, most credentialing services were provided by commercial organizations (many of which were established to meet the needs of managed care organizations) or via medical societies that established a credentialing service. It was fairly rare to see centralized credentialing within a health system.

Fast forward to 2022 and you will find that it is the rare health system that does not already have a centralized credentialing service/CVO – and if a CVO is not already present, those health systems are busy getting them started. Health systems that already have CVOs are closely examining their efficiency and effectiveness – credentialing has become important in today’s healthcare world because credentialing providers is inherently connected with the organization’s ability to get paid.

What is similar across health system CVOs?

Most health system CVOs provide the following core services:

  1. 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.
  2. Population of the Provider Database. This includes manual data entry from the application or importing the data into the database (highly dependent upon the type of software used).
  3. Verification Services. This includes obtaining verification of education, training, licensure, DEA registration, professional liability insurance, peer references, etc. Some CVOs also include verification of privileging criteria. For example, a provider may request the privilege of doing robotic surgery, which requires that the provider provide evidence of having completed the manufacturer’s training. If the CVO does not provide verification of privileging criteria, it is frequently the responsibility of the organization that will be granting those privileges.
  4. File Closure and Analysis. Evaluation of completed files against agreed-upon procedures (may include identification of credentialing red flags).
  5. Management of Expirables. This includes obtaining/verification of items that are subject to expiration, such as licensure, board certification, professional liability insurance, etc.

  6. Additional services that may be provided via a health system CVO:

    1. Obtaining/verification of privileging criteria (this usually occurs when there has been standardization of privileges across the participating facilities).
    2. Management of the evaluation and decision-making process at the participating facilities (this only works for organizations that have established completely electronic credentials files).
    3. 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).
    4. Database administration for the software used to manage credentialing and payer enrollment, as applicable.
    5. Development of customized reports for all users of the database.
    6. 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.).
    7. Managing the routine responses to hospital affiliation requests for participating facilities.
    8. Payer enrollment.
    9. Managing new provider onboarding services.

    Whether your organization has a CVO or is a stand-alone facility with a credentialing department/medical staff office that supports credentialing and privileging services, the choice of the software that is used to manage provider data, and the extent to which the software is effectively can make a huge difference in how the CVO/credentialing department must be staffed.

    The 2022 Annual Report on Medical Staff Credentialing (to be distributed to healthcare organizations in May) includes staffing information that will be helpful for CVOs/credentialing departments that would like to evaluate their staffing against the organizations that responded to the survey. To register for this upcoming webinar, sign up to receive our webinar email notifications, and we will send you a link to register as soon as it is available. You’ll see some interesting data that informs us that the number of providers per staff member went up last year. We will discuss why this is occurring (one reason: we believe that technology is being used more effectively). We will also have data on what is being verified by credentialing departments and a host of other key metrics. Don’t miss this opportunity!