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A Beginner’s Guide to CVO Credentialing

January 29, 2020

Proper credentialing is at the core of the health care industry and other highly skilled service industries. Without proper, continuous, and verifiable credentialing, patients can be put at risk, as well as the health care organizations that hire and manage these providers. Those risks can extend to fines, civil monetary penalties, litigation, malpractice, and other expensive consequences.

In 2019, the Government Accounting Office (GAO) reported that the Department of Veterans Affairs (VA) wasn’t doing enough to properly verify the credentials of their staff. The report from the GAO stated, in part, that the VA hired or employed staff that were ineligible, “because hiring staff overlooked or missed disqualifying information in a national database.” Whether it’s the government or a private health care organization, insufficient credentialing can lead to dangerous outcomes for patients.

Patient safety is improved when organizations use accurate and up-to-date data to credential their providers. Patients expect when they have a serious operation or share sensitive data about their health that their provider is fully vetted and credentialed and has the qualifications to diagnose and treat them.

And, just like patient safety depends on the right training and certification, many organizations rely on Credentials Verification Organizations (CVOs) to vet and verify credentials. This is a time-consuming process that involves primary source data verification, accurate identity matching, and ongoing monitoring of providers. Even more, it sets the framework for ongoing evaluation and monitoring of health care organizations to ensure that patients are receiving quality care and practitioners are continuing to meet important compliance requirements.

Just as it’s important for the VA to credential their health professionals, health care organizations are equally required to know all they can about their providers to ensure high-quality patient outcomes.

What is a Credential Verification Organization? What Do They Do for Health Care Organizations?

According to the NCQA, a non-profit CVO accreditation organization, a CVO is “an organization that conducts primary source verification of practitioner credentials for other organizations.”

CVOs work on behalf of their clients — healthcare systems, hospitals, clinics, etc. — to gather all relevant information on providers. CVOs are on the front lines of protecting patients from potentially fraudulent or dangerous practitioners, ensuring compliance for the systems they serve and preserving the integrity of well-qualified providers. CVOs can be an external entity, an internal department, or a hybrid of the two.

A CVO relies on primary source verification, not a practitioner’s provided documentation. They not only search for work history, licenses, and certifications but they search thousands of databases such as sex offender registries and abuse registries.

CVOs also handle the ongoing work of monitoring sanctions, exclusions, debarments, and checking for any new matches or adverse actions that arise. Ongoing monitoring is critical to patient safety, so important, in fact, that the Joint Commission released guidelines for ongoing monitoring (OPPE) that include chart review, external peer review, and discussions with patients. These types of maintenance monitoring programs aim to stop any potential problems or risks in their tracks.

How are CVOs Certified and What are the Benefits of CVO Certification?

While certification isn’t required for CVOs, it comes with some significant benefits. For one, organizations have industry recognition and the approval that comes with going through the certification process. It also shows a commitment to patient safety, thorough data collection and analysis, and continuous monitoring.

The certification process involves documenting organizational structures, procedures, and processes throughout the business and evaluating them against industry standards. Evaluation methods can include yearly audits, surveys and questionnaires about the CVOs structures and existing processes, a review of error rates, and references from clients.

These evaluations happen on- and off-site and are extremely rigorous. They help organizations identify gaps and areas for improvement in their organization to streamline and protect the verification process.

Verisys is a Certified Credential Verification Organization

Verisys is certified by NCQA and accredited by URAC, two of the leading accreditation organizations in the nation. Verisys uses a SaaS-based solution to determine if a provider’s relevant credentials are current, active and unimpaired, and to verify the veracity of the information provided by an applicant. And, like most CVOs, at Verisys, we do not rely on self-reported data. We require that all provider credentialing goes through a rigorous primary source verification and identity matching process.

Verisys offers a 360-degree approach to credentialing, allowing clients to efficiently manage their workforce from recruitment to hiring and credentialing, and beyond. We also deal directly with providers to handle provider disputes and adverse event reporting if necessary.

A CVO saves an organization significant time and mitigates risks of costly potential liability by streamlining the credentialing process. It allows organizations to have confidence in their physicians, knowing their providers are fully vetted, it increases patient safety and allows for full compliance to industry regulations thus reducing their own liability and risk.

The peace of mind and increase in patient safety that comes from utilizing a CVO does not have a price tag. Ensuring proper credentials protects clients, patients, vulnerable populations, as well as the licensed professional; further, it protects health care organizations on the ground level, starting at personnel. Hiring a CVO like Verisys is an important step you can take to improve the overall quality of care that patients receive.

Juliette Willard Written by Juliette Willard
Healthcare Communications Specialist
Being creative is my passion! Writer. Painter. Problem Solver. Optimist.
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