CVO Credentialing: Lowering Cost and Reducing Burden
Improve patient care and your bottom line
As a payer, it’s necessary to have up-to-date credentialing data to ensure providers have the proper license to perform specialized services. After all, the last thing you want is providers who lack the training, educational background and experience required to do the job. However, we can’t ignore that credentialing is a time-consuming process with a heavy administrative burden. Over time, it can negatively impact a payer’s bottom line.
While it’s understood that the credentialing process is aligned with providing a better quality of patient care and preserving the integrity of the provider-payer relationship, is there a way to minimize operating costs without sacrificing quality and safety? The answer is yes, and that’s where Credentialing Verification Organizations (CVOs) come in. Below, we’ll explore how CVO partnerships can help lower costs and streamline your administrative workflow.
First, what is a CVO?
NCQA-accredited Credentialing Verification Organizations, like OpenLoop, provide medical credentialing on behalf of healthcare facilities. They handle responsibilities like verifying provider licensing and enrolling them into payers’ health plans.
To achieve this certification, organizations must undergo an intensive CVO credentialing audit that ensures procedures are aligned with NCQA requirements.
The NCQA CVO certification prioritizes customer service and consumer protection. It provides a framework that follows efficient industry best practices, which is advantageous to busy payers and healthcare organizations like you in numerous ways.
The benefits of a CVO partnership
Now, let’s go ahead and explore four ways that CVOs can benefit payers while also answering the question of “How does a CVO work?”
1. Maximizes time and resources
Did you know that administrative costs are the biggest source of health system waste, costing nearly $266 billion? A large part of the problem is administrative complexity, as navigating insurance claims, clinical documentation and other tasks is time-consuming.
If your administrative staff is having trouble managing credentialing tasks along with their other obligations, this could lead to issues like incomplete paperwork which can cause credentialing backups.
If your company is in growth mode, these problems become even more pronounced. The last thing you want to deal with is drawn-out turnaround times and your staff struggling to meet the demands of your scaling provider network.
Fortunately, when you delegate to a CVO, you access their high-level experience and enjoy a more streamlined credentialing process. While credentialing is a necessary hassle, supporting and training an internal team can become costly. Aligning with a CVO could significantly reduce an organization's burdens, especially on the administrative front.
If your staff isn’t bogged down by credentialing to-dos, they can focus on delivery quality care to your patients.
2. Access to credentialing experts
Let’s face it: if your staff lacks credentialing experience, it will slow down your turnaround and create administrative bottlenecks. As you might expect, this can eat up costs.
Plus, mistakes are likely to be made, and healthcare credentialing errors can be very damaging. For instance, what if they overlook an incomplete form and an unqualified provider slips through the cracks? This not only puts patients at risk but also interferes with your credibility.
A CVO is trained to handle credentialing complexities and can spot paperwork inaccuracies.
Accessing their specialized knowledge can optimize your credentialing process and lead to cost savings.
3. Stay up-to-date on compliance and regulatory requirements
Expired provider certifications and failing to comply with new regulatory requirements put patients at harm and can lead to loss of productivity and revenue. If your staff is finding it challenging to keep up and putting your company at risk, it’s time to consider hiring a CVO.
The credentialing and verification process can be tedious, especially for staff members already bogged down by other tasks. However, a CVO can step in and help reduce risks, maintain regulatory adherence and protect your company.
We recognize that trying to make sure your credentialing process follows industry standards isn’t easy to do on your own. NCQA-accredited CVOs know what to look for, which can help you avoid contract loss, penalties, fines and reputation damage.
4. Ongoing review and maintenance
Completing the initial credentialing and licensing processes is just one part of the equation. It’s also important that you continue to monitor where providers stand. Licensing lapses are a big no-no, so being punctual about renewal reviews is imperative. Plus, how do you stay on top of their performance? Truthfully, many organizations don’t have the tools and resources to handle this correctly.
CVOs have the expertise, resources and tools needed for proper monitoring, which is essential for maintaining a network of high-quality providers. From CME monitoring to updating CAQH profiles, CVOs have the bandwidth to keep your provider network up-to-date and scale with you.
Ready to partner with an NCQA-accredited CVO?
The back and forth between payers and healthcare organizations can create bottlenecks that ultimately cause revenue-generation issues for both parties. Therefore, the best way to prioritize patient safety and avoid preventable financial woes is to partner with those skilled at handling intricate medical credentialing processes.
If you’re looking to lower costs and reduce administrative burdens for your company, partnering with OpenLoop is your solution. Our top-tier, HIPAA-compliant technology and NCQA-accredited provider network allows organizations to streamline enrollment processing so you can realize revenue faster. In other words, you can scale and improve access to care without sacrificing quality.
Want to learn more? Contact us today!
Our full suite of white-labeled virtual care services includes: