CVO Credentialing: A Detailed Guide to Drive Your Decision-Making

Many healthcare organizations conduct credentialing in-house. However, some lack the necessary expertise, which can lead to resource wastage and delays. Credentialing staff must conduct background checks, contact licensing boards, review license applications, obtain education information, interview references, and more. All these tasks take time (ranging from weeks to months) and delay medical providers from starting work at a new facility.

As healthcare facilities’ budgets continue to shrink, there’s more pressure to expedite the revenue cycle, as traditional credentialing methods are no longer sufficient. Credentialing demands far exceed organizations’ in-house capacity, and many are outsourcing the process to credentials verification organizations (CVOs).

This blog post digs deeper into CVO credentialing to help you make an informed decision. It looks at the benefits of CVO credentialing, specifically how it can help reduce costs and streamline workflows.

What is a CVO and How Does it Work?

A Credentials Verification Organization (CVO) is an entity that credentials medical providers. It verifies providers’ credentials through primary source verification. Verified providers can enroll in payers’ health plans, and the healthcare organization can bill for services.

CVOs can verify providers’ licenses, education, medical training, work experience, malpractice insurance, and other qualifications. The organization retrieves information from authoritative sources, including state licensing boards, educational institutions, and exclusion lists.

CVOs streamline the credentialing process for healthcare facilities by thoroughly checking providers for any past or present sanctions, exclusions, debarments, or other disciplinary actions. This important screening protects both patients and healthcare organizations from unethical practitioners.

Manual credentialing is a time-consuming process that involves primary source verification, accurate identity matching, and monitoring providers for status changes. Not all healthcare facilities have the resources to maintaiprovidern this level of screening and monitoring. Improper credentialing can lead to insurance companies denying coverage to providers and disrupting their operations.

A CVO eliminates time-consuming manual processes and reduces the operational costs associated with healthcare provider credentialing.

Why is Partnering with a CVO Important? 

Partnering with a CVO ensures that provider credentials are accurate and compliant, which is crucial for maintaining regulatory standing and ensuring patient safety. These organizations possess the expertise and automated processes that can speed up the onboarding of providers. They speed up the revenue cycle, allowing providers to bill sooner. CVOs also provide scalability, so healthcare organizations can grow without straining their internal resources.

For example, without a CVO, a hospital may take 2 months to credential a new specialist due to the manual verification process. This means lost revenue and delays in patient care for critical treatments. A CVO significantly reduces that time, ensuring providers see patients and generate revenue much faster.

What are the Advantages of Outsourcing Credentialing and Enrollment to a CVO?

CVO credentialing is beneficial to all healthcare organizations, from medical groups to ambulatory surgery centers. Here are some of its top benefits:

Reduced costs

Traditional credentialing is a resource-intensive and time-consuming process due to its extensive paperwork, data collection, and verification requirements. Outsourcing credentialing to a CVO can significantly reduce these costs. 

One way your healthcare organization can save money is by forgoing the need to hire a specialist and entrusting credentialing to existing staff. Outsourcing can also reduce supply costs because there’s no need to purchase printing paper or pay for off-site storage. A CVO also minimizes costs by decreasing errors. Credentialing mistakes can be costly for medical practices. 

For example, if an unqualified physician administers the wrong treatment, they may injure patients, resulting in lawsuits and hefty medical malpractice payouts. The average medical malpractice settlement in the U.S. is $348,065, and outsourcing credentialing to experts helps prevent malpractice by ensuring that only qualified and competent physicians provide patient care.

Missing a vital verification step can lead to costly fines, loss of accreditation, or even exclusion from federal healthcare programs (like Medicare), which would be financially catastrophic. The facility could also face major lawsuits and reputational damage if patients experience adverse events. 

Faster turnaround times

Credentialing demands speed and accuracy. Every day a qualified healthcare provider awaits credentialing, they can’t see patients or bill for their services. This means lost revenue for the organization and delayed patient care and access.

When your organization outsources credentialing, it puts that work into the hands of experts. Processes that took your credentialing specialist weeks will take a CVO days as they have a highly automated process for managing the work. This improves the turnaround time, benefiting everyone.

Boosts productivity

Often, some credentialing tasks can fall through the cracks and have negative consequences on your organization. For example, if staff fail to verify a new doctor's malpractice history from a previous state's medical board, insurance payers can deny claims for their services, leading to a lot of lost revenue per month. By outsourcing credentialing, you ensure it is done correctly, allowing your staff to focus on higher-value tasks, such as improving patient experiences and enhancing clinical operations.

Credentials Verification Organizations ensure that providers get credentialed more quickly. They can start seeing patients and generate revenue for healthcare organizations sooner, improving overall productivity and financial performance. By outsourcing credentialing, healthcare facilities reduce the risk of human error, which often causes delays in the onboarding process. Additionally, CVOs stay up-to-date with compliance requirements and regulatory changes, enabling facilities to maintain accreditation and avoid costly compliance issues.

Harnessing expertise and enhancing patient safety

CVOs possess in-depth knowledge of ever-changing federal and state regulations and have established processes and technology to perform credentialing accurately and efficiently. They vet providers against the highest standards, so nothing slips through the cracks. They act as a critical safeguard and thoroughly verify providers’ qualifications, ensuring only qualified and competent professionals provide patient care, which significantly reduces the risk of medical errors.

Scalability 

Organizations that outsource credentialing can scale healthcare operations according to demand without hiring or laying off staff. Because CVOs manage the process, the healthcare organization can scale its provider base up or down without internal credentialing becoming a bottleneck. 

There’s no need to hire or train in-house credentialing staff to match peaks in their recruitment needs. Outsourcing credentialing also allows organizations to pursue growth opportunities like acquisitions, mergers, or new service line launches with confidence because credentialing isn't a limiting factor.

Hiring a CVO: Simplified in 5 Steps

If you’re looking to hire a Credentials Verification Organization, use this approach to identify a reputable one: 

1. Assess your needs: Define why you need a CVO. Identify the pain points in your current credentialing process and document the resources you currently dedicate to determine the specific services you need, such as primary source verification only or full-scope credentialing
2. Research potential CVOs: Look for CVOs accredited by authoritative bodies such as NCQA or URAC, as they adhere to rigorous standards and can provide your organization with "deemed status." They should possess deep expertise in state and federal regulations and have extensive experience in your specific healthcare sector
3. Develop a Request for Proposal (RFP): Outline your exact requirements in an RFP and specify the scope of services, desired turnaround times, and integration needs. Define Key Performance Indicators (KPIs) to measure success, such as the average number of days to credential. Get proposals from different CVOs
4. Shortlist CVOs: Review all proposals against your criteria, then conduct thorough interviews with shortlisted CVOs. You can request client references and receive candid feedback on the CVO's performance. Prioritize HIPAA compliance, data security protocols, and support

1. Negotiate the contract and get started: Create a contract with clear Service Level Agreements (SLAs). Understand the pricing structure and the responsibilities of both parties. Then work collaboratively during the transition process and establish a plan for continuous performance monitoring

How Atlas PRIME® Helps Healthcare Organizations

Medical credentialing is highly time-consuming and expensive if done manually. Atlas PRIME® offers healthcare organizations an automated solution that boosts efficiency and ensures compliance. It streamlines the labor-intensive processes of primary source verification and continuous monitoring, which are essential for maintaining accurate provider directories and meeting regulatory demands.

Multiple healthcare organizations outsource credentialing and exclusion monitoring and more to Atlas PRIME®. We help healthcare facilities onboard new providers faster and manage their existing physicians with greater confidence. If your organization faces surging credentialing demands, Atlas PRIME® is a perfect solution.

Reduce overhead and ensure accuracy in every credentialing process. Book a demo today.

Frequently Asked Questions

How does a CVO streamline the credentialing process?

A CVO centralizes and standardizes the verification of provider credentials. A healthcare facility doesn’t have to manually verify the qualifications of each provider, as the CVO gathers essential documentation and then verifies this information directly with the governing authority. There’s no duplication of efforts, as provider credentials can be shared with multiple organizations once verified.

Why do healthcare organizations use CVO services?

Healthcare organizations use CVO services to alleviate their administrative burden and comply with stringent regulatory and accreditation standards. Non-compliance can result in severe penalties, loss of accreditation, and substantial financial consequences. 

Can you provide an example of how a hospital benefits from a CVO?

A new specialty clinic needs to credential 20 new physicians quickly. The decision-makers decide to use a CVO instead of manual credentialing. The CVO quickly verifies provider data, identifying issues immediately for quick resolution. This enables the clinic to credential the 20 physicians in weeks, rather than months. It launches on schedule, generates revenue sooner, and starts providing timely patient access to care.

How does using a CVO impact the overall efficiency of healthcare operations?

A Credentials Verification Organization centralizes provider data and continuously monitors provider qualifications, reducing the administrative burden on staff and ensuring a quick provider onboarding process. The tool also boosts operational efficiency by enhancing compliance and mitigating risks. It helps healthcare facilities avoid errors, fines, and potential legal issues associated with non-compliant credentialing.