The Benefits of Outsourcing for Hospital Recognition

Hospital attestation is the most intensive eligibility process for medical providers, being repeated more frequently than other eligibility standards and involving more organizational contacts and supporting documents. The staff time and research costs of each medical provider can be high, diverting resources from other administrative functions, and requiring experienced staff and access to research resources. However, hospitals have been slower to outsource the certification process than other medical organizations, despite potential benefits: faster turnaround time, cost efficiencies, and savings in staff time and training.

Hospital eligibility covers the most detailed questions of any certification standard, from medical school to the provider's entire career. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) produces manuals that detail the attestation processes for all of the different healthcare providers within an organization. The prohibited areas must be verified in a manner that conforms to JCAHO standards. This includes direct contact with organizations associated with the provider and obtaining copies of all certificates and licenses. All of these areas need to be checked:

• DEA certificates
• All government licenses and sanctions
• Professional indemnity insurance and claims history
• Training, internships and residencies
• Board Certifications
• Medical education
• All past and current hospital privileges
• Professional background (verified via direct contact)
• Medicare sanctions or opt-outs
• peer references

Both the contact results and the supporting documentation are collected to create a final profile report for the vendor, which is submitted to the certification board for review. Any warning signs or previous issues with the provider must be specifically brought to the attention of the committee.

Most hospitals still conduct the credential verification in-house. When they have unlimited access to information resources and available money and man-hours to deploy staff, and have experienced staff, in-house authentication can be as quick and thorough as outsourcing. Most hospitals do not have these resources or need to allocate these resources elsewhere. In addition, hospitals bear responsibility for errors or omissions made during the certification process, and these errors can affect the results of future audits and result in reprimands or penalties.

Credentialing Verification Organizations (CVO) allow hospitals to outsource the certification process for all medical providers such as physicians, respiratory therapists, radiographers, nurses, and mental health specialists. CVOs provide resources and training for certification, which means staff have experience, adhere to appropriate standards, and have access to verification resources. Hospitals can make better use of their staff and finances while reducing hospital liability for errors. Additionally, in addition to eligibility, CVOs can also offer support services that can make managing audits, license renewals, and other processes more efficient.

There are minimum services that CVOs should provide to hospitals:

• Compliance with JCAHO standards.
• Minimum number of contact attempts to and organization.
• Adaptation of processes to take into account hospital inquiries and special information requirements.
• Completed profiles with no unconfirmed sections.
• Improved turnaround time, typically within 60 days.
• Fast scrap notification for problem files.
• Quick response to questions or problems.
• Web access to profile reports and verification documentation and printouts.

Quality CVOs provide hospitals with other useful, resource-intensive services:

• Monitoring between an initial certification process and the first re-certification process for any disciplinary action or sanction.
• Routine notification for re-authorization and expiration dates.
• Support for internal or external audits.
• Training and advice for internal certification.

Using a CVO for medical provider certification saves hospitals time in staff hours, money and resources, and also provides support services such as audit support and monitoring of providers for sanctions or issues even after certification is complete that a hospital may not be able to maintain inside. Hospital certification standards are the most rigorous and detailed certification standards for medical providers. CVOs can relieve hospitals of the burden of meeting these standards through dedicated resources, experience, and support services.

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