Medical staff services departments (MSSD) that partner with remote or third-party credentialing verification organizations (CVO) augment their staffs for the crucial tasks of primary source verification (PSV) or payer enrollment. As a result, synchronizing efforts is essential for success. It might entail creating zones or boundaries, adjusting policies or processes, beefing up communication channels, or adopting new tech protocols. Even internal CVOs that don’t share the same physical space as the MSSD likely can identify areas where they’ve embraced a lone wolf policy that doesn’t contribute to the cohesion of the whole.
Cultivate these five habits to strengthen the medical staff/health plan and CVO partnership when remote staff are used.
1. Move to web-based credentialing software for accessibility
While remote CVOs are widely used under normal circumstances, less common events ranging from mergers to community emergencies can also require a rapid flex-up of CVO credentialing staff or the ability to allow in-house staff to work remotely. Software-as-a-Service (SaaS) is increasingly becoming the preferred choice over traditional on-premises software installation for multiple reasons, chief among them price, accessibility, and rapid deployment of upgrades.
With SaaS, the software provider hosts the hardware and software application so there’s no hardware to install or maintain. Remote staff can simply log in and connect once they have been issued access using the proper security measures. While on-premises software is equally as scalable, SaaS has the advantage of being fully accessible with no limitations except an Internet connection and can be accessed from multiple devices.
2. Embrace shared technology
Embracing the same technology is like speaking the same language. The MSSD is ultimately responsible for the proper handling and security of all provider data. As a result, it can be difficult initially to share access by extending database permissions to an “outside” party whose staff work remotely.
But establishing or sharing a single provider database provides advantages and can be structured thoughtfully through items like:
- Shared screens for common data
- Dashboard notes and message areas that alert all users
- Unique screens for specific functions
- Controlled access rights and permissions
- VPN log-ins that protect from data breaches
As the CVO collects provider data for credentialing, the MSSD can use database functionality to check the efficiency of its processes in real time. For example, a CVO can track how long it takes providers to submit data or documentation to the organization. Armed with information, the MSSD can modify credentialing workflows and streamline onboarding and re-enrollment. Using technology to measure timelines and success rates, the CVO can home in on a particular process level and identify what’s working and what’s not.
Sharing technology does require upfront coordination including using the same terminology. For example, the CVO and MSSD must ensure they’re using the same action types to communicate in any data environment
3. Hone job descriptions
Regardless of physical location, staff on both sides of the partnership require a clear path that begins with training on the ownership of roles and responsibilities to avoid redundancies or gaps in the process. Not only does thorough training keep each staff member on task, it’s a helpful tool for identifying strengths and weaknesses that might lead to work allocation changes that make sense for the combined team.
Clear, well-communicated roles and responsibilities eliminate wasted resources that initially spurred the need for CVO support and foster desirable outcomes of:
- Speed and accuracy
- Accreditation adherence
- Scalability for growth
- Integration of multiple entities
- Access to experienced support
It’s never too late to revisit role clarity for remote staff. If clear-cut responsibilities were not documented in the initial contract establishing the relationship between the CVO and the MSSD, it’s worth conducting an audit to ensure there’s no overlap or holes. Consider creating a job description for third-party CVO staff, just as you would for in-house MSSD professionals.
Sample role allocation
The following example shows the responsibilities’ breakdown for a healthcare organization that has determined the MSSD requires more time and resources to focus on the decision-making process:
Medical Staff Service Department: In-house Staff Roles and Responsibilities
Credentials Verification Organization: Remote Staff Roles and Responsibilities
|Ultimate adherence to standards & regulations
Serve as members of leadership/management team
Perform PSV according to accreditation standards & bylaws
Provide critical data analysis on applications
Distribute data to aid in informed decision-making
Develop and track key performance metrics
Support the MSO in its responsibility to ensure patient safety
Maintain/increase revenue streams; serve as stewards of department’s finances
Provide admin support to enroll practitioners with payers
Directly connect privileges to quality and patient safety within healthcare reform initiatives
4. Set protocol for special circumstancesEnsure that credentialing and enrollment staff understand where aberrations in the process might occur. Start by identifying variances that historically have occurred along with their frequency. This might sound easy to do when the roles and responsibilities for each party break cleanly down the middle, for example when a hospital system outsources only PSV. But the reality for many MSSDs is that credentialing—and all of the steps it entails—is never simple.
Often the MSSD keeps high-priority initial applications such as temporary or expedited privileges. Plus, there will be inevitable back and forth with application questions when issues arise and must be resolved. Will all on-premises staff field any questions from the remote staff? Or perhaps designated employees will handle questions by topic.
It’s important for staff at every level to keep in mind why the partnership was established with the CVO in the first place: Namely: New visibility for the MSSD brings new responsibilities that focus on key organizational initiatives. Establishing a clear path for question resolution by remote staff keeps the team on track to achieve goals.
5. Communicate through regular reporting
Face-to-face meetings are still an option when using remote credentialing and enrollment staff thanks to the video capabilities in nearly every software application. However, inadequate staffing is a primary reason for outsourcing credentialing or allowing flexible remote staffing options in the first place. As a result, it’s optimal to keep meetings to a minimum and keep staff on task to meet strict credentialing and enrollment timeline metrics.. Communicating through regular reporting is one way to achieve productivity goals in less time.
Start by creating position-based metrics. Efficiency is realized when various moving parts of the credentialing and enrollment functions improve communication and work together—yet focus on their specific roles.
Determine what questions/answers are important to your team. This will help decide what data is important to your processes. Once you have identified these metrics, use your system to enter, manage, and report on the full range of data elements needed to keep all team members on the same page.
Using a third-party CVO or enabling internal employees to work remotely doesn't have to mean dealing with disconnects throughout the work day. Preparation and the use of available technology foster collaboration and the ability to meet team goals, no matter how widespread the members may be.
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