Medical facilities, hospitals, health plans, and medical practices are crucial in protecting patients by ensuring that the medical providers they work with are professionally trained, educated, and have no prior history of doing damage. Primary Source Verification, or PSV, comes into play here: it verifies whether or not someone has the proper (and valid) license, registration, or certificate, as well as education, training, and work history of providing care to patients.
The list of credentials must be confirmed, each action step requiring a keen eye for detail. The welfare of patients should be of the utmost concern. One skipped step could find the provider, practice, or hospital facing hefty lawsuits.
Primary Source Verification Can Help Reduce Malpractice Risk.
While accidents do happen, employing properly verified providers can reduce the chances of patient harm. It can also help when lawsuits are brought to court. An accused medical organization that properly conducts primary source verification on their staff can use this detail for their defense.
According to Becker’s ASC Review, 51% of physicians were sued for medical malpractice in 2021. Another study found that 75% of doctors in low-risk specialties will face malpractice litigation by age 65. The same study stated that 99% of high-risk physicians would also be sued. With the average malpractice claim being approximately $300,000, medical organizations cannot afford to miss the opportunity to prevent negligence.
How long does primary source verification take?
Traditional credentialing consists of 52 conventional credentialing steps that should be completed before a provider can work. The standard process can last between 90 to 120 days. For a medical practice facing low revenue, this time frame can cost them more. However, this is the price some practices pay to maintain safety standards.
Initial PSV Action Items Include:
- Verify Board Certification. This proves the provider can demonstrate their knowledge and skills in their specialty.
- Review and Confirm AMA and AOA Profile. AMA stands for American Medical Association. AOA stands for American Osteopathic Association. These profiles list the provider’s information, including education, training, and board certifications.
- Verify medical School Internship, Residency, Fellowship, and Affiliations. These references prove the provider has a complete history of experience.
- Confirm State Medical Licensure. This ensures the provider can perform medicine in a particular state.
- Obtain Professional Peer References. These attest to the provider’s current clinical competency. This step may take the longest to perform, depending on the availability of each reference.
- Gather current Medical Malpractice claims history. If it is shown that the provider didn’t submit an honest account, then the process will either end here or be delayed.
- Research Primary and Out of State License for Disciplinary Actions. This step reviews if a Provider has performed any wrongdoing out of state, whether they disclosed it or not.
- Verify DEA certification.
- Verify CDS certification (as applicable). The provider cannot prescribe controlled substances if either DEA or CDS certifications are not found.
- Obtain a copy of the provider’s current Certificate of Insurance. Adequate insurance protects a practice and the provider from financial risks associated with patient bodily injury and medical expenses.
- Verify any Medicare and Medicaid sanctions (OIG) and exclusions (SAM). If sanctions exist, then the provider will be able to participate in federal healthcare programs. Sanctions usually result if a Provider performs Medicare or Medicaid fraud.
- Perform an extensive 10 Year criminal background check. This check includes local and national databases and sex offender registry searches. Fingerprinting searches are also common.
- Run an NPDB query. NPDB stands for National Practitioner Data Bank. It contains information on medical malpractice payments related to healthcare Providers. It helps prevent providers from moving from state to state without disclosing their previous damaging history.
Do potential errors slow down PSV?
In nearly every facet of life, mistakes delay events. It takes time to fix them. Any credentialing errors could make the credentialing process last longer than 120 days. Medical practices already facing a prolonged period before a provider can start working for them could wait even longer to earn revenue.
Seasoned credentialing experts should be able to accurately perform primary source verification with minimal effort and maximum precision. However, some practices do not hire specialists. Instead, they give the vital job of credentialing to office staff with little experience. Experts cost money to employ.
What does PSV typically cost, and how long does it take?
Primary Source Verifications Background Cost Information
- Industry Cost: Per NAMSS Medical Service Staffing Study Sept 2009 and salary data from salary.com, the average market cost is $649 per provider.
- Cost to a hospital: Per Merrit Hawkins Physician Inpatient/Outpatient Revenue Survey 2009, the average annual revenue generated by all physicians is $2,378,727. This equates to an average revenue loss of $9,149 daily per provider for every day not enrolled in health plans.
- Time to complete: Per NAMSS, the average time to complete credentialing is 90-120 days, and per NAMSS, it takes 5-7 days longer to complete credentialing using internal resources compared to using a CVO.
Alternate Solutions Cost Less For PSV
- 5ACVO Cost: is much lower than the market; answers are needed to determine additional pricing discount on pricing of $285 per new file or $200 per reappointment file
- Time to complete: average file completion time a/o 3/9/23 is 19 days to have a completed file in hand to give to the committee for final review and approval
- NEW hospital revenue opportunity: this equates to a unique billing/revenue opportunity of $45,745 per provider or (5 days * $9,149 in avg daily revenue loss)
Delegated Payer Enrollment Notes: The above data does not include Medicare/Medicaid or Facility Applications. This data uses Regional pay scales that may skew numbers. The regional number of payers may skew numbers (Oklahoma average closer to 30 payers rather than the 20 used in the survey) and is based on 260 working days a year. NAMSS Medical Service Staffing Study and compensation data from salary.com; visit com/smarter-credentialing-less-risk-more-reward/ for details
In an economy where the only certainty is its volatility, some organizations might balk at the cost of credentialing. They cannot reach their profit margins if they hire exceptional office staff, especially if they struggle to pay existing employees. Too much overhead can sink a troubled business.
Why do primary sources need to be verified?
Medical organizations might consider sidestepping this process or taking shortcuts to get their providers working faster. After all, billing cannot begin unless providers are credentialed and enrolled on a health plan. If an unverified provider is pushed through the system, it’s possible that this would allow an untrained, uncertified professional to provide medical attention to a patient. This is dangerous and could result in harm to a patient and a medical malpractice claim payout.
Here are a few examples of medical malpractice payouts due to misdiagnoses:
- A surgeon’s failure to diagnose their patient’s breast cancer resulted in the patient suffering advanced-stage cancer. The patient received a $1.25 million settlement.
- A group of doctors misdiagnosed a man’s heart attack. The man’s widow received $75,000 in damages.
- A team of surgeons failed to properly prepare and perform a surgery that ended with the patient’s paralysis and vision loss in one eye. The patient received nearly $3 million.
Could proper credentialing have prevented these incidents? No one can say. However, primary source verification may have helped pinpoint missing training. It would require a doctor to obtain specific training or education that may have helped prevent the above cases. As a last resort, psv can help avoid these negligent providers from gaining medical employment.
Studying the events of Dr. Christopher Duntsch, aka ‘Dr. Death’, is a good example where perhaps better sourcing and verification of his background could have even saved lives. Medical organizations do not have to forgo primary source verification for profits or rely on overwhelmed and untrained staff. They can seek a cost-effective answer to all of their credentialing difficulties.
Outsource Your Primary Source Verification To A CVO Like 5ACVO
One solution to help practices properly eliminate credentialing challenges is partnering with a credentialing verification organization like 5ACVO. Outsourcing primary source verification can be the lifeline that protects lives, reputations, and finances.
What is 5ACVO?
5ACVO is a Fifth Avenue Healthcare Services member that began serving providers around 2003. The company streamlines the credentialing process for medical providers, faculty, staff, and other medical entities. Serving 1000s of healthcare professionals across the United States, 5ACVO has earned its reputation as a leading medical credentialing team.
Supported by 385+ years of industry knowledge, 5ACVO conducts smarter and simpler credentialing, which generates speed and accuracy. Adept providers can get to work quicker and bill sooner.
Can 5ACVO Cut Costs?
63% of the 5ACVO team have 10+ years of industry experience, and their expertise can reduce the credentialing workload by 88% and cut costs by 69%. 5ACVO lowers the traditional 52 credentialing steps to 6.
For credentialing and primary source verification, medical office staff and providers have to:
- Initial credentialing: Provide 5ACVO with a signed release.
- Initial credentialing: Assess the final completed file.
- Initial credentialing: Present the file to the relevant board or committee for final review and approval.
- Recredentialing: Provide 5ACVO with a signed release.
- Recredentialing: Review the delivered reappointment completed file.
- Recredentialing: Present the file to the relevant board or committee for final review and approval.
Faster credentialing can create more billing opportunities, up to $47,000 per provider. Additional revenue can go towards facility upgrades, more staff, new locations, and better equipment.
However, the benefits continue beyond gaining time and money.
How Can 5ACVO Reduce Risk?
Our team has 385+ years of industry experience. They can accurately and efficiently fulfill every primary source verification duty. Questionable providers can be found. Suitable ones can start work. Practices and organizations can count on having the best providers under their banner.
5ACVO also reduces the risk of data compromises. Medical information should be protected, even all the details providers must give for credentialing. 5ACVO’s cloud-based solution can keep data secure and lessen the need for paperwork. Data can be accessed via 5ACVO’s easy-to-use Web Portal. Users can track, report, and control their information 24 hours a day, 7 days a week.
Can 5ACVO Help Reduce Our Credentialing Stress?
The medical industry might be one of the most stressful in the world. Even highly-skilled providers face physical and mental fatigue. They sometimes cannot give patients their best. Office staff can also suffer in high-stress environments. In healthcare, dealing with people requires patience and critical thinking skills. If staff must manage credentialing on top of all their other duties, their morale might affect how they interact with people. This can tarnish the reputations of practices, providers, and the industry.
5ACVO can remove some of the stress on providers and office workers. Taking over credentialing can lighten the burden weighing on practices. Morale can rise, creating a happier place for everyone involved.
5ACVO + Primoris = Your Provider Enrollment Solution
Primary source verification is the essential first step of provider enrollment. Also known as “payor enrollment,” provider enrollment is the process where providers apply for and contract with health plans, networks, Medicare, and Medicaid. Enrolled providers can bill and receive payment for services rendered.
Primoris Credentialing Network, the largest independent physician association in the Midwest, offers 54+ health plan and network options. Like 5ACVO, Primoris employs administrative simplicity, streamlining the entire process so providers do not have to wait long to start billing.
For example, traditional enrollment involves applying to individual plans with separate applications. Primoris users only need to submit one application to apply to 25+ delegated health plans. Providers no longer need to fret over the number of applications they must obtain, fill out, and send. 5ACVO and Primoris can set providers on the fast track toward prompt enrollment and billing.
5ACVO + Fifth Avenue Agency = Better Medical Malpractice Insurance Shopping
Healthcare providers should carefully choose malpractice insurance. Subpar coverage might not protect them or their practice in the event of a claim. Since insurance shopping is yet another chore for them, providers can help themselves by getting assistance. Fifth Avenue Agency leverages the credentialing data and technology of the Fifth Avenue Healthcare Services family to reduce the monetary costs and time involved with obtaining medical malpractice insurance. This unique system can contribute to a competitive market, stimulating lower rates.
Fifth Avenue Agency is an unbiased company that puts the needs of providers ahead of those of insurance carriers. To service providers better than other agencies, the company considers multiple factors before recommending a carrier, including the availability of defense counsels, coverage breakpoints, practice structure, costs, and financing.
The Answer to Primary Source Verification Difficulties
Primary source verification is a necessary function that helps protect patients from negligent physicians and organizations from liability risk. The credentialing process is lengthy but is ultimately worth the investment despite its intricacies. Due to its complex nature, primary source verification can be vulnerable to mistakes. Errors can force providers and practices to pay exorbitant damages if proven negligent, and patients can even pay for their health.
Primary source verification cannot be left to chance. 5ACVO, the foundation of Fifth Avenue Healthcare Services, can also be the foundation of your protection and long-term success. With the 5ACVO team on your side, you will have more time to ensure fewer hoops to jump through while verifying credentials. It allows you to spend more time on what matters: keeping the day-to-day operations running and providing quality healthcare for your patients.
More information about 5ACVO
5ACVO is an NCQA Credentialing Accredited specializing in credentialing and primary source verification and is part of the Fifth Avenue Healthcare Services family. 5ACVO sister companies include Fifth Avenue Agency (MPLI and medical malpractice insurance specialists) and Primoris Credentialing Network (credentialing and provider enrollment specialists with 54+ health plan and network provider enrollment options).
5ACVO originally published this article here. For more information on 5ACVO, please visit 5ACVO.com or Contact Us.
