CHCS Delegated Credentialing & CVO Operations 3

Question 1

Under what circumstance must a delegating organization terminate a delegation agreement with a CVO?

Accepted Answer

When the CVO fails to correct deficiencies identified in an audit within the agreed corrective action timeframe

Answer

After any single audit finding, regardless of severity

Answer

When the CVO credentials more providers than initially projected in the agreement

Answer

Only when directed to do so by a state or federal regulatory agency

Question 2

How is the required file review sample size typically determined during a CVO oversight audit?

Accepted Answer

According to the sample size defined by applicable accreditation standards or the delegation agreement

Answer

Always 1% of all credentialed providers, per federal law

Answer

A minimum of exactly 5 files per audit cycle

Answer

100% of all credentialing files must be reviewed annually

Question 3

Which of the following is typically NOT within the scope of a CVO's delegated credentialing activities?

Accepted Answer

Making final adverse credentialing decisions that affect provider panel status without delegating entity review

Answer

Performing primary source verifications

Answer

Collecting and processing provider applications

Answer

Conducting sanction and exclusion checks

Question 4

During its NCQA accreditation renewal, what must a health plan demonstrate regarding any credentialing CVOs it uses?

Accepted Answer

That proper delegation agreements are in place and required oversight audits have been conducted

Answer

That all CVOs are subsidiaries owned by the health plan

Answer

That CVO services represent the lowest cost credentialing option available

Answer

That all CVOs are physically located within the same state as the health plan

Question 5

Before engaging a new CVO for credentialing delegation, what should a hospital system evaluate?

Accepted Answer

The CVO's accreditation status, operational processes, technology, and compliance track record

Answer

The CVO's marketing budget and total client count

Answer

Whether the CVO uses the same EHR system as the hospital

Answer

The CVO's geographic proximity to the hospital's main campus

Question 6

What is the purpose of a pre-delegation audit when establishing a new CVO relationship?

Accepted Answer

To assess whether the CVO is capable of performing delegated functions before the formal delegation begins

Answer

To determine the CVO's fee structure and negotiate pricing

Answer

To review the CVO's financial statements and profitability

Answer

To count the total number of providers already credentialed by the CVO

Question 7

In which situation would a health plan most likely choose to use a CVO for credentialing rather than performing it in-house?

Accepted Answer

When the health plan wants to reduce credentialing costs, increase efficiency, or leverage specialized credentialing expertise

Answer

When the health plan has a very small provider network of fewer than 10 providers

Answer

When state law mandates the use of CVOs for all health plan credentialing activities

Answer

When the health plan is currently under an NCQA accreditation survey