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CCNV offers services specifically designed to meet the needs of community health centers and private practices on a nationwide basis.
SERVICES
CENTRAL BUSINESS OFFICE
Community health center and private practice billing and revenue cycle management services are customized to fit a practice’s needs including:
- Charge entry
- Insurance claims processing
- Payment posting
- Claims follow-up
- Statement processing
- End-of-month processing and reporting
- Collections
- billing and claims professionals with measured performance and benchmarked for excellence.
- on-site operational reviews and feedback
- support for different practice management software
COMPLIANCE
COMPLIANCE PROGRAM
Provides education and training for medical practices in order to comply with federal, state, and local laws that govern the health care delivery.
CCNV has developed a complete Compliance Program that provides a framework of compliance standards and can be tailored to meet the needs of an individual medical practice.
EVALUATION AND MANAGEMENT CODING AUDITING PROGRAM
Provides E&M coding audits for all participating provider encounters. CCNV performs medical record reviews using an audit tool, developed by CCNV, based on the 1997 Evaluation & Management Guidelines. Results are reports by practice and on an individual provider basis. The goal of these audits is to provide feedbackand training to improve coding accuracy.
HIPAA COMPLIANCE INFORMATION
Provides up-to-date information on HIPAA regulations and how they affect operations. CCNV has an in-depth introductory education session available that discusses regulations and how to ensure compliance with these regulations.
EDUCATION OPPORTUNITIES
Education sessions provided upon request:
- E&M Coding Guidelines
- ICD-9 Coding Guidelines
- Compliance Program Education
OUTSIDE RESOURCE LINKS
Centers for Medicare & Medicaid Services
CREDENTIALING
CCNV is certified by NCQA as a Credentials Verification Organization and accepts delegated credentialing arrangements from managed care organizations and third party payers.
Services offered include the following;
- Application Completion: complete applications for third party payer or hospital including automatic completion of applications for all CCNV contracted health plans.
- Application Tracking: monitors the progress of applications after they are delivered to the payer/hospital. Practices are provided with status reports bi-monthly.
- Primary Source Authorization and Release: primary source verification for all practitioners joining the network.
- Pre-employment Verification Request: Primary Source Verification for practitioners undergoing the interview process. Some practitioner information and a signed release are required in order to perform this service.
- Document Expiration Reports: bi-monthly report listing all documents that are due to expire, such as license and board certification.
- Credentials Application. Use of this application requires you have Adobe Acrobat installed. If you do not have Acrobat installed you can get a free copy from Adobe by going to:
. Once you click on the Credentials Application link an Acrobat PDF will download to your desktop. You can save and return to this application at anytime. The file name is: practitioner_app.pdf, if you misplace file on your desktop. If you have any questions about this application contact us at 804-237-7686, ask to speak with Credentialing Services.
- Practice Information Addendum
- Credentials Reappointment Application
PRACTICE MANAGEMENT AND ADMINISTRATION
Provides short- and long-term Practice Administrator Support by placing qualified practice management leadership staff on-site for interim assignments or long term relationships. Full time or part time arrangements are available.
CCNV is also able to perform operations enhancement analysis, reviews and training. Operational reviews can be performed by department or practice wide. To request more information contact: David Selig.
Community Care Network of Virginia’s vision for performance improvement is for continuous and sustainable performance improvement across three strategic goals:
- Clinical Excellence
- Operational Excellence
- Financial Excellence
Clinical performance improvement via a traditional clinical quality improvement focus has been a hallmark of the provider community at CCNV since 1999. However, because clinical, operational and financial outcomes are interrelated and cannot be impacted absent a systematic approach to performance improvement, CCNV has consciously broadened the scope and reach of its performance improvement efforts over time.
As the first statewide network of community health centers organized in the nation, CCNV has developed and is continually refining a state-of-the-art Performance Improvement Program capable of measuring, benchmarking and ultimately improving clinical, operational and financial performance for Virginia’s community health centers on a statewide level.
Clinical Performance Improvement/Medical Management
Community Care Network of Virginia sponsors a statewide clinical performance improvement program for Virginia community health centers via a provider-led Network Medical Management Committee, which dates to 1999. The Network Medical Management program was established to promote consistent, high-quality care at practice sites across the Network The work of this statewide provider committee includes:
- Ddevelopment of network-wide Clinical Practice Guidelines for high risk diagnoses
- Dissemination, education and training to network provider staff on guideline principles and scientific evidence supporting “best practices”
- Data collection to determine compliance with evidence-based guidelines
- Targeted quality improvement interventions based on results of data collection
- Regular updating of the Clinical Practice Guidelines to ensure compliance with the most up-to-date scientific evidence and treatment recommendations
Clinical Practice Guidelines have been created for diabetes and for three cardiovascular conditions (hypertension, cholesterol and obesity). Network treatment goals have been established for each condition, and results of quality monitoring activities are compared with Network-wide treatment goals.
Network providers representing each geographic region of Virginia, as well as small and large multiple-site health centers are actively involved in all aspects of this clinical quality improvement effort. Providers are responsible for the creation of the evidence-based guidelines, for the prioritization of clinical quality improvement efforts and for the analysis of clinical quality improvement data. The work of the members of this provider committee is supported by the CCNV Board of Directors.
Collection of data to measure compliance with the adopted Network treatment guidelines plays an important role in measuring success of both the adoption of evidence-based guidelines and any targeted quality improvement intervention deployed as a result of data analysis.
Contracting
Negotiates and executes third party payer and managed care organization participation agreements including single signature authority for network practices.
Contracting services and programs include:
- Negotiation and execution of network master participation agreements
- Participation agreement reviews
- Analysis and reviews of reimbursement and profitability
- Relative Value Unit modeling
- Provider fee schedule analysis and rate setting
- Primary care and specialty contracting
- Risk agreement development
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