Services Details

Effectiveness Reviews

We can measure the effectiveness of your organization’s corporate compliance program, conduct risk assessments, facilitate an organizational SWOT analysis and provide your organization with recommendations to improve your compliance program. Advanced Quality Compliance & CVO has developed specific tools to help health care providers evaluate the effectiveness of their compliance programs. These tools include questionnaires, checklists, surveys and other forms designed to identify gaps, risks and flaws in compliance programs.

Sanction Monitoring Program

AQC has programs to meet your organizations needs to maintain the highest level of Health care compliance. We monitor many clients with > 2500 employees.

Program Review & Design

Advanced Quality Compliance & CVO have developed tools to help health care providers create an effective, customized compliance program. Our approach incorporates the OIG’s model compliance program guidance and regulatory developments. Provider programs developed before the original OIG guidance most likely need revision. AQC can review your compliance plan document, recommend enhancements and draft the revised compliance plan to incorporate the OIG’s model compliance guidance and other recommended compliance provisions.

Risk Assessments

We facilitate the process of identifying potential risks to your organization and quantifying the level of risks. We also can assist in developing a work plan to define the scope of compliance work your organization will perform.

Independent Review Organization

If your organization enters into a CIA with the DOJ, it typically must contract with an independent review organization (IRO) to provide independent verification that your organization is complying with CIA terms. Advanced Quality Compliance & CVO can serve as an Independent Review Organization (IRO) to health care organizations by combining our knowledge and expertise of corporate integrity agreements, compliance program operations and coding and billing audits to provide health care organizations with cost-effective and proven results that meet the CIA requirements.

Training & Education

Advanced Quality Compliance & CVO can help train your compliance committee, employees, management, board members and physicians on compliance issues. Examples of training include fraud and abuse, current industry developments, compliance program effectiveness, board governance, corporate responsibility and revenue cycle compliance.

Credentials Verification Services

Our services include efficient data management for tracking and updating provider credentialing information. We are able to provide continuous reporting to our client organizations. Our clients can trust that practitioner data is maintained in a completely secure credentialing system.
Above all, AQC strives to meet or exceed the unique requirements of all of its client organizations. We believe in partnering with you in order to ensure your organization is able to consistently comply with the standards and regulations governing your credentialing procedures, as well as with the rules and regulations of your organization.

Initial Application and Primary Source Verifications for Healthcare and Insurance Providers
  • Current and Prior State Professional Licensure
  • Board Certification
  • National Practitioner Data Bank (NPDB)
  • Education
  • Training (Internship, Residencies, Fellowships)
  • DEA/CDS Certification
  • OIG Check for Medicare/Medicaid Sanctions (this can also be ongoing)
  • Malpractice Coverage and Claims History
  • Hospital Affiliations (past and current)
  • Academic & Faculty Appointments
  • Professional References
  • Work History
Recredentialing Application and Primary Source Verification for Healthcare and Insurance Providers (every two or three years as required)
  • Current and Prior State Professional Licensure
  • American Board of Medical Specialties
  • National Practitioner Data Bank
  • Board Certification
  • Additional Training (Internship, Residencies, Fellowships, if applicable)
  • DEA/CDS Certification
  • OIG Check for Medicare/Medicaid Sanctions
  • Malpractice Coverage and Claims History
  • Hospital Affiliations (past and current)
  • Academic & Faculty Appointments
  • Professional References
Application Population – Hospitals, Provider Health Plan Enrollment and Participation, Professional Licensure

AQC offers services for automatically populating any type of application or form requiring your provider’s information. With our unique system, we are able to auto-populate and track initial applications for hospital privileges, health plan participation, professional licensure, etc. We can also provide this same service for reappointment or recredentialing applications.

We are able to mail, fax or email forms directly to the provider for review and signature. Depending on the services we are contracted to provide to your organization, we will ensure that the provider application package is securely sent to the recipient you have directed us to send the information to, or we will immediately begin the process of primary source verification on your behalf, or we will return the completed application package to you if requested.

Update Reports

As a part of our standard service, we send status reports to you throughout the process so you are continuously updated and informed about the credentialing status of your providers.

RUSH Verifications and Application Processing

AQC offers expedited credentialing, primary source verification and application management services as well. This level of service can be critical to organizations needing to ensure the completion of work in less than the normal time or as agreed upon between your organization and the CVO.

Provider Data Management, Monthly, Quarterly, or yearly Credentials Tracking and Document Storage

Our unique credentialing system gives us the ability to track the expiration of important provider credentials such as licensure, DEA registration(s), Board certification, malpractice insurance, etc. In addition to tracking this critical information, we also have the ability to store current and history documents in our database. Because our database is accessible by the manager also, the PSV process is no longer done in secret.

Ongoing Monitoring

Our system gives us the ability to monitor and provide reports relating to licensure status changes, disciplinary and other actions that are taken by licensing boards and/or OIG.

When we know that any actions have been taken against a provider that affect licensure or the practitioner’s ability to participate in Medicare or Medicaid, we will notify you immediately.

Custom Reporting

We will work with you to create any customized reports you may need to track the status of verifications and provider enrollment activities.

Fast Track Credentialing/Re-Credentialing

AQC’s service is designed to assist organizations with verifications and application management during peak times of the year when a high volume of new credentialing or recredentialing is anticipated.

“A la Carte” Verifications

A significant discount is available for clients who may not want to include all primary source verification services provided by Advanced Quality Compliance & CVO due to cost containment or other reasons. For these clients, there is an option to select certain verifications from a “menu” provided by the AQC.

Web Access

Our ground breaking data base includes the ability for our clients to access their practitioner credentialing information via the Internet. With a link to the database via the Internet, our clients will have an up to the minute status for all practitioners.

AQC is dedicated to keeping medical organizations in full compliance with standards, laws, and effective teamwork.