Electronic visit verification was created to reduce fraud and ensure that people receive the documented care they need. EVV was designed to help verify that services billed for home healthcare are for actual visits made. The passing of the Affordable Care Act signed into law in 2010 made provisions for reducing fraud and over-payments, requiring states to stop Medicaid payments to providers when there is credible evidence of fraud

What is EVV?’

Electronic visit verification (EVV) is a method used to verify home healthcare visits to ensure patients are not neglected and to cut down on fraudulently documented home visits. Electronic Visit Verification (EVV) system must be able to electronically verify, to visits conducted as part of the PCS or HHCS, the following:

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The type of service performed
The individual receiving the service
The date of service
The location of the service delivery
The individual providing the service
The time service begins and ends

What is the Cures Act?

Beginning January 1, 2020, home care agencies that provide personal care services must have an EVV solution in place or risk having their Medicaid claims denied, under a mandate included in the 21st Century Cures Act. The Cures Act requires states to implement an EVV (Electronic Visit Verification) system by January 1, 2020, for Medicaid funded Personal Care Services (PCS) and by January 1, 2023, for Home Health Care Services (HHCS) that require an in-home visit by a provider.

How do EVV Systems work?

Most EVV systems use Global Positioning Services (GPS) to capture the location where the service is provided. Another option to capture the location is Interactive Voice Response (IVR) which requires the caregiver or employee to check-in and out using a landline or cellular device located at the patient’s home.

Under Cures Act, services either starting or stopping in the patient’s home are subject to EVV requirements. Capturing the location in which the services started and stopped is sufficient to meet the Cures Act’s requirements.

Why do Home Care Agencies need to implement EVV?

The purpose behind EVV is to ensure that PCS and HHCS visits that are being billed to Medicaid are taking place, the services are provided to the right patient at the right location. Reimbursement for Medicaid visits will be linked to EVV to reduce fraud.

Current State:

Each state has selected a vendor as EVV Aggregators
EVV Aggregators provide their EVV solutions
They are usually limited only to services requiring EVV and narrow in scope
Aggregator solutions are not comprehensive Revenue Cycle Management solutions and are not complete enough to meet the requirement of the agency

Imperatives for Home Care Agencies

Agencies should implement a comprehensive, integrated software platform that meets Cures Act EVV Requirements.

Interfaces with multiple states selected EVV Aggregators.
Integrated with intake, authorization, scheduling, billing, and Revenue Cycle Management.
Handles additional lines of service beyond EVV mandated services.

Challenges with solutions from EVV Aggregators:

While many third-party aggregators offer EVV Solutions, lack of integration with software platforms makes it cumbersome to utilize their solutions. Below are some of the challenges of EVV Aggregators:

Limits the choice of a software platform to only a few state selected vendors
Narrow or limited focus on EVV and related services
Usually does not have comprehensive Revenue Cycle Management options
Does not handle other lines of service and payers
Agencies providing services across multiple states or multiple lines of service will be forced to use multiple software
When the state changes the aggregator or aggregators leaves a state, agencies will be forced to migrate to a new software
Limited options for Point of Care Solutions

Benefits of a comprehensive, integrated EVV Solution:

The ability to interface to multiple EVV aggregators offers the following benefits:

The comprehensive, integrated software platform can interface to multiple EVV Aggregators
Can use one software platform for multiple states and EVV Aggregators
Continuity of operations when aggregators change
Will keep Intake, authorization, scheduling, clinical, and billing information in one database for all lines of services
One patient and employee record all lines of business
Shares clinical and financial information across multiple lines of services
Handle multiple payers – Medicare, Managed Care, Insurance, Private Pay
The transition of care from one service to another without re-entering information
Provide multiple services concurrently with one patient and employee records
Improve the quality of care by providing visibility to clinical information across service lines
Integrated scheduling across service lines will significantly reduce schedule conflicts and overtime.
One invoice and statement to the patient for all services
Consolidated reporting for all services

Conclusion:

Agencies need a software platform that is more than EVV.
We should look for a comprehensive, integrated software platform that provides a strong interface with multiple EVV Aggregators.
One software platform for multiple states and lines of services.
Integrated and comprehensive authorization management, scheduling, clinical, revenue cycle management, and reporting.

ABOUT CAREVOYANT

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.