Electronic visit verification for home care agencies

The deadline for electronic visit verification (EVV) is quickly approaching. Beginning January 1, 2020, home care agencies that provide personal care services (PCS) must hold an EVV solution in place or risk having their Medicare and Medicaid claims denied.

Part of the 21st Century Cures Act, the EVV mandate is meant to restrain healthcare fraud and misuse. According to the federal mandate, states need electronic verification for PCS visits starting next year, and for home healthcare (HHCS) visits by January 1, 2023. Understand what does this means for home care agencies? What will it take to be compliant?

What Is Electronic Visit Verification?
EVV means being able to provide electronic proof of each caregiver visit. An Electronic visit Verification must verify:
  • Location of service delivery
  • Date of service
  • Start and end times of the service
  • Type of service performed
  • Individual providing the service
  • Individual receiving the service
Each state can ask for additional information, set their own policies about how and when EVV data should be submitted.

Which services must be electronically verified?
According to the Centers for Medicare & Medicaid Services (CMS), “All services requiring an in-home visit that are included in claims under the home health category or personal care services category on the CMS-64 form are subject to the EVV requirement.”

Rewording the same, if personal care or healthcare service is provided in a private home and if Medicaid or Medicare is paying for it, an Electronic visit verification is required. Care services that are provided to hospital inpatients or nursing home residents do not require EVV.

What is considered as Electronic Visit Verification?
The federal government has suggested many possible EVV methods but each state can decide which are acceptable for the agencies within its limits. These options include:
  • Mobile apps that leverage GPS tracking on caregiver smartphones.
  • Interactive voice response (IVR), which allows caregivers to call a toll-free number from the client’s landline phone at the start and end of each visit.
  • Fixed devices that remain at a client’s home for the duration of care.
States decide which of these methods is acceptable for EVV, and while some states permit all three, other states require one or the other. Most states and agencies are opting for mobile solutions because many people no longer have landline phones, and fixed devices are not cost-effective and difficult to implement than mobile apps.

Can agencies choose their own EVV solutions?
That depends on which EVV model your state has chosen. There are five possible models:
  1. In-House System: The state develops and manages its own EVV system. (California, Maryland, Mississippi, and Oregon will use this model.)
  2. State Mandated External Vendor: States choose and engage with a particular EVV vendor to execute a state-wide solution. (This is the chosen model for Alabama, Connecticut, Illinois, Kentucky, Nevada, New Mexico, Oklahoma, South Carolina, South Dakota, and Texas.)
  3. Open Vendor: States contract with at least one EVV vendor or operate their own in-house system, but also allow providers and managed care organizations (MCOs) to use third-party solutions that meet state and federal requirements. (By far the most popular approach, this model has been adopted by Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Hawaii, Indiana, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, West Virginia, and Wisconsin.)
  4. Provider Choice: Agencies choose their own EVV vendor and fund the implementation. States set EVV standards and data collection requirements. (Utah and Virginia will adopt this model.)
  5. MCO Choice: MCOs select and reimburse EVV vendors. (Tennessee uses this model.)
Most states have selected a vendor because solutions operated by the state or by a state-sponsored vendor qualify for enhanced federal medical assistance percentage (FMAP) matching funds — 90 percent for implementation and 75 percent for ongoing costs, according to the Congressional Research Service.

What happens if agencies fail to comply?
States will deny Medicaid and Medicare claims without electronic visit verification. Enforcement deadlines vary by state.

What are the benefits of EVV for vendors?
The Congressional Budget Office expects EVV systems to save the federal government $290 million over 10 years by preventing Medicaid fraud.

That’s great news for taxpayers but what advantage does EVV provider agencies, aside from just compliance?

For smaller agencies that haven’t already invested in mobile solutions, EVV is yet another good reason to embrace digital transformation. With the right software integrations, smartphones can provide agencies with many benefits, including the ability to:
  • Integrate with electronic health records (EHR) so caregivers have mobile access to important client information
  • Communicate with caregivers in the field via multiple channels (talk, text, video)
  • Boost caregiver productivity by enabling real-time charting and documentation
  • Convert paper-based workflows into electronic forms that caregivers can submit immediately after a visit
  • Automate timekeeping for payroll
  • Track mileage and other care provider costs
  • Monitor caregiver safety
  • Provide caregivers with turn-by-turn directions to patients’ homes
  • Optimize caregiver schedules and routes for greater efficiency

By deploying smartphones to field workers, home care agencies will be able to do more than just meet the EVV mandate: They can also improve communications and enhance business processes.

In other words, EVV doesn’t have to be just another burdensome government shift for home care agencies. It is also a timely opportunity to future-proof organizations and equips caregivers with tools that help them work faster and smarter and deliver the best possible patient experience.

Get a free consultation on how mobile solutions can help your agency satisfy EVV requirements in your state, or explore affordable EVV compliance solutions from ONE BCG.

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