EVV and how it is impacting the home health care industry

What is EVV?

Electronic Visit Verification (EVV) has become more popular than ever before among home health agencies. It refers to a technology that seeks to plug the leakages of paper time sheets that lead to false Medicaid claims. This technology does the job of electronically verifying home healthcare visits while identifying specific details surrounding the service rendered to the client.

A provider uses this technology to report information about the services provided, such as:

  • Date of a visit
  • The exact time that a client made a visit
  • Type of service rendered to the client.
  • The name of the individual who attended to the client or rendered the service.
  • Name of the client that was attended to or received the service.
  • Location of the visit. Providers don’t report the actual address; instead, they report it as either “home” or “community.”

The EVV system usually makes use of GPS tracking and computer software. In some cases, it features mobile, telephonic, and web-based verification inputs. With this, home care agencies can effectively track the activities of their staff for adequate compensation.

EVV Legislation

The EVV solution became mandatory under the 21st Century Cures Act (December 2016). This federal mandate affects services under Medicaid personal care and home health (PSC and HHCS) in all states. The penalty for non-compliance is a reduction in federal Medicaid funding for the defaulting state.

When the law was enacted in 2016, the set deadline for compliance was January 1st, 2019. This was revisited and updated to January 1st, 2020. A provision was made that if a state is making a “good faith effort” to comply, they could be granted an extension to January 1st, 2021, upon request.

Why is EVV so important?

Healthcare has been an easy target for crooks over the years, with Donald Berwick, one-time head of the Centres for Medicare and Medicaid Services (CMS), estimating in 2012 that fraud increased the yearly Medicaid and Medicare spending by $98 billion. He and Andrew Hackbarth, a RAND Corporation affiliate, further asserted that this figure hit $272 billion when looking at the entire health system.

However, with the introduction of EVV, fraudulently documented visits are now a thing of the past. Best of all, authorized beneficiaries of Medicaid can receive the services they deserve. In all, the benefits of EVV include:

  • Real-time verification of visits
  • Relevant authorities can quickly validate work for home health employees.
  • Billing data entry errors are a thing of the past.
  • Relevant authorities can checkmate abuse, waste of resources, and fraud.

EVV deployment models

State’s can explore four different implementation models for EVV. They include:

Provider Choice System

This model allows home health agencies to decide their preferred software and operate under state rules. However, the software provider must submit important EVV data, claims, and the details of the service rendered (When the service began and ended). Authorities will then validate all claims.

State Provided Solution

This allows providers to get an EVV solution from the state at no cost or decide to use their resources to employ an alternate vendor’s services. This model is mostly used by agencies who’s clientele is majorly Medicaid authorized. On the other hand, agencies that opt for alternative vendors usually want to differentiate their services.

Managed Care Organization Choice (MCO)

In this model, states work hand-in-hand with Managed Care Organizations (Mostly insurance companies) to deliver their Medicaid programs. MCOs may choose the system that providers will use and, in some cases, mandate them to submit certain information.

State-Mandated System

In this model, the state mandates providers to use a particular system, which can either be an external vendor and an EVV system built/managed by the state. In most cases, providers aren’t required to pay anything.

Open Vendor

Here, an EVV vendor and a company to manage relevant data are handpicked by the state. But providers are free to either make use of the state-sponsored vendor at no cost or work with a vendor of their choice at their own expense. Usually, it will be required that alternate vendors integrate with the company managing data for the state.

Selecting your vendor

Below are vital things that all providers should take note of while selecting an EVV vendor

State Deployment Model

Before choosing a vendor, the first step for all providers is to be aware of the state’s available options. The ability to make a choice depends on the deployment model being used by the state. Models like the State-Mandated Choice are limiting, while others like the Open Choice, Providers Choice, etc., gives providers the freedom to select their preferred system.

As a home care agency owner, It is essential to understand the different models available and the ones implemented by the state to plan accordingly.

Different solutions affect agencies differently

In states where home health providers are free to choose an EVV vendor, they must evaluate different options and determine how the EVV solution can affect them. Not every system is right for your agency, so you must understand the EVV solutions available. Ask yourself, “how will this solution impact my ability to provide care to clients?”

It is advisable to go for solutions that provide device flexibility and functionalities beneficial to your business.

Identify potential issues and ask vital questions

Before choosing an EVV vendor, it will do you a lot of good to identify the system’s potential issues, the extent to which it can affect your business, and how to guard against them. Also, ensure that you get buy-in from private duty aids that will regularly use the system.

Ask your prospective vendor important questions like the level of training required to get your staff familiar with the system, the level of complication involved in implementing the system in your agency’s processes, the level of support available, among others.

It would be best if you were satisfied with the answers, as this is key to determine which vendor is right for your home health agency.