What is Electronic Visit Verification?
Electronic Visit Verification (EVV) has become a hot topic in the home health industry as all states must implement EVV for Medicaid-paid clinical services by January 2023. Most states have implemented EVV for their non-clinical services, targeted after several delays for a 1/1/2021 implementation. Some states have already chosen to implement EVV for both clinical and non-clinical services.
To help your agency better understand EVV, we discuss in this article what EVV is, why it’s important, the states that haven’t implemented it, and the different model types of EVV that states can choose to implement.
We also have a short KanTime table talk video about EVV hosted by industry experts. If you would like to access it, click here.
What is Electronic Visit Verification?
Electronic Visit Verification or EVV is used in home health care by requiring caregivers to check-in, document services provided, and check out from the visit on smartphone and tablet GPS enabled devices, telephony, or fixed devices. These events occur in real-time and through various electronic methods confirm the six required elements necessary to comply with the 21st Century Cures Act.
Why EVV is Important
The 21st Century Cures Act (2016) requires state Medicaid post-acute care agencies to implement EVV on a timeline based on the lines of business the agency supports. In some cases, individual states can and have accelerated that timeline, which agencies have to abide by to stay compliant.
EVV was created to reduce the number of fraudulent claims that occur in the home healthcare industry. CMS wanted to make sure that agencies were staying compliant and that the patients’ visit happened and matched the submitted claim.
Many times, the patient may forget that a nurse came and visited them that week. However, using EVV can help the agency prove that the nurse/aide provided the service to the beneficiary and when the agency gets audited.
Some Benefits of EVV are:
- Electronic check-in/check out upon arrival/departure, which, with most software, notifies the agency in real-time that the caregiver is there providing services.
- Ensure that service time is recorded accurately, significantly reducing payroll errors associated with manual entry.
- Accurately record both service type and time to ensure accurate billing.
- Matches claims data to EVV recorded data to ensure claims get paid.
Note: If a state fails to implement EVV in the required timeline, CMS will reduce the amount of Medicaid funding provided to the state.
States That Have Not Implemented EVV
All states MUST implement EVV for clinical services by January 1, 2023, and were required to implement EVV for non-clinical/PCS services by January 1, 2021. COVID impacted the implementation for many states, but CMS refused to approve a delay, so many states have yet to get their programs in place. Many are in process, but some have yet to start.
Below are the states that haven’t implemented EVV for non-clinical/PCS services:
- New Hampshire
If you would like to see what your state is planning or what your state is doing regarding EVV, click here.
Open vs. Closed Method
There are two primary types of EVV and a third Hybrid type that states can implement:
“In an open (or open choice) EVV model, states allow providers to use their existing EVV system, or allow them to choose one that best meets their individual needs” (Home Health Care News). This method also requires the provider agency to pay for their selected system without additional state funding.
“The state Medicaid program contracts with a single EVV vendor, and mandates all provider agencies use that vendor’s EVV system” (Home Health News). In this model, the state funds the cost of a base-level EVV system that meets the Cures Act requirements, but then often results in provider agencies having to work in two disparate systems with associated manual copy and paste actions between the two systems.
This third type of EVV system is the most common and has variations that we won’t go into in this article. In this type of system, the state usually contracts with an individual, and in some cases multiple EVV vendors, and funds the provision of those EVV systems to provider agencies. However, they don’t mandate those vendors as a sole source and instead require the contracted EVV vendors to integrate with “Alternative EVV Vendors” that provider agencies can use and pay for. The benefits of this kind of system are significant, not the least of which is efficiency for the provider agency as it generally facilitates an electronic data flow between the platforms and allows staff to operate primarily or entirely out of one system.
A few examples of EVV vendors:
EVV helps agencies track when their clinicians check-in, check out and perform services. Agencies have a lot of information and data to remember, and EVV is just one of the ways to help stay organized and compliant.
Agencies must be ready even if their state has not yet decided on which EVV method to use. It’s better to be prepared than to play catch up, especially when it comes to EVV.