When Electronic Visit Verification (EVV) became a federal mandate for personal care and home health services, many agencies were understandably nervous about the challenges they might face implementing a new technology. Some saw it as a chore, another compliance box they needed to check. What they didn’t realize, and what many may not know even now, is the full power of EVV and all ways it can protect their interests, streamline their operations, and revolutionize their clients’ care. Here we explore the hidden power of EVV and how it’s so much more than a compliance task. 

What is Electronic Visit Verification (EVV)? 

Before we dive in, let’s cover the basics. The 21st Century Cures Act mandated that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider. EVV is the process of using electronic means like interactive voice response (IVR), FOB devices, or GPS-enabled mobile apps to verify that care has been delivered for these services. EVV must capture: 

  • Type of service performed 
  • Individual receiving the service 
  • Date of the service 
  • Location of service delivery 
  • Individual providing the service 
  • Time the service begins and ends 

Agencies use EVV to remain compliant with federal requirements and as an effective tool to track caregiver arrivals and departures, ensuring clients get the care they need, when they need it.  

How EVV Protects Homecare Providers 

Here is the difficult truth: fraud, waste, and abuse was, and still is, a problem within the Medicaid home and community-based services (HCBS) space. According to a new report from the Office of Inspector General (OIG), PCS attendants accounted for a large proportion of fraud convictions from 2014 through 2023 and were the most prominent provider type for fraud convictions in 2023. 

Medicaid Fraud Control Units (MFCUs) are mandated by the Social Security Act to investigate and prosecute Medicaid provider fraud and patient abuse or neglect, and they are certainly cracking down on fraud. In 2023, the MFCU recovered $26.4 million from PCS agencies.  

So, how can homecare agencies protect themselves from bad actors who are committing fraud without them knowing? The answer is EVV. 

Establishing a culture at your agency where you require your caregivers to use EVV religiously can greatly protect your interests. When your caregiver clocks in and out using an EVV method, you can guarantee that they are indeed at the client’s home. Additionally, all that data is automatically stored within your EVV platform’s database, providing you with a paper trail in case of an audit.  

With software like HHAeXchange, you can also monitor your EVV compliance percentage and see how compliant you are at the agency level, the caregiver level, and the client level. This will give you the insight you need to spot red flags and correct behavior that may appear fraudulent. And when it comes time to submit a clean claim, our pre-billing function will catch any non-compliant claims before they get submitted. 

How an Integrated EVV Dashboard Speeds Up Your Day 

When you use a software whose only function is EVV, it will help you fulfill your EVV requirements, but an all-in-one homecare software like HHAeXchange can transform your homecare operations.  

Your EVV data can be used to inform your billing and payroll functions, eliminating the need to perform these jobs manually. Let’s look at how it works: 

  1. It all starts with that ever-important EVV. As soon as a caregiver clocks in and out, that data appears in the HHAeXchange Call Dashboard, allowing schedulers to manage any exceptions, like missed or late visits. 
  2. After these exceptions are cleared, HHAeXchange’s pre-billing function will automatically verify that the visit matched the contract, authorization, and plan of care. 
  3. Once this pre-billing process is complete, providers can perform a final billing review to resolve any remaining contractual issues with the visits. 
  4. HHAeXchange will then generate the 837 claim file to be sent electronically to payers in their preferred format. 
  5. Based on the verified visit and EVV data, HHAeXchange will generate the payroll file to be exported to your payroll system. 
  6. Once the 835 is received, HHAeXchange will match it against the 837, automatically reconciling claims and allowing you to work denials and AR. 

Having your EVV data inform your billing submission and payroll file means your team has significantly less manual work to complete.  

The Promise of EVV for Value-Based Care 

Your caregivers are the eyes and ears of your agency. They’re interacting with your clients in person more than their doctors and nurses, sometimes even more than their own family members. Which means they often notice when your client is acting unusual or feeling sick before anyone else does. Now, thanks to EVV mobile apps, providers have access to caregivers when they’re in the client’s home, and caregivers have a way of sharing their observations with their agency in real-time.  

Caregivers can convey behavior changes, social determinant of health indicators like a lack of food in the house, or even fall risks. And when they share this information, you can act, potentially avoiding a costly hospitalization and truly helping your client live a happier, healthier, and safer life.  

EVV has transcended its initial perception as a government mandate, emerging as a real asset for both homecare providers and clients. EVV not only ensures compliance but is also revolutionizing the delivery of homecare services, ultimately fostering improved quality of care for those in need. To learn more about how HHAeXchange has integrated EVV into our homecare management software, contact us today!