In the ongoing battle against Fraud, Waste, and Abuse (FWA) in the homecare industry, technology has emerged as a powerful ally. One innovation Medicaid programs are using to tackle this challenge is Electronic Visit Verification (EVV). EVV is a system that electronically verifies when a caregiver visits a member’s home and documents the services provided. It’s the best tool in our arsenal against FWA, making it critical for Medicaid payers to have a vested interest in ensuring EVV compliance due to the direct impact it has on members’ outcomes and costs overall. 

The Role of EVV in Preventing FWA 

EVV systems enable real-time confirmation of when a caregiver visit begins and ends, ensuring that the right services are delivered at the right time by the right individual to members receiving in-home services. The intent of EVV solutions is to electronically validate that services are provided as scheduled and billed for appropriately, reducing the opportunity for fraudulent activities.  

EVV requires caregivers to clock in when they are present at the member’s home, either through a landline phone call (IVR/telephony), a FOB device, or the gold standard, by submission of a GPS enabled location through the use of an app on a smart phone. This verification method ensures there are no phantom visits (billing for visits that never occurred). EVV significantly reduces both waste and fraud in billing practices and allows for oversight to ensure that clients receive the care they need. 

Why Payers Should Care About Ensuring EVV Compliance 

1: Improved Outcomes: Making sure that members receive the care they need, when they need it, will improve their health outcomes and allow them to maintain independence in their own homes. This leads to happier, healthier members, and prevents unnecessary, costly care escalations such as emergency room visits and/or hospitalizations. 

2. Cost Reduction: EVV compliance directly reduces unnecessary costs for payers, including fraud, waste, and abuse. Accurate billing validated through EVV means payers are only charged for services provided, preventing financial losses due to fraudulent claims. 

3. Enhanced Operational Efficiency: EVV streamlines the billing process by automating the verification of services. This efficiency allows payers to process claims faster and with greater accuracy, reducing administrative costs and improving the utilization of resources. It stands to reason that the further up in the billing process, or ideally at the pre-billing or pre-claim generation stage, that EVV is incorporated, the more efficient the process becomes. 

4. Legal and Regulatory Compliance: The 21st Century Cures Act mandates the use of EVV for all Medicaid personal care services (PCS). Payers that comply with these regulations avoid legal repercussions and associated fines, safeguarding their financial stability and reputation. 

5. Protection of Reputation: Medicaid Managed Care Organizations that actively enforce EVV compliance send a strong message about their commitment to integrity and member safety. This commitment fosters trust among members, caregivers, with the state Medicaid program, and the wider community, enhancing the payer’s reputation in the industry. 

6. Long-Term Sustainability: By preventing FWA and ensuring EVV compliance, payers contribute to the long-term sustainability of the homecare industry. Efficient use of resources means that the industry remains robust. 

Keeping up With Compliance 

EVV stands as a beacon of hope in the fight against FWA in the homecare industry. Its ability to ensure accurate visit tracking, prevent unauthorized activities, and streamline operations makes it indispensable for providers, caregivers, payers, and members alike. Payers have a vested interest in championing EVV compliance because the right oversight capabilities lead to better member outcomes and serve as a shield protecting their bottom line.  

By promoting EVV technologies, and monitoring homecare provider compliance with EVV, payers not only safeguard their financial interests but also uphold the core values of the homecare industry – providing genuine, compassionate care to those in need. Through these efforts, the industry can thrive, ensuring a future where quality homecare is accessible, reliable, and above all, trustworthy. 

HHAeXchange’s Network Management solution seamlessly connects payers and homecare providers across the homecare ecosystem, allowing for aggregation of all visit data, regardless of providers’ EVV tools. Our web-based platform gives payers visibility into their network while providing centralized communication and information exchange, informing care coordination, and enhancing data integrity. To learn more about how HHAeXchange helps payers monitor the EVV compliance of their provider networks, contact us today