Seven years after the passage of the 21st Century Cures Act, misconceptions still abound in the homecare industry about the purpose and benefits of Electronic Visit Verification (EVV). At HHAeXchange, we believe that it’s vital for all of us within the homecare ecosystem to understand how EVV can help us reduce fraud, waste, and abuse (FWA) and streamline administrative tasks in homecare. In this blog post, we’ll unravel the myths surrounding EVV and shed light on the fundamental facts that underscore its significance.
Federal regulations, specifically the 21st Century Cures Act, mandated the use of EVV for all Medicaid personal care services (PCS) and home health care services (HHCS). This federal regulation emphasizes the importance of EVV for homecare services before any payment is made.
Some argue that EVV is an unnecessary bureaucratic hurdle. In reality, it safeguards the interests of homecare recipients, standardizes tracking of homecare service delivery, and provides oversight capabilities through valuable visit data collection.
While there is a federal mandate requiring homecare providers to utilize EVV, states have flexibility in how they choose to enforce this mandate. For instance, there are multiple types of EVV models that can be adopted at the state level. A Closed Model requires the providers to use an EVV vendor selected by the state. An Open Model allows providers to choose from multiple EVV vendors to carry out the mandated EVV functionality. And there are other hybrid models that combine characteristics of the Open and Closed models.
Regardless of which EVV model the state has chosen, one thing remains the same, EVV collection and claim submission are two separate processes. Selected EVV vendor(s) may have the capability to bill on behalf of the providers, but this doesn’t necessarily mean that billing must be performed by the EVV vendor. Payers, including states and their managed care organizations (MCOs), make these policies and administrative decisions.
This EVV method records the start and end times of visits and captures the location of the caregiver only at clock in and out. It’s not meant for constant surveillance during the entire care session as some may mistakenly believe. Verifying that the caregiver is at the location of the client they are delivering care to decreases fraud, waste, and abuse by ensuring that the client is getting the care they need, when they need it.
Most EVV systems are designed to streamline administrative processes. Automating data entry eliminates the need for manual timekeeping which reduces paperwork for caregivers and providers. Additionally, EVV results in more accurate claims which means providers spend less time working claim denials.
Clocking in and out should take only a few moments, and ultimately the providers can see in real-time that their clients are being serviced. This alone increases the quality of care being delivered.
Some argue that separate vendors for EVV and billing are more efficient. The reality is that a unified system reduces administrative burdens, minimizes delays, and enhances overall operational efficiency.
The beauty of intersecting EVV data with homecare claims generation and processing is that it can help facilitate a more efficient billing process between the homecare providers and payers. When the ecosystem is connected through one platform the EVV data becomes the basis for the submission of a claim. Utilizing the same EVV vendor for EVV and billing leads to seamless integration, reducing manual entry errors and expediting the billing process.
The validation of EVV can occur at various stages of the claiming process. State Medicaid agencies and payers have the option to require that EVV mandates are achieved at the pre-billing phase, post claim submission, but pre-payment, or post-payment.
The most cost-effective choice is to perform these claim checks pre-billing. This minimizes fraud, waste, and abuse by preventing unvalidated claims from entering the claims processing system, that should ultimately be denied regardless.
Clogging up the claims processing system with known unpayable claims leads to processing delays of payable claims, higher clearinghouse charges, higher claim denial rates, and increased costs for providers.
EVV aggregators/vendors do not process claims. Sophisticated EVV vendor systems like HHAeXchange generate and submit an industry-standard claim format (the 837) on behalf of the provider, but it is clearinghouses and payers that process and pay the claims.
There’s a misconception that EVV vendors formulate the rules and policies on how Medicaid EVV mandated claims are submitted and processed. While EVV vendors may provide solutions that support the billing rules dictated by the state Medicaid agency and/or its contracted MCOs, they do not create these rules.
EVV in homecare isn’t a bureaucratic headache; it’s a tool that ensures transparency, efficiency, and accountability. There are many misconceptions about EVV, but it’s crucial that everyone in the homecare ecosystem understands how it’s used, what the mandates require, and what role we all have in preventing fraud, waste, and abuse.
To learn more about how your organization can use the HHAeXchange homecare management solution alongside our EVV tool, contact us today.
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