Many home care providers are hesitant to get started with Medicaid because they're fearful of the complexities that come along with Electronic Visit Verification (EVV).
We've recognized this and have created this simple guide to clear up any confusion you might have so that you can streamline your way into accepting Medicaid clients and grow your business without any hesitation.
What is Electronic Visit Verification?
EVV, or Electronic Visit Verification, is a system used to verify when caregivers and home health providers visit patients in their homes. This system helps ensure that caregivers are providing the care they are supposed to, that clients are receiving the care they need, and that agencies are complying with regulations.
How Does Electronic Visit Verification Work?
EVV typically involves the use of a GPS-enabled mobile app, a dedicated EVV device in the client's home, or interactive voice response (IVR), decided on by the state, that caregivers use to capture the location of personal care services (PCS) and home health care services (HHCS). This data is then transmitted in real-time to a secure online portal, where administrators can monitor and track caregiver visits.
Why is EVV required?
EVV was introduced to eliminate fraud by preventing providers from billing for visits that never occurred. EVV is required by federal law for certain Medicaid-funded home care services, including PCS and HHCS. States have been mandated to implement EVV systems to comply with the 21st Century Cures Act.
Benefits of EVV include increased efficiency in scheduling and tracking patient visits, improved accuracy in billing and payroll processes, reduced opportunities for fraud and abuse, and improved overall quality of care provided to patients. By ensuring that caregivers are present at scheduled appointments, EVV helps to ensure that patients receive the care they need in a timely manner.
Open vs. Closed State Models Explained
Home care agencies must implement Electronic Visit Verification (EVV) in order to provide services to Medicaid clients. This can be either an EVV system chosen by the agency or one mandated by the state. This is referred to as the open and closed state models.
Under the closed model, only a single EVV vendor is allowed which maintains consistency but may strain states, providers, and caregivers. The open model allows providers to choose their own EVV systems and uses a universal EVV aggregator to refine all the data. EVV Aggregators gather, process, and standardize live data, facilitating cross-comparison with submitted claims.
Even in a single state, different programs and payers/MCOs may enforce distinct EVV requirements, necessitating the utilization of multiple systems by home care agencies.
The Different EVV Models
There are a few EVV models that states can choose from which generally fall under the open or closed model category:
- Open Vendor: States choose an EVV vendor and a data aggregator. home care providers can use these state-endorsed vendors for free or they can choose to work with a different EVV vendor at their own cost. If an organization decides to use an alternative vendor, it usually needs to integrate with the state's chosen data aggregator.
- State-Mandated External Vendor: Providers have to use a specific vendor selected and funded by the state.
- State-Mandated In-House System: States may develop and manage their own EVV systems, which providers must use.
- Provider Choice: Providers have the freedom to select their own vendors and cover the expenses on their own. Some states may increase reimbursement rates to help cover these costs.
- Managed Care Organization (MCO) Choice: MCOs have the authority to choose the vendor and cover the costs. They may or may not receive support from the state to assist with these expenses.
EVV State-by-State Overview
To Sum Things Up
It's clear that Electronic Visit Verification (EVV) is a struggle that many home care providers have to overcome when contemplating Medicaid involvement. We hope our guide has brought some clarity on the matter. If you still have any questions feel free to fill out the form below and get in touch with us.
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