How to prepare for the 21st Century Cures Act

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  • April 25, 2018

Signed into law in December 2016, the 21st Century Cures Act is designed to help accelerate medical product development and bring new innovations and advances faster to patients who need them. But the Cures Act also has a significant impact on the homecare industry. Here’s what homecare agencies should know and how they can prepare for the changes ahead.

  1. Adopting EVV

A provision of the Cures Act is enforcing the use of electronic visit verification (EVV) to combat fraud, waste and abuse in home care. The law requires states to implement EVV requirements for Medicaid homecare providers by January 1, 2019, giving agencies less than a year to prepare for the changes ahead.

Agencies can use EVV as an effective monitoring tool to track caregiver arrivals and departures, reducing false claims of time spent with a member. But the benefits of EVV don’t stop here – it’s just the first step to an effective agency management solution. Beyond simply tracking caregiver visits, EVV offers financial, operation and clinical benefits for homecare agencies.

Agencies should implement EVV as part of a comprehensive system that will truly improve efficiency and provide better outcomes. Such a system should allow for open communication between Medicaid payers and homecare providers because when both parties collaborate effectively, there is more opportunity to recognize issues, spot instances of fraud, and proactively prevent them.

  1. Manage your Data

The Cures Act also requires states to create a centralized database of caregivers, which will make it easier for CMS to verify caregiver credentials and identities, as well as prevent providers who are terminated from Medicaid from relocating to another state to provide services.

In order to stay compliant with this regulation, providers need to collect and submit information from their caregivers, such as name, date of birth, Social Security number, provider identifier, state license and certification numbers.

Furthermore, providers will have to categorize and analyze the data they collect to address any anomalies. Data is the best weapon against fraud and abuse, but only if used properly. For example, there are correlations between aide timeliness, missed visits and exceptions to member quality of care. A fully integrated agency management system can do all the heavy lifting associated with this workflow, while also notifying providers before one of their caregivers falls out of compliance.

  1. Prove your Value

The Cures Act has the potential to change the way hospitals are evaluated when it comes to readmissions. This, combined with the pressure MCOs are facing to deliver value – improving results while controlling costs – is trickling down to providers. Due to the increasing pressure, agencies will be forced to effectively demonstrate value without taking hours away from core business functions. Providers must be able to deliver metrics on hospital readmissions, completion of scheduled visits, adherence to the plan of care, hours delivered and billing accuracy, and show their cost benefit to hospitals.

The homecare industry is constantly evolving with new regulations and requirements, making it a challenge for agencies to keep up. Stay up to date on the latest agency news and resources for agencies by following us on Facebook, LinkedIn, or Twitter.