How Does a Verification Organization Benefit You?

Verification Organizations (VOs) have helped to reduce fraud, waste, and abuse in New York State. HHAeXchange achieves this by employing an integrated, shared-platform that allows full visibility to your provider and MCOs’ activities.

More specifically, you could view processes such as:

• Electronic Visit Verification (EVV) Processing

• Scheduling vs. Confirmed or Unconfirmed Visits

• Billing

If you have the shared-platform, you also have the ability to run Conflict and Exception Reports. Conflict Reports compare EVV and Point of Service (POS) Data Capture to reveal any incongruities in services or items with respect to a defined duty roster. Exception Reports compare EVV and POS Data Capture to reveal conflicts between the identity of the caregiver providing service and the Medicaid recipient to ensure that the caregiver is not billing for services provided to multiple recipients concurrently.

With the addition of the VO service offering, HHAeXchange can offer experienced and qualified staff to deliver individual provider assessments. The assessment identifies gaps in compliance processes and provides remediation through education, process updates and ongoing support. HHAeXchange VO staff delivers ongoing feedback as needed to providers involved in the VO process. VO staff will utilize the existing reports from the shared-platform prior to the scheduled assessments to identify focus areas. Having a team that is highly focused as well as knowledgeable of the market, system and compliance processes can greatly reduce the level of effort required to audit and review provider compliance from the state Office of Medicaid Inspector General or Program Integrity staff.  Knowing that these assessments will be taking place will serve to minimize conscious fraud, waste and abuse within the provider community — saving additional funds in the Medicaid services program to be redirected to eligible consumer services.

These features are just the tip of a robust regulatory and processing platform.

Let’s connect to talk one-on-one about the benefits a VO such as a reduction in fraud, waste and abuse.

Download this guide to discover how providers were determined, the role of the VO and requirements for NYS Medicaid Assistance.