Electronic Visit Verification (EVV) enables real-time confirmation of when a caregiver’s visit begins and ends for members receiving in-home services. This technology is a requirement for Medicaid funded homecare and home health providers.  

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. While this is its intended purpose, there are many other wonderful benefits to EVV outside of detecting fraud. Here we’ll review everything providers need to know about EVV requirements, the many benefits of EVV, and how they can go about implementing EVV tools at their agency. 

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The concept of EVV emerged as a response to growing concerns about the integrity and efficiency of homecare services. Before EVV, verifying that a caregiver visited a client’s home was challenging, and providers often had to rely on manual logs that could be easily falsified. In 2016, the 21st Century Cures Act was passed in the United States, mandating the use of EVV for all Medicaid-funded personal care services and home health care services. This legislation aimed to improve transparency, reduce fraud, and ensure that clients receive the care they deserve. 

Broader Implications of EVV on the Homecare Ecosystem 

EVV doesn’t just benefit homecare agencies and their clients; it also has broader implications for the homecare industry. By ensuring that homecare services are delivered as promised, EVV helps to build trust within the homecare ecosystem. It also provides valuable data that can be used to improve service delivery and patient outcomes. In a way, EVV is part of a larger movement towards data-driven healthcare, where decisions are informed by accurate, real-time information. 

EVV systems function by recording key details of each visit. When a caregiver arrives at a client’s home, they clock in using an EVV method (like a mobile app, IVR, or FOB device). The system captures the exact time and location, confirming the caregiver’s presence. When the visit is completed, the caregiver clocks out, and the EVV system records the end time and location. This information is then sent to a central database where it can be reviewed and used to submit compliant billing claims to Medicaid payers, and is then able to inform payroll output. 

Types of Data Captured by EVV 

EVV systems must capture the following data: 

  • Type of service performed  
  • Individual receiving the service  
  • Date of the service  
  • Location of service delivery  
  • Individual providing the service  
  • Time the service begins and ends 

Compliance with the 21st Century Cures Act 

The 21st Century Cures Act requires Medicaid-funded homecare services to use EVV to verify visits. The deadline for states to implement an EVV solution was January 1, 2020 for all Medicaid-funded PCS and January 1, 2023 for home health care services. At this point, almost all states are in compliance and have offered a state-funded solution. Now, it is essential for all agencies to adopt EVV to avoid penalties from the state, and ensure they get paid for their services.  

Specific State Requirements and Deadlines 

Each state has its own set of requirements and deadlines. Some states may have stricter guidelines and have already started cracking down on homecare provider compliance. For example: 

  • Pennsylvania is requiring 85% compliance rate by January 1, 2025. 
  • Florida has a 85% compliance rate requirement (or higher based on MCO policies). 
  • New York is anticipating 90% EVV Compliance by January 1, 2025.

Agencies must stay updated on their specific state’s requirements to ensure compliance and avoid penalties. 

Closed Model vs. Open Model vs. Hybrid Model 

States have flexibility in how they choose to implement the federal EVV 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. 

Penalties for Non-Compliance 

Non-compliance with EVV requirements can result in serious penalties, including: 

  • Payment Denials: Agencies may not be reimbursed for services provided if they do not comply with EVV requirements. 
  • Fines: States may impose fines on agencies that fail to implement EVV correctly. 
  • Loss of Licensure: In extreme cases, agencies could lose their license to operate. 

Medicaid Fraud Control Units (MFCUs) are mandated by the Social Security Act to investigate and prosecute Medicaid provider fraud and client abuse or neglect, and they are certainly cracking down on fraud. In 2023, the MFCU recovered $26.4 million from Personal Care Services (PCS) agencies.  

Benefits of EVV Compliance 

While EVV compliance may seem daunting, there are significant benefits: 

  • Assured Payments: Ensures that agencies receive prompt and correct payments for services given. 
  • Improved Care Quality: Helps ensure that clients receive the care they need, when they need it. 
  • Operational Efficiency: Streamlines administrative processes, reducing the burden on staff. 

Ensuring compliance with the 21st Century Cures Act is not just about avoiding penalties; it’s about improving the overall quality and reliability of homecare services. 

Methods of EVV 

EVV systems use various methods to verify visits, ensuring flexibility and reliability for different homecare settings. Each method has its unique features and benefits, allowing agencies to choose the best option for their needs. 

GPS-enabled Mobile Apps 

Mobile apps with GPS tracking are a popular EVV method. Caregivers use these apps to check in and out of visits, capturing their location to confirm they are at the client’s home. This method is convenient and provides real-time data, making it like having a digital diary that keeps track of every visit. 

  • How it Works: Caregivers download the EVV mobile app on their smartphones. Upon arrival at the client’s home, they open the app and check in, which records the GPS coordinates and time. At the end of the visit, they check out using the app, logging the departure time and location. 
  • Benefits
    • Real-Time Data: Provides immediate verification of visits. 
    • Ease of Use: Simple for caregivers to use with minimal training. 
    • Detailed Records: Captures comprehensive visit data, including GPS location, time, and type of service provided. 
  • Additional Resources: Some mobile apps, such as HHAeXchange, have additional features that allow caregivers to manage their schedule, accept new shifts, get directions to client homes, log plans of care, communicate with their agency, and more. 
  • Considerations: Requires a smartphone 

Interactive Voice Response (IVR) 

IVR systems allow caregivers to use the client’s phone to call a toll-free number and check in and out of visits. This method is useful in areas with limited internet access, ensuring that visit data is still captured accurately. It’s like leaving a voicemail for a friend to let them know you’ve arrived safely. 

  • How It Works: Caregivers call a designated number from the client’s phone upon arrival and follow automated prompts to check in. They repeat this process to check out at the end of the visit. 
  • Benefits
    • No Internet Required: Ideal for areas with poor internet connectivity. 
    • Accessibility: Can be used with any landline phone. 
    • Simplicity: Easy for caregivers to use without needing additional devices. 
  • Considerations: Relies on access to the client’s phone, which might not always be possible. 

FOB Devices 

FOB devices are small gadgets placed in the client’s home. Caregivers use these devices to check in and out by pressing a button, which records the visit time. FOBs are simple and reliable, making them a good option for homes without smartphones or internet. Think of them as the trusty old school attendance punch cards, but more advanced. 

  • How It Works: FOB devices are installed in the client’s home. Caregivers press a button on the FOB device to check in at the start of the visit and again to check out at the end. The device provides a unique code, which can later be synced with the agency’s system. 
  • Benefits
    • Reliability: Functions without internet or phone access. 
    • Durability: Robust and long-lasting, suitable for various home environments. 
    • Ease of Use: Simple for caregivers to operate with minimal instructions. 
  • Considerations: The agency may have to pay for these devices, and there is no way to track additional visit information. 

Choosing the Right EVV Method 

Selecting the right EVV method depends on several factors, including the availability of technology, caregiver preferences, and specific agency needs. Some agencies may benefit from a combination of methods to ensure coverage across different environments and situations. 

  • Assessment of Technology: Evaluate the availability of smartphones, internet access, and landlines in the areas you serve. 
  • Caregiver Training and Comfort: Consider the ease of training and the caregivers’ comfort level with different technologies. 
  • Operational Integration: Ensure that the chosen EVV method integrates smoothly with existing agency systems and workflows. 

By understanding the different methods of EVV, agencies can choose the most effective solution to meet their needs and ensure compliance with regulations. 

With the right approach, implementing EVV can be straightforward. Start by training your caregivers on how to use the system and make sure they understand its importance. Choose an EVV solution that integrates with your current software to streamline processes. Regularly review the data collected to ensure accuracy and address any issues promptly.  

Steps to Implement EVV Successfully 

Assess Your Needs 

  • Evaluate the specific needs of your agency, including the number of caregivers, types of services provided, and geographic coverage. 
  • Determine the most suitable EVV methods based on technology availability and caregiver preferences. 

Choose the Right EVV Solution 

  • Select an EVV solution that integrates seamlessly with your existing systems, such as scheduling, billing, and payroll software. 
  • Ensure the solution is compliant with federal and state regulations. 
  • Consider user-friendly features that make it easy for caregivers to adopt. 

Train Your Caregivers and Staff 

  • Develop a comprehensive training program for caregivers and administrative staff. 
  • Provide hands-on training sessions and create user manuals or video tutorials. 
  • Address any concerns or questions to ensure everyone is comfortable with the new system. 

Communicate with Stakeholders 

  • Keep open lines of communication with caregivers, patients, and their families about the implementation process. 
  • Explain the benefits of EVV and how it will improve care delivery and accountability. 
  • Address any concerns or resistance to the new system. 

Monitor and Evaluate 

  • Regularly review the EVV data to ensure accuracy and compliance. 
  • Conduct periodic audits to identify and resolve any discrepancies. 
  • Use the data collected to improve service delivery and operational efficiency. 

Provide Ongoing Support 

Offer continuous support and resources for caregivers and staff, including a dedicated help desk or support team. 

Common Challenges and Solutions 

  • Resistance to Change: Some caregivers may be hesitant to adopt new technology. Address their concerns by providing thorough training, demonstrating the benefits, and offering ongoing support. 
  • Technical Issues: Internet connectivity and device availability can pose challenges. Have backup methods like IVR or FOB devices in place and ensure all caregivers have access to the necessary technology. 
  • Data Accuracy: Ensuring the accuracy of data collected through EVV is crucial. Conduct regular audits and provide training on proper check-in and check-out procedures. 

By following these steps and best practices, agencies can successfully implement EVV, ensuring compliance and improving the quality of care provided to patients. 

Electronic Visit Verification (EVV) offers numerous benefits that extend beyond compliance. By ensuring that caregivers are providing services as planned, EVV helps improve care quality, streamline agency operations, and prevent fraud. Let’s dive into these benefits and understand how EVV can transform homecare services. 

Fraud Prevention 

EVV helps prevent fraud by ensuring that care visits happen as scheduled. It captures accurate data, making it difficult for caregivers to falsify visits. This transparency builds trust and ensures that patients receive the care they need. It’s like having a security system that keeps everything honest and transparent. 

  • Accurate Data Collection: EVV systems capture detailed data on each visit, including time, location, and type of service. This data is automatically recorded and stored, reducing the risk of manual entry errors or falsification. 
  • Accountability: Caregivers are held accountable for their visits, knowing that their location and time are being verified. This accountability helps maintain high standards of care and reduces the likelihood of fraudulent activity. 
  • Audit Trail: EVV systems provide a comprehensive audit trail that agencies can use to verify services and investigate any discrepancies. This audit trail is invaluable for compliance reviews and fraud investigations. 

Streamlined Agency Operations 

With EVV, agencies can streamline their operations. The system automates visit verification, reducing the need for manual data entry and minimizing errors. This efficiency saves time and resources, allowing agencies to focus more on patient care. It’s like having an extra pair of hands to help with the workload. 

  • Automated Processes: EVV systems automate the process of checking in and out, capturing visit data, and updating records. This automation reduces administrative workload and frees up staff to focus on more critical tasks. 
  • Improved Scheduling: EVV data can be used to optimize caregiver schedules, ensuring that visits are well-coordinated and efficient. Agencies can quickly identify gaps or overlaps in schedules and make adjustments as needed. 
  • Accurate Billing and Payroll: With accurate visit data, agencies can ensure that billing and payroll processes are based on verified information. This accuracy reduces billing errors, disputes, and delays in payment. 

Improved Care Quality 

By ensuring that caregivers are providing services as planned, EVV helps improve care quality. Patients receive timely and consistent care, leading to better health outcomes. The data collected also helps agencies monitor performance and make informed decisions. It’s like having a quality control system that ensures everyone gets the best care possible. 

  • Timely Care Delivery: EVV ensures that caregivers arrive on time and spend the appropriate amount of time with patients. This timely care delivery is crucial for maintaining patient health and satisfaction. 
  • Consistent Care: EVV helps ensure that care is provided consistently, with accurate records of each visit. This consistency is vital for patients who rely on regular, scheduled care. 

Enhanced Communication and Coordination 

EVV mobile apps can facilitate better communication and coordination between caregivers and administrative staff. This improved communication enhances the overall care experience and helps address issues promptly. 

  • Real-Time Updates: EVV systems provide real-time updates on caregiver locations and visit status. This information helps agencies coordinate care more effectively and respond quickly to any changes or emergencies. 
  • Secure Two-Way Chat: Caregivers can easily reach out to their administrative staff if they are out in the field and encounter a problem. 

Regulatory Compliance 

Compliance with EVV requirements ensures that agencies meet federal and state regulations, avoiding penalties and ensuring continued funding. By adopting EVV, agencies demonstrate their commitment to transparency, accountability, and high-quality care. 

  • Peace of Mind: Knowing that the agency is compliant with EVV regulations provides peace of mind to administrators, caregivers, and patients. It ensures that the agency is operating within legal requirements and standards. 
  • Funding Assurance: Compliance with EVV requirements is often tied to Medicaid funding. By using EVV, agencies can ensure that they receive the necessary funding for the services they provide, maintaining financial stability. 

By leveraging the benefits of EVV, homecare agencies can enhance their operations, improve care quality, and build trust with patients and their families. EVV is more than just a compliance tool – it’s a powerful system for transforming homecare services. 

HHAeXchange offers an integrated EVV solution that works seamlessly with existing agency systems. It provides various verification methods, ensuring flexibility and reliability. The platform also supports scheduling, billing, and payroll, making it a comprehensive tool for managing homecare services. It’s like having a Swiss Army knife for all your homecare needs. 

Features of HHAeXchange’s EVV Solutions 

  • User-Friendly Mobile App: Designed to be intuitive and easy to use, reducing the learning curve for caregivers and staff. 
  • Real-Time Data: Provides real-time updates on caregiver visits, allowing agencies to monitor and manage services effectively. 
  • Compliance Monitoring: Ensures compliance with federal and state regulations by capturing all required data points. 
  • Integrated Homecare Management System: The HHAeXchange solution uses EVV data to inform billing and payroll—automating many backend administrative duties. 
  • Reporting and Analytics: Offers robust reporting and analytics tools to help agencies track performance, identify trends, and make data-driven decisions. 

The future of EVV technology is exciting, with ongoing advancements aimed at further improving efficiency and care quality. Now, thanks to EVV mobile apps, providers have access to caregivers when they’re in the client’s home, and caregivers have a way of sharing their observations with their agency in real-time.   

Caregivers can convey behavior changes, social determinant of health indicators like a lack of food in the house, or even fall risks. And when they share this information, you can act swiftly, potentially avoiding a costly hospitalization and truly helping your client live a happier, healthier, and safer life. EVV has transcended its initial perception as a government mandate, emerging as a real asset for both homecare providers and clients. 

The HHAeXchange team is committed to staying at the forefront of these technological advancements, continually improving our homecare management solution to meet the evolving needs of homecare agencies. To learn more, request a demo today.