Why Payers Should Go Beyond Traditional EVV

Late last year, Congress passed the 21st Century CURES Act which, among other things, requires that all fifty states must choose a form of electronic visit verification (EVV) to verify in-home visits for both home care and personal care appointments. While EVV systems work to combat fraud and abuse to ensure members are receiving proper care and caregivers are held accountability, it is only the first step in a truly effective home care program.

While EVV is an effective monitoring tool for tracking arrivals and departures – thereby reducing false claims of time spent with a member – it only goes so far. Capturing and tracking data from an EVV solution won’t help Medicaid payers reduce readmissions and monitor other quality measures unless they actively manage the process and consider a collaborative and transparent home care platform.

Providers billing a payer without third party oversight may put payers at risk. With no way to prove what type of care was delivered – or if a caretaker even showed up – providers bill on faith, leaving payers with little ability to properly ensure accurate billing. The 21st Century CURES Act is a major step toward eliminating those issues, but if states and MCOs don’t implement EVV effectively, the potential impact of the technology will never be fully realized.

So how can parties implement EVV effectively? What is that next step that must be taken?

• Manage the data: As with every industry, data alone can’t solve any problems. Take time to categorize and analyze it, and address any anomalies. Data is your best weapon against fraud and abuse, but only if you use it properly. For example, correlations between aide timeliness, missed visits and exceptions to member quality of care.
• Collaborate with all parties: The siloed nature of the home and home health care system results in many opportunities for missed, lost or incongruent communication. It’s clear that the systems that perform the best are those that share information freely between Medicaid payer and provider. When two parties collaborate effectively, there is more opportunity to recognize issues and proactively prevent them.

Medicaid payers at the state and MCO-level need to consider how to implement EVV as part of a comprehensive system that will truly improve efficiency and provide better outcomes. When addressing how you as a payer will approach EVV in Florida, consider thinking about the bigger picture vs rushing to react to the ruling and implementing or mandating a certain EVV solution before taking those next steps.

Check out HHAeXchange’s Payer Management Solution and see how it can help you tackle traditional EVV and more.