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. Read More
Primary data from HHAeXchange highlights transparency, fraud and technology in home care
- 5 percent of respondents indicated that their home care provider didn’t always proactively address or seek care for potential medical issues or ailments.
- Less than 30 percent (27.9) of respondents indicated that their home care provider showed up on time and stayed the hours they were expected to work 100 percent of the time.
- 5 percent of respondents indicated that wearables will be an important part of home care in the future.
NEW YORK – Feb. 28, 2017 – Today, HHAeXchange, the home care leader in connecting payers, providers and members, released its inaugural State of Home Care 2017 survey results. This benchmark survey examines the current home care experience, shedding light on how members are impacted and how states, payers and providers can make efforts to improve the industry.
Posted by Home Health Care News; contributed by Tom Meyer, HHAeXchange
The numbers don’t lie.
After more than 10 years serving in the New York Office of the Medicaid Inspector General, including as the Acting Inspector General, I can attest firsthand to the unfortunate instances of fraud, waste and abuse that occur with too much regularity in home health care and home care.
Between 2011 and 2015 alone, investigations from the national Office of the Inspector General (OIG) resulted in more than 350 criminal and civil actions and $975 million in receivables. In fact, the OIG estimates more than $10 billion in improper payments in the 2015 fiscal year.
In spite of the numbers that point to the need for improvements, home health and home care play a vital role in the broader healthcare ecosystem, and increasingly, states are relying on managed care organizations (MCOs) to deliver efficient and effective Medicaid programs. For MCOs and state Medicaid programs alike, the balance between preventing fraud and continuing to provide quality care is a delicate one.ReadMore
Home Health Care News:
The numbers don’t lie.
After more than 10 years serving in the New York Office of the Medicaid Inspector General, including as the Acting Inspector General, I can attest firsthand to the unfortunate instances of fraud, waste and abuse that occur with too much regularity in home health care and home care.Continue Reading... Go To Article
In an industry where issues of mistrust and system abuse often rule the headlines, family and friends want reassurance that their loved ones are being provided with proper care. Government programs, like Medicaid, need accountability for the money they pay out, and proof positive that members are receiving proper care and caregivers are being held accountable. Electronic visit verification (EVV) alone doesn’t solve all problems, but implementing an EVV system is the first step to combatting fraud and abuse to ensure program integrity.
Signed into law this week by President Obama, the 21st Century CURES Act mandates, among other actions, that EVV be used for in-home visits for home care and personal care visits.
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 unless they actively manage the process and consider a collaborative and transparent home care platform.
The EVV Bill proposed to reduce FWA while improving patient care
The Office of the Inspector General of Health & Human Services has identified that personal care services provided in Medicaid are at high risk for fraud, waste and abuse. By using an electronic visit verification (EVV) solution, State Medicaid Agencies, Managed Care Organizations (MCOs) and homecare providers can reduce the level of fraud and improper payments, while ensuring that some of the most vulnerable Medicaid beneficiaries receive the care they need. Read More
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 Read More
HR Bill 2446 was rolled into section 207 of HR 2646 and passed the House by a vote of 422-2 on July 6, 2016.
- There were some Medicaid provisions in the Mental Health bill and therefore, to incorporate the following items
- EVV vendor neutrality clauses were added
- The scope was expanded from PCA services only to include home health services as well