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.
Before technologies could track and report a caregiver’s visit, the providers would bill a payer based solely on the plan of care – which may or may not have been followed by the home aide. With no way to prove what type of care was delivered – or if a caretaker even showed up – the provider billed on faith, the payer would often overpay, and the member was left without proper care. 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.
- Collaborate with all parties: The siloed nature of the home and home health care system results in many opportunities for fraud, waste and abuse, and 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, spot instances of fraud and proactively prevent them.
- Understand how your state will handle the CURES mandate: Though it’s now federal law, the CURES Act will be carried out differently across states. Stay tuned to your own state’s conversations for more specific information about how to comply.
Medicaid payers at the state and MCO-level need to consider how to implement EVV as part of a system that will truly improve efficiency and provide better outcomes. The mistake that many will make is rushing to react to the ruling and implementing or mandating a certain EVV solution, without thinking about the bigger picture and taking those next steps.
Learn more about how your organization can effectively implement EVV and take the right steps to actively manage the home care process.