Keeping up with the homecare industry’s changing rules and regulations, and ensuring your network’s compliance, can be all-consuming. If you’re like most payers, you might find yourself spending more time in the weeds than working to move your organization forward.
But as with conquering any of life’s challenges, your success in meeting new regulations is largely dependent upon your perspective and approach, as well as on the resources you choose to utilize.
In this blog post, we’ll discuss how payers can succeed in complying with the 21st Century Cures Act’s Electronic Visit Verification (EVV) mandate with the right tools and the right mindset.
Understanding the Cures Act
Established in 2016, the Cures Act mandates that states implement EVV for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2020 and HHCS by January 1, 2023.
This is a big undertaking. But what if instead of focusing on the headaches EVV could bring to your organization, you focused on the value?
Changing your perspective on EVV can start with recognizing its main purpose: to ensure timely service delivery for members and prevent fraud, waste, and abuse (FWA).
If EVV can enable you to deliver a better quality of care, why not put in the work to implement it effectively?
EVV Success – It’s All in the Network
The responsibility of EVV compliance is not only on you, but on your providers as well. You can set your network up for success by encouraging their use of convenient, easy-to-use EVV services that help them streamline their operations and reduce their administrative burden.
HHAeXchange provides managed care organizations (MCOs), state agencies, and providers with innovative EVV tools and a web-based platform that connect payers and providers for communication, billing, and workflow efficiencies. Through connecting with your providers in one shared platform, you can get the visibility you need into the day-to-day performance of your networks.
Once you understand exactly how EVV can ultimately help your company ensure a higher quality of care – and make your day-to-day lives easier – being positive and proactive in your approach may come more naturally.
So, how will EVV benefit your organization?
EVV can improve network management and oversight. Having a good handle on your provider networks is key to ensuring compliance and payment alignment. With a real-time overview into homecare service delivery, payers gain actionable insights into the health and efficiency of their networks.
EVV enables better data collection and visibility. Data is important to ensuring care delivery, PoC compliance, timely value-based payment interventions, and for making decisions for generating positive revenues. Some EVV platforms automatically check for caregiver and visit compliance and give advanced business analytics to monitor EVV compliance. With HHAeXchange, for example, payers can monitor the activity and compliance aspects of their network by claim, care plan, participant, caregiver, or system-wide.
EVV can help you identify at-risk members. As we’re in the midst of a global pandemic, it’s more important than ever to have visibility into the care of the people who need it most. Through analyzing EVV data in a week-over-week view, payers can see which providers’ visits declined considerably and intervene where necessary.
EVV enables better claims management. Payers often struggle to process claims due to incorrect billing codes, paper claims, and discrepancies with claims data or hours not authorized. With EVV, payers can streamline homecare claims management, reducing denials and ensuring clean claims. Claims cannot pass beyond HHAeXchange unless the service rendered reconciles with both the authorization and the electronic verification of the visit.
EVV supports value-based payment models. EVV provides the technology infrastructure to collect patient data in the home which can be used to monitor changes in condition and track provider quality metrics. Caregivers can be prompted at clock-in or clock-out with patient-specific questions and report their observations back to the agency, right from their mobile phone. These observations can help prevent adverse, costly events such as emergency room visits and hospital admissions.
Implementing EVV can be challenging, but if you focus on the good it can bring to your organization – data visibility, streamlined operations, and better member outcomes – the process will seem less like a burden and more like an opportunity.
If you’d like to learn how HHAeXchange can help you ensure compliance with the Cures Act and improve your business, schedule a demo.