Electronic Visit Verification (EVV)

Electronic Visit Verification, commonly referred to as EVV, is a technology-based system that verifies when and where home health care services are provided. This system is designed to ensure accuracy and reliability in the delivery of care services, particularly for those who are elderly, disabled, or require long-term care. 

EVV systems work by using technology to record and verify key information about the services provided during a home health care visit. This can be done through various methods, including mobile applications, landline telephones, and fixed devices installed in the patient's home. 

When a care provider arrives at a patient's home, they check-in using the EVV system, which records the time, date, and location of the visit. The same process is repeated when the visit ends. The system then transmits this information to a central database for verification and billing purposes. 

EVV offers numerous benefits for both care providers and patients. For providers, it simplifies the process of documenting and verifying services, reducing the risk of errors and fraud. It also provides a reliable record of care, which can be used for quality assurance and compliance purposes. 

For patients, EVV ensures that they receive the services they need, when they need them. It also provides a level of transparency and accountability, giving patients and their families peace of mind that their care is being properly managed. 

The 21st Century Cures Act, enacted by the U.S. Congress in 2016, mandates the use of EVV for all Medicaid-funded personal care services and home health care services. However, the requirement of EVV for Medicare is not as straightforward. 

As of now, the Centers for Medicare & Medicaid Services (CMS) does not require EVV for home health services under Medicare. However, this does not mean that EVV is irrelevant for Medicare beneficiaries. Many home health agencies that provide services to Medicare beneficiaries use EVV systems to ensure service delivery and streamline operations. 

The Role of EVV in Medicare Advantage Plans 

While EVV is not mandated for traditional Medicare, it plays a significant role in Medicare Advantage plans. Medicare Advantage plans are an alternative to traditional Medicare, offered by private companies approved by Medicare. These plans often include additional benefits, such as home health care services, that are not covered under traditional Medicare. 

Many Medicare Advantage plans require the use of EVV for home health care services. This requirement ensures that beneficiaries receive the services they are entitled to and helps prevent fraudulent claims. Therefore, while EVV is not directly required by Medicare, it is a critical component of many Medicare Advantage plans. 

Federal Regulations Surrounding EVV 

The federal government has recognized the importance of EVV and has implemented regulations to ensure its widespread adoption. The 21st Century Cures Act, enacted in 2016, mandates EVV implementation for Medicaid-funded personal care services and home healthcare services. This legislation aims to curb fraud, promote accountability, and ultimately enhance the quality of care provided to Medicaid beneficiaries. 

Under the 21st Century Cures Act, EVV systems must meet certain criteria to comply with federal regulations. These criteria include capturing the date, start time, end time, and location of the service, as well as the individual providing the service. By standardizing these data elements, the Act aims to create consistency and transparency in EVV implementation across different healthcare settings. 

State-by-State EVV Requirements 

While the federal government sets the groundwork for EVV, individual states have the autonomy to implement their own requirements. It's important for healthcare providers to familiarize themselves with the specific EVV requirements in the states they operate in. Each state may have slight variations in terms of implementation timelines, data elements to be collected, and penalties for non-compliance. 

State-specific EVV requirements can pose challenges for multi-state healthcare providers, as they must ensure compliance with varying regulations. Some states may require additional data elements to be captured in the EVV system, such as caregiver qualifications or specific service tasks performed. Understanding these nuances is essential for healthcare organizations to tailor their EVV systems accordingly.