What is EVV? If you are in the home healthcare business, chances are you’ve at least heard of EVV (or electronic visit verification). So, what is it and why should you care? EVV stands for Electronic Visit Verification. Essentially, it is a technology that verifies where and when a caregiver begins services for a client and when they clock-out. This provides a breadcrumb trail that provides the basis for billing and ensuring the client or consumer received care. The need arose from abuse from some providers and/or their caregivers inflating and making up timesheets. It became too easy for an unethical agency owner to pencil in false service times and then bill Medicaid / Medicare for the services. The result was that billions of dollars were being fraudulently or inappropriately collected by agencies. Now with EVV technology, there is no disputing that a caregiver is in the location they checked in from (via GPS or registered land lines). You can imagine the millions of dollars this has already saved the healthcare system.
New Regulations Require EVV
Many states have already begun requiring electronic visit verification for registered agencies, but the EVV requirement is about to become a national mandate. In the last couple months of President Obama’s time in office, he signed the 21st Century Cures Act, which contained a lot of legislation. Pertaining to home health, the Cures Act will require that all home health agencies and personal care services that accept government reimbursements will have to have an EVV solution in place by the end of 2019 (then moved to 2020 due to the delay signed by Congress) for personal care and 2023 for home health agencies. The regulation allowed for a 1 year “good-fatih exemption” if the state was not ready to go live, but made “reasonable good faith” efforts to move the EVV implementation plans forward. Not that reading legislation is especially fun, but I am providing you with a link to the legislation if you’d like to do more research, here is the Cures Act and EVV legislation from the U.S. Congress website in relation to the Cures Act.
State Mandates Are Individual and Some EVV has Existed Before
Some states like Texas and South Carolina had mandated EVV long before this issue was ever a part of federal home care legislation. Missouri is another state that had EVV in place for several years already. Most states did not even have it on the radar. Now that there is a national mandate in the near future, many states are in the process of creating EVV policies right now.
Current EVV Implementation Models
- Provider Choice – Provider Choices means it is up to individual agencies or providers to select a compliant electronic visit verification software. Many times in this model, a state will create or purchase an EVV aggregator that pulls together all the visit data for analysis, reporting, and potentially verifying for claims payments. States like New York, Missouri, and Virginia are under the Provider Choice model.
- Open Model/ Hybrid Model – Under the open EVV model, a state contracts with an EVV provider and aggregator, but the providers still have a choice if they want to use their own EVV vendor, and connect with the state system. States like Ohio, Colorado and others have chosen this model.
- MCO Choice Model – Under the MCO choice model, each MCO or payer that manages Medicaid programs chooses their own aggregator or vendor. This can be a complex model, because one agency might contract with multiple payers, and that will require them to connect with multiple EVV aggregation systems, or even worse have to use multiple EVV software systems. Imagine training a caregiver on using three different EVV mobile apps and remembering which one to use when at different clients’ houses. States like Tennessee, and to some degree Pennsylvania, Florida and New Jersey have gone down this path.
- State Contracted Single Vendor EVV – under the state contracted model, the state will contract with one single EVV vendor and providers have no choice in what software system they use for electronic visit verification. Oftentimes, the EVV portion of the software will be free for providers, but helpful agency management features are an upcharge. In essence, it creates a monopoly in that state for the EVV vendor with the contract. Connecticut, Texas, Louisiana and some others have chosen that model, but more recently as the contracts expire, states are considering an open model.
We’ll discuss some of the warnings and successes of different state EVV mandates.
Warnings of Single Vendor Systems
- In Louisiana, the state mandated a single system in 2013, then a different one in 2015. They ended up cancelling both. Through that process both the state and providers wasted a tremendous amount of money, time and energy. Yet they have another mandated approach that is being implemented this year.
- Connecticut is currently suffering a class-action lawsuit for its single EVV implementation from a group of some of the largest providers in the state.
- Texas experienced major interruptions in care and reimbursements when its “preferred vendor” was forced to pull out of the state. Providers that were using that vendor had to migrate all of their data from one system to another and train their staff all over again on a new system.
- South Carolina and Tennessee have providers that operate across state lines having to use more than one EVV vendor. This causes an operational headache for those providers. Some of them have had to hire additional staff just to manage those different EVV systems.
- WHAT-IFs. What if that single vendor goes out of business? What if their systems go down for an extended period of time? What if the data quality cannot be trusted with no oversight?
In contrast, other states such as Missouri allowed providers to choose an EVV vendor that worked best for them as long as the vendor complied with Medicaid regulations. Well over 600 providers have implemented EVV in that state. We believe the risks of litigation, one company reliability and uptime, vendor business continuity and the satisfaction of stakeholders outweigh any benefits gained from having a single vendor system that does not allow competition in the marketplace. A multiple vendor solution is simpler, easier and more cost-effective for all parties involved. Finally, there are three potential ways that a state can implement a multiple vendor approach.
- Provider Choice. Providers choose their EVV of choice and ensure that all standards are met. Additionally, a common format export of data may be required by the state.
- State Overseer or Open Choice or Hybrid Model. State overseer of EVV in an open choice model. An organization (state or private sector) with no conflicts of interest will verify and oversee the data and quality of data coming from the various EVV vendors in a single database or data warehouse, and provide data insights to the state.
- Approved Vendor List. The state creates an approved vendor list. The list should not be static, but rather allows for different vendors to either be rewarded or punished for good or poor performance and design.
Providers Have a Say! Step Up
In the Cures Act legislation, the electronic visit verification mandate requires that states consult providers on a solution and that the solution is “minimally burdensome”. Let’s say that you’ve already spend the time, money and energy on creating a software solution for your company, including EVV. It works for you, and now you don’t even have to think about it. What if all this sudden, you had to switch EVV vendors? You have to now get all of the data out of your current EVV system and migrate it over to the new EVV! What if the new mandated EVV is not reliable and breaks frequently (a common complaint from many providers in one-vendor mandated state)? Not to mention, this will cause many wasted hours of training time for your staff to learn a new system. You are called to have a say in this matter in your state. Reach out to your associations and legislators to let them know that a provider choice solution is best for everyone involved.
Don’t Fight EVV, Embrace It
Some home care providers have been resistant to the idea of EVV, and like it or not, it’s coming. However, it’s not a bad thing, and it can actually make your business more profitable and efficient. EVV allows you to automatically eliminate paper time sheets, record visits, and create billing / payroll data at the push of a button. Additionally, if an audit comes your way, you won’t have to worry about digging out stacks of paper, you can just download your data in minutes. Most providers that use EVV find ways to save hours of admin time, cut overpayments, and find ways to increase revenue. So embrace the technology, it’s good for you. Bottom line is EVV will save your home care company money.
What types of EVV Technologies Exist?
Originally, EVV started out as a landline telephony technology that recorded the time called in and out at the client’s home. That method is still widely used today. However, with the advent of smartphones, more and more visits are being verified through smartphones using GPS location. This is by far the fastest growing method. Also, computers and tablets can be used for verified visits. Additional technologies include non-smartphone cell service triangulation, fixed-device check-ins, and now voice-bot check-ins. The non-smartphone method occurs when a caregiver calls through a non-smartphone, and then the cell carriers use the towers to locate where the caregiver is. With a fixed-device, some areas don’t have cell service or a landline, so caregivers will scan a barcode, record a number or scan an RFID card to clock-in/out.
- Cellphone Triangulation
- Computer or Tablet
While you may not need all of these technologies, some states are requiring multiple technologies in an EVV solution. Make sure that at the very least there is both telephony and mobile visit verification in your EVV solution.
CareTime Can Help
CareTime offers one of the best home care software solutions in the marketplace with a built in EVV system. We also can provide customized software and integrations for large organizations. Talk to us about how we can help you get ahead of the compliance requirement for EVV. Find out more about CareTime’s Electronic Visit Verification (EVV) software solution.