Medicaid offers incredible opportunities for home care agencies, providing access to a reliable revenue stream while empowering agencies to serve underserved populations who need care the most. However, it also comes with its own unique challenges, with one of the most complex and critical being Electronic Visit Verification (EVV).
To help you make the most of the Medicaid opportunity, we’ve created this guide to equip you with the knowledge you need to navigate EVV correctly and confidently.
What is Electronic Visit Verification (EVV), and Why Is It Required?
Electronic Visit Verification (EVV) is a system designed to confirm when and where caregivers provide services to clients in their homes. By tracking key details such as time, location, and type of care delivered, EVV ensures caregivers fulfill their responsibilities, clients receive the care they need, and home care agencies remain compliant with Medicaid and state regulations.
EVV was introduced as a federal requirement under the 21st Century Cures Act to combat fraud and ensure accountability in Medicaid-funded home care services, including Personal Care Services (PCS) and Home Health Care Services (HHCS). By preventing providers from billing for visits that never occurred, EVV enhances compliance and integrity across the industry.
In addition to meeting legal mandates, EVV offers several benefits: it increases efficiency in scheduling and tracking visits, improves billing and payroll accuracy, reduces opportunities for fraud and abuse, and enhances the overall quality of care provided to patients. By ensuring caregivers are present at scheduled appointments, EVV plays a vital role in delivering timely, reliable care to those who need it most.
How Does Electronic Visit Verification Work?
Electronic Visit Verification (EVV) works by electronically collecting specific pieces of information, including the type of service performed, the individual receiving the service, the date and location of service delivery, the caregiver providing the service, and the start and end times of the visit. In some states, additional details may also be required, such as the name of the caregiver and their relationship to the care recipient.
This information is typically captured through a GPS-enabled mobile app, which tracks the caregiver’s check-in and check-out times and locations.
Open vs. Closed State Models Explained
Home care agencies must implement Electronic Visit Verification (EVV) in order to provide services to Medicaid clients. This can be either an EVV system chosen by the agency or one mandated by the state. This is referred to as the open and closed state models.
Under the closed model, only a single EVV vendor is allowed which maintains consistency but may strain states, providers, and caregivers. The open model allows providers to choose their own EVV systems and uses a universal EVV aggregator to refine all the data. EVV Aggregators gather, process, and standardize live data, facilitating cross-comparison with submitted claims.
Even in a single state, different programs and payers/MCOs may enforce distinct EVV requirements, necessitating the utilization of multiple systems by home care agencies.
What is an EVV Aggregator?
An EVV aggregator is a centralized system used to collect and process data from multiple EVV vendors. Regardless of whether a state operates under an open or closed model, these systems automatically send visit data to the state’s aggregator. The aggregator ensures the data meets state-specific requirements and serves as a reference point for validating claims and billing submissions.
While EVV aggregators simplify compliance by standardizing data, they can also introduce challenges. Mismatches between EVV data and Medicaid claims can complicate billing, causing delays or denials. Agencies must ensure EVV and billing data is transmitted accurately and on time to avoid these issues. This is especially important in states with multiple programs or payers, each with unique submission requirements.
The Different EVV Models
There are a few EVV models that states can choose from which generally fall under the open or closed model category:
- Open Vendor: States choose an EVV vendor and a data aggregator. home care providers can use these state-endorsed vendors for free or they can choose to work with a different EVV vendor at their own cost. If an organization decides to use an alternative vendor, it usually needs to integrate with the state's chosen data aggregator.
- State-Mandated External Vendor: Providers have to use a specific vendor selected and funded by the state.
- State-Mandated In-House System: States may develop and manage their own EVV systems, which providers must use.
- Provider Choice: Providers have the freedom to select their own vendors and cover the expenses on their own. Some states may increase reimbursement rates to help cover these costs.
- Managed Care Organization (MCO) Choice: MCOs have the authority to choose the vendor and cover the costs. They may or may not receive support from the state to assist with these expenses.
EVV State-by-State Overview
To Sum Things Up
It's clear that Electronic Visit Verification (EVV) is a struggle that many home care providers have to overcome when contemplating Medicaid involvement. We hope our guide has brought some clarity on the matter. If you still have any questions, feel free to fill out the form below and get in touch with us.
.webp)
