If you are in the home health business, chances are you’ve at least heard of EVV. 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.
The need arose from abuse from some providers 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 for personal care and 2023 for home health agencies.
State Mandates Coming Your Way
Some states like Texas and South Carolina had mandated EVV long before this issue was ever a part of federal home care legislation. 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.
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. 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 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.
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.