Overview:
Even though Electronic Visit Verification (EVV) has been in use for a while, 21st Century CURES Act mandates the use of EVV for Medicaid providers. The Cures Act requires states to implement an EVV (Electronic Visit Verification) system by January 1, 2021, for Medicaid-funded Personal Care Services (PCS) and by January 1, 2023, for Home Health Care Services (HHCS) that require an in-home visit by a provider.
Electronic Visit Verification (EVV) system must be able to electronically verify the following, with respect to visits conducted as part of the PCS or HHCS:
The type of service performed
The individual receiving the service
The date of service
The location of the service delivery
The individual providing the service
The time service begins and ends
Most EVV systems use Global Positioning Services (GPS) to capture the point of service. Another option to capture the location is Interactive Voice Response (IVR) which requires the caregiver or employee to check in and out using a landline or cellular device located at the patient’s home.
Under CURES Act, services either starting or stopping in the patient’s home are subject to EVV requirements. Therefore, capturing the location in which the services started and stopped is sufficient to meet the Cures Act’s requirements.
The purpose behind EVV is to ensure that PCS and HHCS visits billed to Medicaid are taking place, the services are provided to the right patient at the right location. Hence, Reimbursement for Medicaid visits must be linked to EVV to reduce fraud.
EVV Implementation Options for States
Under The 21st Century CURES Act, states have the flexibility to implement one of the three EVV models as long as it meets minimum mandated requirements. The following are the three models:
Open Model
State selects the EVV aggregator while allowing home care agencies to choose and use their software platform for EVV. State-selected vendors may also provide an EVV solution which is usually free for agencies. EVV aggregator will be required to provide a standard interface option for third-party EVV software platforms to send EVV data to the aggregator
Closed ModeL
State selects the EVV aggregator and the EVV solution. Home care agencies will be required to use the state-selected vendors to collect EVV data. EVV solution is usually free for home care agencies.
Provider Choice Model
The State allows the agencies to select the EVV system. Systems should be capable of submitting required elements to the State data aggregation mechanism, interoperating with claims submission functions. In addition, they should be able to adapt to any future federal or the State’s policies with regard to the submission of EVV data.
At this stage, most states have settled on a model and selected one or more EVV vendors. Some states have allowed MCOs to choose their EVV vendors. Even though some states chose Closed Model, more states have chosen Open Model or Provider Choice Model, providing flexibility to home care agencies.
EVV Implementation Options for Home Care Agencies:
In a Closed Model, agencies do not have a choice other than using slate selected EVV vendor for the services requiring EVV. For other services, agencies will have to use some other software platform.
In the Open Model, home care agencies will have the option of using the state-selected EVV vendor for the services requiring EVV. For other services, agencies may choose to use some other software platform. Another option will be to use one software platform for all services and send EVV data to the state aggregator.
In the Provider Choice Model, home care cares will choose the software platform for EVV and send EVV data to the state aggregator.
State-selected vendors usually provide EVV services to agencies for free. Even though it is tempting to use free EVV software, home care agencies should take a holistic view before settling on an EVV software platform. Cost savings of using free EVV software might not be enough to offset the additional cost associated with using multiple software platforms for agency operations.
Challenges with EVV solutions from state aggregators
One of the potential benefits of using the State-selected EVV vendor is that it is free. But, ‘Free’ EVV can cost the agency more through many operational inefficiencies.
The following are some of the challenges of using State-selected EVV Vendors.
Limits the choice of a software platform to only a few State-selected vendors
Narrow or limited focus on EVV and related services
Usually does not have comprehensive Revenue Cycle Management options
Does not handle other lines of service and payers
Agencies providing services across multiple states or multiple lines of service will be forced to use various software platforms
MCOs may use different EVV vendor
When the State changes the aggregator or aggregators leave a state, agencies will be forced to migrate to new software
Limited options for Clinical and Point of Care Solutions
Benefits of a comprehensive, integrated EVV Solution:
Home Health Care agencies should take a holistic view of their needs for a software platform rather than just focusing on their EVV needs. Using an integrated home care software platform to meet all the requirements of a home care agency will provide significant benefits that will outweigh the cost savings of ‘Free’ EVV.
The following are the benefits of using a comprehensive and integrated home care agency software platform:
Makes it easier to interface to multiple EVV Aggregators
Can use one software platform for multiple states and EVV Aggregators
One software platform will bring operational efficiencies to the agency
Continuity of operations when aggregators change
Will keep Intake, authorization, scheduling, clinical, and billing information in one database for all lines of services
One patient and employee record all lines of business
Shares clinical and financial information across multiple lines of services
Handle multiple payers – Medicare, Managed Care, Insurance, Private Pay
The transition of care from one service to another without re-entering information
Provide multiple services concurrently with one patient and employee records
Improve the quality of care by providing visibility to clinical information across service lines
Integrated scheduling across service lines will significantly reduce schedule conflicts and overtime
One invoice and statement to the patient for all services
Consolidated reporting for all services
Conclusion
At first glance, it is very attractive to hear that the State will pay for the EVV software. However, seemingly free EVV software might have many hidden costs for the home care agencies. Agencies should need a software platform that is more than just EVV. They should look for a comprehensive, integrated software platform that provides a strong interface with multiple EVV aggregators. The software platform should be able to handle numerous states and various services. The software platform should have integrated and comprehensive authorization management, scheduling, clinical, revenue cycle management, and reporting functions.
CareVoyant for Home Care is an integrated, cloud-based EVV software platform specifically designed for Home Health Care Agencies offering multiple services – Private Duty Nursing, Non-Medical, Personal Care, and Home Health - under ONE Patient and ONE Employee making it a Single System of Record.
ABOUT CAREVOYANT
CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.
CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.
For more information, please visit CareVoyant.com or call us at 1-888-463-6797.
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