Electronic Visit Verification (EVV) is a technological system used in home healthcare settings to confirm that authorized services were delivered to the patient at the correct time and location. The system addresses a longstanding need for accountability in the delivery of personal care and home health services, particularly those funded by Medicaid, and was established as a direct response to concerns about fraudulent claims. By digitally recording visit details at the point of care, EVV replaces outdated paper-based methods, creating an immediate, verifiable record of service delivery. This process enhances program integrity and helps reduce the risk of fraud, waste, and abuse within the publicly funded healthcare system.
Core Components and Verification Methods
The verification process relies on various technological tools designed to capture visit data directly from the patient’s home. One common method involves mobile applications installed on a caregiver’s smartphone or tablet, which use built-in GPS capabilities. This GPS function automatically records the precise location of the caregiver when they log in and out, confirming they were at the service recipient’s residence. Some systems are designed with an offline mode that encrypts the data and transfers it later if connectivity is poor, ensuring the record is still captured accurately.
A second widely used technology is Telephony Visit Verification (TVV), designed for situations where a caregiver does not use a mobile app or if the client lacks Wi-Fi. In this scenario, the caregiver uses the patient’s landline telephone to call a toll-free number at the start and end of the visit. The system uses the caller ID function to verify that the call originated from the authorized service location associated with the patient.
A third, less common method involves a fixed verification device, which is a small hardware unit placed permanently in the patient’s home. Caregivers interact with this device upon arrival and departure, often using a unique personal identification number or an electronic fob. These different components provide states and agencies with flexibility in choosing a system that best suits their providers.
The Step-by-Step Verification Workflow
The verification process follows a standardized chronological sequence for every service encounter. When the home care provider arrives at the client’s home, the first step is the electronic “check-in” to log their arrival time. Using the chosen verification tool, such as a mobile app or the patient’s landline phone, the system immediately records the date and the time the service period begins. Simultaneously, the tool confirms the physical location of the check-in, typically through GPS coordinates or caller ID recognition.
The caregiver then performs the scheduled services for the duration of the visit. The EVV system runs passively during this service delivery period, recording the elapsed time. Once care has been provided, the caregiver initiates the electronic “check-out” process. This action logs the departure time and, in many systems, prompts the caregiver to confirm the specific services rendered during the visit.
After the check-out is complete, the recorded data is transmitted from the caregiver’s device to a secure data aggregator system. This transmission happens either in real-time or as soon as the device regains cellular or Wi-Fi connectivity. The system validates the captured data by comparing the actual visit details—like the time and duration—against the client’s pre-authorized service plan and schedule. Any discrepancy between the recorded visit and the authorized schedule is flagged for review by the agency or state payer.
The Six Required Data Elements
Federal legislation mandates that every Electronic Visit Verification system must capture and verify six specific pieces of information for a visit to be eligible for payment. These elements ensure a comprehensive, verifiable record of service delivery:
- The specific type of service performed, confirming the caregiver delivered the authorized care tasks.
- The individual receiving the service.
- The individual providing the service, establishing the correct patient-provider pair.
- The date of the service, ensuring the care event occurred within the authorized timeframe.
- The location of service delivery, verified by technology like GPS or caller ID to prove the visit occurred at the client’s approved address.
- The time the service begins and the time the service ends, which together establish the total duration of the visit and validate the billed hours.
Collecting these six data points is fundamental for billing validation.
Compliance and Data Security
The requirement for states to implement Electronic Visit Verification stems from the 21st Century Cures Act, a federal law aimed at improving health care system integrity. This mandate applies to all Medicaid-funded personal care services and home health care services requiring an in-home visit. While the federal law sets minimum requirements, each state manages its own EVV system and compliance model, which can include state-mandated systems or models that allow providers to choose their own vendor.
Due to the sensitive nature of the information collected, EVV systems must adhere to strict data security standards, primarily the Health Insurance Portability and Accountability Act (HIPAA). The system is capturing Protected Health Information (PHI), which includes the patient’s identity, the services they receive, and their location at specific times. Compliance involves using technical safeguards like encryption for data both in transit and at rest, as well as secure hosting environments.
Failure to use an approved EVV system or to accurately capture the six required elements can result in the denial of claims, which leads to payment delays or reduced federal Medicaid funding for the state.