Electronic Visit Verification (EVV) is a technology-driven system designed to accurately document and confirm the delivery of services within the home healthcare industry. It functions as a digital record keeper, capturing specific details about a visit in real-time to replace paper-based timesheets. The core purpose of EVV is to ensure that authorized care is delivered to the individual at the correct time and location.
This system provides an electronic method to verify service integrity, helping to reduce fraud, waste, and abuse in government-funded programs. By creating a transparent record, EVV streamlines administrative processes for providers and protects public funds. It confirms that the services billed for were the services received by the patient.
Federal Mandates and Verification Requirements
The necessity for EVV systems stems from federal legislation intended to improve the integrity of Medicaid programs. Section 12006 of the 21st Century Cures Act mandated that states implement EVV for Medicaid personal care services (PCS) and home health care services (HHCS) requiring an in-home visit. States faced incremental reductions in federal funding if they did not comply with the implementation deadlines.
Federal law establishes six specific data elements that must be collected and electronically verified for every service visit. These elements provide a complete picture of the service delivery event for audit and billing purposes. The required data points are:
- The type of service performed.
- The specific individual receiving the service.
- The date of service.
- The location where the service was delivered.
- The identity of the individual providing the service.
- The precise time the service begins and ends.
These six data points are the foundation for compliance and are used to validate billing claims against the authorized care plan. While the federal government mandates these core elements, states have the flexibility to select the specific technology used to capture this information. The requirement applies to a broad range of personal assistance services, such as help with daily living activities, and skilled home health services.
Technology Used for Data Capture
The front-end process of EVV involves the caregiver using one of several approved technologies to electronically record the six mandated data elements in real-time.
Telephony
Telephony relies on the client’s landline telephone to verify the service location. The caregiver uses the client’s phone to dial a toll-free number, and the system uses Caller ID to match the phone number to the client’s registered address, verifying the location. The Telephony system prompts the caregiver to enter a unique identifier and a service code to “check in” at the start of the visit. They follow the same process to “check out” upon departure, electronically recording the start and end times. This method is often used in homes without reliable internet or where the caregiver does not have a smartphone.
Mobile Applications
For caregivers with mobile devices, a GPS-enabled application is a widely used alternative. This mobile application allows the caregiver to clock in and out, with the device’s GPS functionality capturing the coordinates of the service delivery location. The GPS data is matched against the client’s authorized service address to confirm the caregiver was on-site. The mobile app can also store visit data temporarily if the caregiver is in an area without network connectivity and transmit it once a signal is restored.
Fixed Verification Devices
Fixed Verification Devices, sometimes called Fixed Objects, are dedicated electronic tools placed in the client’s home. The caregiver interacts with this device, often by scanning a barcode or entering a unique code, to register their arrival and departure. These devices provide a location-verified check-in/check-out without relying on a landline or the caregiver’s personal mobile phone.
Data Validation and Claim Processing
Once the caregiver completes the service, the visit data is immediately transmitted to a central EVV data aggregation system. This aggregator collects and organizes visit records from all providers, regardless of the specific EVV technology used. The system’s first back-end function is data validation, where the captured visit record is automatically compared against the client’s authorized care plan.
The system compares the electronic record to ensure the service type, duration, and provider are authorized for the recipient on that date. If the captured EVV data does not align with the authorized service plan, the system generates an “exception” or “alert.” These exceptions flag discrepancies, such as a visit that was too short or a location that does not match the client’s residence.
Agency administrators must review and resolve these exceptions by providing a valid justification or correcting the record before the visit is approved for billing. A claim will be automatically denied, known as a “hard edit,” if it is submitted without a corresponding, verified EVV record. After the EVV data has been validated and any exceptions cleared, the system compiles the information for financial processing.
The validated EVV data is integrated with the provider’s billing system and transmitted to the payer, typically the state Medicaid agency or a Managed Care Organization. This electronic record serves as evidence that the service was delivered as claimed, leading to final payment approval. Integrating EVV data into the claims process ensures that reimbursement is only issued for services demonstrably rendered.