In-home and community-based healthcare settings require meticulous oversight to confirm that authorized services are delivered to the recipient. Tracking care provision, often occurring without direct supervision, challenges healthcare payers and providers. A standardized technological solution was adopted to ensure accountability and integrity by verifying service events electronically.
Defining Electronic Visit Verification
The acronym EVV stands for Electronic Visit Verification, a system that uses technology to electronically document and authenticate in-home and personal care services. The core function of EVV is to confirm that an authorized caregiver was present at the correct location at the scheduled time to deliver the documented service. EVV serves as a digital record to match the service billed with the service provided to the recipient. This system aims to reduce administrative burden associated with paper-based verification and improve the accuracy of service claims.
The Required Data Points for Service Confirmation
To achieve verification, federal law mandates that every EVV system must capture and store six distinct pieces of data for each service visit. The system must record the specific Type of service performed, detailing the exact care delivered to the patient. It must also identify the Individual receiving the service and the Individual providing the service to establish the participants in the encounter.
Additionally, the EVV system must capture the precise Date of the service and the exact Time the service begins and ends to confirm the duration of the visit. Finally, the system must verify the Location of service delivery. The collection of these six data elements is the basis for validating the service and processing the subsequent claim for payment. This electronic confirmation helps prevent fraud, waste, and abuse within home care programs.
Legislative Mandate and Compliance Scope
The requirement for states to implement Electronic Visit Verification originated with the federal 21st Century Cures Act, specifically Section 12006. This law mandated the use of EVV systems for specific services funded through Medicaid programs to promote fiscal integrity. The mandate applies to all Medicaid-funded personal care services (PCS) and home health care services (HHCS) that require an in-home visit by a provider.
The compliance deadlines for states were set incrementally. States were initially required to have EVV systems in place for personal care services by January 1, 2020. The second deadline required EVV implementation for home health care services by January 1, 2023. States that fail to comply with these requirements risk incremental reductions in their Federal Medical Assistance Percentage (FMAP), which is the federal share of their Medicaid funding.
Methods Used for Visit Verification
Caregivers use various technologies at the point of care to capture the six required data points. One common method involves mobile applications used on smartphones or tablets, which utilize the device’s built-in Global Positioning System (GPS) to verify the service location upon check-in and check-out. The mobile app automatically time-stamps the start and end of the visit, recording the necessary location and time data. This method provides flexibility for caregivers who travel to multiple homes.
Another widely used method is the Telephony/Interactive Voice Response (IVR) system. The caregiver uses the client’s landline phone to call a toll-free number at the start and end of the visit, and the system verifies the service location using the phone number’s Caller ID. For homes without a landline, some systems employ Fixed Verification Devices. These are small electronic units placed in the recipient’s home that the caregiver interacts with to log the visit. Regardless of the method chosen, the technology must securely transmit the captured data to a central system for audit and claims matching.