Electronic Visit Verification (EVV) is a technology framework designed to confirm the delivery of personal care and home health services. This system electronically records specific details about a service visit to ensure authorized care was provided at the required time and location. EVV is used predominantly in Medicaid-funded services, serving as an automated method for validating claims. Its goal is to enhance program integrity and accountability by reducing fraud, waste, and abuse within the home care industry.
Essential Data Points for Visit Verification
The core function of an EVV system is to capture and confirm six specific pieces of information about every in-home service interaction. These required data elements create a verifiable digital record of the visit, which is then used to validate billing submissions to state Medicaid programs. The information collection begins with identifying the individual receiving the care, ensuring the service is tied to the correct patient record and care plan.
The system must record the identity of the caregiver who provided the service, confirming that an authorized professional was present. A third data point specifies the exact type of service performed, linking the action taken to the service authorized and billed for.
Recording the date of the service visit provides a calendar reference for the care delivered, matched against the patient’s schedule. Precise time tracking is also required, capturing the exact moment the service begins and concludes. This time-stamped data establishes the duration of the visit, verifying the length of time billed.
Finally, the system must electronically confirm the location where the service was delivered, typically the patient’s residence. Verifying this location is a significant anti-fraud feature, confirming the caregiver was physically present at the authorized address. All six data points must be collected for a service visit to be considered compliant and eligible for Medicaid reimbursement.
Methods for Electronic Visit Verification
The process of collecting the required six data points relies on several distinct technological methods that caregivers use to electronically clock in and out. One of the earliest and most common methods is telephony, which involves the caregiver using the client’s landline or registered phone number to call a toll-free number. The EVV system then verifies the visit’s location by matching the incoming phone number with the patient’s address on file.
Another widely adopted mechanism is Mobile GPS Applications, allowing the caregiver to use a smartphone or tablet to check in and out. These applications utilize the device’s Global Positioning System to log the precise geographical coordinates of the transaction. The location data is then compared against the patient’s authorized service address to confirm the caregiver’s presence.
Some systems utilize Fixed Visit Verification Devices, which are dedicated pieces of equipment placed inside the client’s home. These devices employ verification techniques, such as generating a one-time password or token that the caregiver enters upon arrival and departure. This method establishes physical presence without relying on a patient’s phone or a caregiver’s mobile device.
The chosen verification method must reliably capture the start time, end time, and location to create a compliant record. Many state programs allow providers to choose from a range of methods to accommodate varying patient circumstances, such as a lack of internet access or a mobile phone signal. The system is designed to upload time and location data in real-time or store it for later transmission if connectivity is unavailable.
Compliance Requirements and Federal Mandates
The nationwide requirement for Electronic Visit Verification was introduced under federal law through the 21st Century Cures Act, specifically Section 12006. This legislation mandated that states implement an EVV system for Medicaid-funded personal care services and, later, for home health services involving an in-home visit. The initial compliance deadline for personal care services was January 1, 2020, though many states received a one-year extension.
The mandate for home health care services required systems to be in place by January 1, 2023. This staggered timeline allowed states and providers time to adapt to the new technology and regulatory framework. The federal government’s Centers for Medicare & Medicaid Services (CMS) oversees compliance with the Cures Act requirements.
States that fail to implement and enforce the EVV system are subject to financial penalties, taking the form of incremental reductions in federal Medicaid matching funds. These reductions can be applied annually, increasing up to a one percent reduction of the state’s federal medical assistance percentage (FMAP). This consequence incentivizes states to ensure timely adoption of the EVV technology.
States have flexibility in how they implement their EVV program, generally falling into one of two models. A “Closed Model” means the state selects a single, mandated vendor that all providers must use. Alternatively, an “Open Model” allows providers to choose their own EVV vendor, provided the system can seamlessly integrate and transmit data to a state-designated data aggregator for compliance reporting.