Electronic Visit Verification (EVV) is a technological system designed to confirm that authorized in-home patient services were delivered. This process uses digital tools to accurately document when a care provider arrives at and departs from a client’s residence. EVV creates an electronic record of service delivery details, replacing traditional paper-based methods. This verification applies specifically to personal care and home health services provided in individuals’ homes or communities.
The Federal Mandate Driving EVV Adoption
The requirement to implement Electronic Visit Verification systems originates from federal legislation known as the 21st Century Cures Act, signed into law in December 2016. Section 12006 of this Act mandates that all state Medicaid programs must require the use of an EVV system for certain types of services. This legislative action was intended to enhance program integrity and curb fraudulent billing within home-based care.
The federal government established distinct deadlines for compliance based on the type of service provided. States were required to have EVV systems in place for all Medicaid-funded Personal Care Services (PCS) by January 1, 2020. A later deadline of January 1, 2023, was set for Home Health Care Services (HHCS) requiring an in-home visit by a provider.
States that failed to meet these federal deadlines faced financial consequences through a reduction in their Federal Medical Assistance Percentage (FMAP). This incremental reduction in federal Medicaid matching funds was designed to incentivize timely adoption of the mandated technology. The penalty structure begins small and can increase incrementally each year the state remains non-compliant, reaching a maximum of a one percent reduction in FMAP.
The Centers for Medicare & Medicaid Services (CMS) allowed states to request a one-year delay in the implementation date if they demonstrated a “good faith effort” to comply but encountered unavoidable delays. However, even with an approved exemption, financial reductions began after the delayed deadline if the state had not fully implemented the system.
The Technology Behind Electronic Visit Verification
EVV systems capture and transmit specific service data using various technological methods designed to verify the time and place of care delivery. One common method is fixed line telephony, where the caregiver uses the client’s home landline telephone to call a toll-free number at the start and end of the visit. The system automatically verifies the call’s location using the registered phone number, serving as a digital clock-in and clock-out.
Another prevalent method involves using a mobile application installed on a caregiver’s smartphone or tablet, which utilizes Global Positioning System (GPS) technology. When the caregiver checks in and out using the app, the system records the precise GPS coordinates to confirm they are within the acceptable geofence area of the client’s home. This mobile approach offers flexibility and is widely used, particularly where landlines are not available.
A third method involves using a small electronic fob or token device placed within the client’s residence. The caregiver interacts with this device upon arrival and departure, often by scanning or entering a unique code, to record the visit time, which is later transmitted to the agency’s system. Regardless of the method used, all compliant EVV systems must capture six specific data elements for every service event.
These six required data points form the core of the verification process and are standardized by federal regulation. The system must capture:
- The type of service performed.
- The individual receiving the service.
- The individual providing the service.
- The date of service.
- The location of service delivery.
- The time the service begins and ends.
The accurate and electronic capture of these six elements is the mechanism by which compliance is measured and claims are validated.
Practical Application for Caregivers and Agencies
For home healthcare agencies, the implementation of EVV systems changes how they monitor and manage service delivery and billing operations. The technology provides agencies with real-time data on visit status, allowing them to quickly identify and address missed shifts or late arrivals. This immediate insight supports supervisory oversight of the care delivered in the field.
EVV streamlines administrative tasks by automatically creating an electronic record of the hours worked, which improves the accuracy of payroll processing. Caregivers benefit from the direct link between their verified visit data and the agency’s payroll system, reducing disputes over hours and ensuring timely and correct compensation. The elimination of paper timesheets removes a substantial administrative burden for both field staff and office personnel.
The digital verification process facilitates faster claims processing with state Medicaid programs. Because the EVV system provides verified data on the six required elements, agencies can submit clean claims with less delay, improving financial turnaround time. This accountability mechanism supports the prevention of fraud, waste, and abuse (FWA) by ensuring that payment is only made for services that were verifiably rendered.
The data collected by EVV systems allows agencies to better manage service authorization limits for clients. The system can provide alerts if a scheduled visit would exceed the authorized number of hours for a given time period, helping agencies remain compliant with the individualized care plan. This integration of verification and authorization data enhances the quality assurance framework for home-based care.