Your Guide to Electronic Visit Verification (EVV)

Electronic Visit Verification is a federal mandate which is part of the 21st Century Cures Act. Its purpose is to mitigate fraud and abuse by using electronic systems to track caregiver visits.

How does it work?

EVV will utilize technologies like mobile applications, phones, or other devices in homes to collect data related to all services provided.

What EVV needs to monitor:

• The type of service performed
• Recipient of the service
• The date of the service and location of service delivery
• Time the service begins and ends

Benefits of EVV:

• Reduces fraud
• Faster billing and payments
• Reduces paperwork
• Improved quality of services
• Accuracy for timing, mileage, and services performed

Does EVV Apply to Your Business?

EVV applies when personal care services, home care services, behavioral health, or private-duty nursing services are provided and Medicaid pays for the services, or when the services are included in the state guidelines.

When Do You Need to Start Implementing EVV?

January 1, 2020 – Personal Care Services

January 1, 2023 – Home Health Care Services

Note: Some states and managed care organizations (MCO) may require EVV implementation earlier than those dates. Those who fail to meet the deadlines will face a penalty.

States Can Choose Between Two Implementation Models:

1. Closed Model – the state implements a single EVV system and mandates that home care providers use it.
2. Open Model – the state allows home care providers to choose from EVV solutions that have been certified to meet certain requirements. 

The open model is the preference for agencies. There are many restrictions with the closed model and in many cases, agencies may be required to duplicate submitted data to both the state-mandated system and to another provider.

Over 75% of states have adopted the Open Model.

Challenges of EVV:

Depending on the state model selection and requirements, agencies may need to submit different format data to different EVV systems. Also, there could be different deadlines for each EVV system.

For example, Florida selected an open model. There are three designated EVV systems based on who pays:

• Florida Agency for Healthcare Administration (AHCA) uses Tellus
• Several MCOs (United, Aetna, Anthem) use Tellus
• Other MCOs (Humana, Staywell, Sunshine Health) use HHAeXchange

Florida requires EVV earlier than the federal mandate dates: October 1, 2018, for state FFS Medicaid (AHCA) October 1, 2019, for MCOs.

After those dates, claims can be denied if EVV data is missing.

SwyftOps is the future of home care solutions. The SwyftOps team has over 60 years of combined experience in the home care industry and understands where the business is heading in regards to EVV. If you are interested in more information about what our software can do to improve your business, contact us today to request a demo or schedule a discovery call.