Understanding and Implementing Electronic Visit Verification

The healthcare industry is in a constant state of transformation, driven by the ever-increasing demand for transparency, efficiency, and accuracy. In this dynamic landscape, healthcare providers and medical billing companies play a pivotal role in ensuring patients receive the care they need while maintaining the integrity of financial transactions.

Among the innovative tools at their disposal, Electronic Visit Verification (EVV) has emerged as a game-changer, reshaping how healthcare services are delivered and billed. The Center for Medicare & Medicaid Services (CMS) has mentioned on its website that as of January 1, 2023, all US states must have EVV for Medicaid-funded home health services (HHCS). This includes various services such as Nursing care, Physical therapy, Occupational therapy, Speech therapy, Medical social work, and Home health aide services.

The first step to implementing EVV is to learn why the need arose in US Medical Practices and how to implement it seamlessly, as it can prove advantageous for both the clients and the practitioners. Read further to obtain a detailed understanding of the process.

What is Electronic Visit Verification?

EVV is a comprehensive system that uses cutting-edge technology to electronically document and authenticate in-home care services, personal care services, and related healthcare offerings. Through geolocation tracking, real-time data transmission, and time-stamping, EVV guarantees that services are delivered accurately, precisely, and in adherence to the highest quality standards.

At its core, EVV represents more than just a technology solution; it symbolizes a commitment to quality care and the responsible use of healthcare resources. EVV’s implementation has become particularly critical to prevent fraud and ensure patients receive the required services.

Background of Electronic Visit Verification (EVV) implementation:

To understand the background of Electronic Visit Verification, we first need to understand the Medicaid program.

Medicaid is a joint federal and state program in the United States that provides health insurance to low-income individuals and families. It is the largest source of public health insurance in the country. It covers a wide range of healthcare services for eligible beneficiaries.

The federal and state governments jointly fund Medicaid, but the states administer it. Each state has some flexibility in determining eligibility and benefits within federal guidelines.

Over the course of time, there have been a lot of frauds associated with Medicaid funds, which affected the financial well-being of the program, thereby compromising patient care quality. To learn more about the issue’s magnitude, refer to this link.

Some of such frauds include the following:

• Billing for services not rendered: Providers charge Medicaid for services they never deliver, misusing funds.
• Upcoding and Unbundling: Billing for more expensive or unbundling services to inflate claims.
• Duplicate billing: Billing Medicaid multiple times for the same service.
• Identity theft: Fraudsters use Medicaid beneficiaries’ identities to claim payments for services they didn’t receive.
• Ghost patients: Providers enroll fictitious individuals and bill Medicaid for services never provided.
• Kickbacks and Self-Referrals: Providers receive financial incentives for patient referrals or prescriptions, violating anti-kickback laws and inflating billing.

To prevent the above-mentioned frauds and preserve the system’s sanity, the 21st Century Cures Act, passed in 2016, mandates EVV use for personal care and home healthcare services.

How does EVV work?

A basic knowledge of EVV will help the service providers ensure proper implementation, accurate billing, and compliance with regulations.

Let us see how Electronic Visit Verification works in this section.

Components of EVV

1. Data capturing devices

EVV relies on various data capture devices. Caregivers or healthcare providers typically use smartphones, tablets, or biometric devices with dedicated EVV apps. Alternatively, they might employ telephony-based systems using landlines or mobile phones. These devices serve as the means for caregivers to log in and out when they begin and conclude a service visit.

2. GPS technology

One of the core components of EVV is GPS technology. When a caregiver initiates a service visit, the system records their precise location using GPS coordinates. This geolocation data is fundamental in ensuring that services are provided at the correct place. It acts as a safeguard against fraudulent claims and inaccuracies in service delivery. This guarantees that patients receive the care they are supposed to.

3. Time stamps

Time stamps are another vital feature of EVV. They record the exact time when a caregiver starts and ends a service visit. These timestamps are crucial for preventing billing for services that were not provided or for overbilling by billing an excessive amount of time.

4. Real-time data transfer

EVV systems often transfer data in real time to a central database or server. This allows for immediate monitoring and reporting, enabling administrators to react promptly to missed visits or late check-ins.

5. Central database for storing collected data

The central database serves as the repository for all data collected through EVV. Authorized personnel can access this database, including caregivers, administrators, and billing departments. Care coordinators and administrators can review the data to ensure that services align with the care plan and that deviations are properly documented.

6. Data analysis

In addition to real-time data transmission, many EVV systems include data analysis and reporting features. These tools enable a more comprehensive examination of the collected data, identifying patterns, deviations, and trends. Data analysis can be instrumental in improving the efficiency of service delivery and care planning.

7. Mobile Apps and Web interfaces

Caregivers use mobile apps or web interfaces to interact with the EVV system. They can log in, access care plans, and record service information through these platforms. This accessibility simplifies the process for caregivers and ensures they have all the necessary information at their fingertips.

The technology used in EVV

Here are some technologies typically used in the Electronic Visit Verification process:

1. Mobile Apps: Caregivers use mobile apps to log visits, ensuring accurate documentation of care services.
2. Biometric Verification: Biometric methods confirm caregiver and patient identities securely.
3. Telephone Systems: Telephone-based check-ins provide a convenient way to verify caregiver presence.
4. RFID and NFC: Tag scanning technology offers a quick and reliable means to record visits.
5. Web-Based Portals: Web portals enable real-time access to EVV records for caregivers and administrators.
6. GPS Tracking: GPS ensures precise location monitoring to validate care services.
7. Electronic Signatures: Electronic signatures provide a digital record of care service confirmation.
8. Electronic Monitoring Devices: IoT sensors enhance EVV accuracy by tracking caregiver activities.
9. Cloud-Based Systems: Cloud technology simplifies data management and access across devices.
10. Electronic Health Records (EHR) Integration: Integration with EHR systems streamlines documentation and billing.
11. Alerts and Notifications: Instant alerts help maintain service consistency and address exceptions.
12. Reporting and Analytics: Data-driven insights enable caregiver performance and service utilization monitoring.
13. Data Encryption and Security: Robust security safeguards sensitive healthcare data within EVV systems.

Are EVVs secure and private?

The use of EVV demands a lot of data transfer, which includes sensitive patient information such as:

• Name and Identification
• Contact Information
• Medical History
• Diagnostic Data
• Medications
• Treatment Plans
• Insurance Information
• Financial Data
• Mental Health Information
• Biometric Data
• Images

This raises doubts about the security and privacy features of Electronic Visit Verification (EVV) systems.

Are EVVs really secure and private?

The Health Insurance Portability and Accountability Act (HIPAA) has strict privacy regulations to protect sensitive patient information to maintain the confidentiality, integrity, and security of healthcare data. Stakeholders involved will be held responsible per HIPAA, State and federal data breach laws, and various other laws per the jurisdiction’s specific laws and regulations. They will have to deal with a data breach’s potential legal and reputational consequences.

So, Yes. As law mandates, EVVs are secure and private.

Advantages of Electronic Visit Verification

Electronic Visit Verification (EVV) presents numerous advantages for the healthcare industry, specifically for Applied Behavior Analysis (ABA) providers.

Accurate service documentation

EVV ensures that ABA services are accurately documented, capturing critical data on session start and end times and the location of service delivery. This documentation is vital for billing accuracy, care plan adherence, and patient progress tracking.

Real-time data for Behavior Analysis

ABA service providers rely on real-time data to assess and analyze patient behaviour. EVV enables the immediate capture of data on patient interactions and activities, facilitating the ongoing assessment and adjustment of treatment plans.

Improved patient care

EVV ensures that patients receive ABA services as scheduled and in the correct location, enhancing patient care and improving treatment outcomes. This accuracy is especially crucial in ABA, where consistency is key to achieving behavioral goals.

Compliance with ABA Programs

EVV helps ABA providers align with the specific requirements of ABA programs. This ensures that services adhere to the program’s expectations, which may vary based on the patient’s age, diagnosis, and individualized goals.

Data-driven treatment plans

With real-time EVV data, ABA professionals can develop and adjust treatment plans based on patient progress. This ensures that interventions are data-driven and personalized for each individual.

Billing accuracy

Precise billing is paramount in ABA services, and EVV helps ensure that providers bill accurately for ABA sessions. This minimizes the risk of underbilling or overbilling and promotes fair compensation for services rendered.

Documentation for progress monitoring

EVV is a tool for documenting patient progress and capturing valuable records of behaviours, interventions, and achievements. This documentation aids in tracking progress, sharing information with caregivers and parents, and making data-driven decisions.

Behavioral feedback and coaching

ABA providers can utilize EVV data to offer real-time feedback and coaching to caregivers and therapists. With immediate insights into patient interactions, providers can maintain consistent and high-quality care delivery.

Efficient resource allocation

By accurately tracking services, ABA service providers can optimize resource allocation. This ensures that therapists and caregivers are assigned to specific cases where and when needed most, maximizing the impact of services.

HIPAA-Compliant data security

EVV systems are designed with patient data security in mind, ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA). Protecting patient data is of utmost importance in the healthcare field, and EVV systems safeguard sensitive information.

Reduced administrative burden

EVV streamlines the documentation and reporting process, reducing the administrative workload for ABA service providers. This efficiency allows professionals to dedicate more time to direct patient care and treatment planning.

Quality assurance

Real-time data capture through EVV allows ABA service providers to monitor the performance of therapists and caregivers. This ensures that services align with care plans and adhere to best practices, maintaining a high standard of care quality.

Better collaboration

EVV facilitates improved collaboration among caregivers, parents, ABA providers, and other healthcare professionals. All relevant parties have access to real-time service records, fostering open communication and a unified approach to patient care.

Training healthcare professionals to use EVV systems

Training healthcare professionals to handle Electronic Visit Verification (EVV) systems is crucial in the rapidly evolving healthcare landscape. It equips them with the skills to navigate these systems, reducing errors and ensuring adherence to regulations.

Data security and privacy are top priorities when handling sensitive patient information. Training programs educate healthcare professionals about the proper measures to safeguard data, reducing the risk of breaches and maintaining patient confidentiality.

Proficient professionals can use EVV systems more efficiently, saving time and directing their efforts towards patient care. This is especially important in resource allocation, where EVV data helps determine where therapists and caregivers are most needed.

Streamlining Electronic Visit Verification (EVV) in day-to-day work requires a client-centric approach, particularly when dealing with ABA clients. Here are some tips to make this process more efficient and client-friendly:

• Ensure effective communication with caregivers and clients by explaining EVV’s purpose, benefits, and data security measures.
• Obtain clear client consent and help them understand the advantages of EVV for their care.
• Opt for user-friendly mobile apps for therapists and caregivers to easily record and verify visits.
• Provide educational materials to caregivers and clients for effective EVV system usage.
• Establish support channels for prompt issue resolution for both clients and caregivers.
• Emphasize data privacy and confidentiality to reassure clients about their information’s security.
• Encourage feedback from clients and caregivers to enhance the EVV experience.
• Seamlessly integrate the EVV system with therapy practice management software for efficient client data management.
• Ensure accessibility for clients with disabilities by providing alternative input options.

As we conclude, it is clear that EVV is more than a digital tool; it is a promise to patients, caregivers, and all those involved in the healthcare ecosystem. It signifies a commitment to excellence, transparency, and unwavering dedication to providing the best care possible.

By embracing the transformative power of EVV and investing in the training and education of our healthcare professionals, we usher in a new era of healthcare, one that is defined by precision, efficiency, and, most importantly, the well-being of the individuals.