Implementing Electronic Visit Verification (EVV): A Comprehensive Guide

In the realm of regulatory compliance, things rarely unfold swiftly. Since the introduction of the 21st Century Cures Act in 2016, CMS has advocated for the implementation of Electronic Visit Verification to track caregiver visits. The goal was to have all Medicaid-funded home healthcare providers integrate the new technology by January 1, 2020. However, forty-nine states plus Guam and the District of Columbia applied for the deadline extension, moving it out another year.

Given that CMS contributes 50% of any state’s Medicaid budget, those states granted extensions based on proven good-faith efforts (GFE) are now scrambling to avoid penalties that would impact their Medicaid funding. With the latest deadline set by Congress for January 1, 2024, state-supported Medicaid programs offering Home Healthcare Services or Skilled Nursing Care must now fully operate under an EVV system. 

To better understand the intricacies of EVV adoption, we’ve compiled the essential information on the different EVV models employed by each state and explored the various vendor options available. With this knowledge, your agency can confidently embark on the path toward successful EVV implementation, ensuring compliance, optimizing patient care, and safeguarding vital Medicaid funding.

What is EVV?

Electronic Visit Verification (EVV) is a system that guarantees accurate billing for home visits and helps ensure that beneficiaries receive the necessary support for their needs. It involves using a computer or phone-based system to capture the following six data elements electronically: 

• the person receiving the services
• the caregiver providing the service
• the type of service
• the location of the service delivery
• the date of the service
• the time the service begins and ends

EVV implementation in Medicaid-funded home health and home care is vital in addressing Medicaid fraud and abuse, streamlining time-consuming tasks for caregivers with automation, and putting the best resource possible toward verified patient care. Failure to comply with these regulations will result in the denial of all claims for services requiring EVV, with any state system that fails to implement EVV seeing a reduction in Medicaid funding by 2%.

Federal Goals for EVV

EVV allows caregivers and agencies to unlock various advantages, revolutionizing how healthcare services are delivered.

Some of the top benefits of EVV include:

1. Streamlined Documentation:
   • Automated and simplified the documentation of caregiver visits, reducing administrative burdens.
   • Enhanced accuracy in capturing visit details eliminates the risk of manual errors and ensures comprehensive record-keeping.
2. Fraud Prevention and Accountability:
   • By verifying the start and end times of each visit, EVV prevents fraudulent activities, fostering trust between caregivers and agencies.
   • Improved accountability promotes compliance and helps identify and resolve any discrepancies in care delivery.
3. Transparent Care Coordination:
   • Real-time visibility into visit details provided by EVV enables effective care coordination among healthcare professionals.
   • Timely interventions can be made if needed, ensuring prompt responses to any issues that arise during the care process.
4. Simplified Billing and Reimbursement:
   • EVV simplifies billing and reimbursement processes by automating data collection and eliminating manual paperwork.
   • Minimized errors and accurate documentation result in efficient and timely payments, reducing financial complexities for both caregivers and agencies.
5. Empowerment and Communication:
   • EVV empowers home healthcare professionals by increasing efficiency and streamlining workflows.
   • Seamless communication among caregivers, patients, and agencies is facilitated, leading to improved collaboration and better patient outcomes.

While the benefits mentioned above are general advantages of EVV systems, it is important to note that the specific capabilities may vary depending on the provider. Agencies should choose an EVV solution that aligns with their unique needs and state requirements to unlock even greater potential in delivering exceptional care.

EVV Vendor Models

Each vendor model varies in the degree of state involvement in vendor selection and system management. 

Here is a breakdown of each vendor model:

1. Open Vendor

• Most flexible model.
• Agencies can use an EVV vendor selected by the state free of charge.
• Agencies can work with a different vendor at their own expense as long as their EVV solution passes certification criteria.
• States also require an aggregator system that can integrate all EVV data and will set requirements for vendors to connect with an aggregator.

1. Providers Choice

• Agencies must select a vendor or build an EVV system themselves.
• The state will set data collection requirements and can provide a list of approved vendors for an easier choice.
• States can incorporate the costs of purchasing or building EVV technology into their reimbursement rate calculation.

3.   MCO Choice

• Managed care organizations (MCOs) select the vendor and pay for it. 
• If the state has multiple MCOs, providers might be required to learn to use several EVV systems, but they’re allowed to require administrative support.

4.   State-mandated External Vendor

• A state picks one EVV vendor and requires all MCOs, providers, and individuals to use it. 
• While this model puts all financial burdens on the state, it eliminates problems with data standardization and access. 
• The state must also provide system training.

5.   State-mandated In-house Vendor 

• This most burdensome option for states requires complete development and management of an EVV system. 
• While it might be the most expensive option, it makes sense for states with solid EVV solutions. 
• Other benefits include complete control of data access and training.

Most states operate under the Open vendor model, which grants providers the most flexibility but also requires them to find a vendor. For more information about each state’s EVV requirements, visit this EVV resource page. In the following sections, we will provide simple steps and address common concerns to help providers navigate the vendor selection process more efficiently.

Pros and Cons of Each System Type

Now, let’s dive into the different types of vendors for Electronic Visit Verification and explore the advantages and disadvantages of each approach.

State-based system

When implementing Electronic Visit Verification (EVV) in your home healthcare agency, state-based EVV software is a compelling option. This vendor model allows your agency to effectively streamline operations and ensure adherence to state regulations while optimizing patient care.

Some of the benefits of using a state-based EVV software include:

1. Compliance: State-based EVV software ensures compliance with specific regulatory requirements and technical standards set by the state.
2. Cost-effectiveness: State systems are often provided at no cost or with minimal fees, reducing financial burdens for home healthcare agencies.
3. Seamless Integration: State-based EVV software is designed to integrate smoothly with existing state-run systems and platforms, facilitating data exchange and streamlining workflows.
4. Technical Support: State-based EVV software typically has dedicated technical support and assistance to promptly address any issues or concerns.
5. Data Standardization: State systems enforce standardized data collection and reporting protocols, ensuring consistency and compatibility across agencies and providers.
6. Updates and Enhancements: State-based EVV software undergoes regular updates and enhancements to align with evolving regulatory requirements and incorporate new features and functionalities.
7. Interoperability: State systems often prioritize interoperability, allowing for efficient data sharing with other healthcare stakeholders, such as Medicaid agencies and managed care organizations.
8. Training and Education: State-based EVV software providers offer training and educational resources to assist agencies and caregivers in understanding and effectively using the system.

It’s important to note that while state-based EVV software offers these benefits, there may be variations in features and capabilities depending on the specific state and its implementation model. Also, working with an independent vendor can unlock more outstanding features and capabilities. The same can also be said for using a custom-built system. 

Independent vendor

While transitioning to and training on new software can be frustrating at first, it’s worth it if it can streamline operations and make every day easier for your staff. Independent vendors offer features and capabilities designed to automate repetitive tasks and improve patient satisfaction. 

The benefits of using an independent vendor for EVV include:

1. Customization: Independent vendors often offer more flexibility in customizing the EVV system to meet the specific needs and workflows of the home healthcare agency. This allows for tailored solutions that align with the agency’s unique requirements.
2. Advanced Features and Capabilities: Independent vendors frequently provide additional features and capabilities that may not be available in state-based systems. Some examples include:
   • Integrated EMR + EVV mobile application: All-in-one mobile apps that allow caregivers to capture time, geo-location, and complete documentation on their personal devices, improving efficiency and reducing costs.
   • Intuitive workflows: Automated alerts for clinicians, schedulers, and billers ensure accuracy in documentation, claims, and compliance.
   • Streamlined scheduling: Utilizing a mobile app allows caretakers to view the most up-to-date appointment information and set reminders about upcoming appointments, reducing wasted commute time, no-shows, and scheduling errors. 
   • Financial automation: Real-time data entry and instant upload of billing codes, reducing errors and delays in billing and reimbursement processes.
3. Dedicated Customer Support: Independent vendors often provide personalized customer support, offering timely assistance, training, and troubleshooting to ensure a smooth implementation and ongoing usage of the EVV system.
4. Innovation and Agility: Independent vendors are often at the forefront of technological advancements and industry best practices. They continuously update and enhance their systems, offering access to the latest features, updates, and innovations in EVV technology.
5. Integration Capabilities: Independent vendors may have more flexibility in integrating their EVV system with the agency’s other software or platforms, such as electronic medical records (EMR) or scheduling systems. This allows for a seamless and efficient workflow, eliminating the need for manual data entry or duplicate systems.

By opting for an independent vendor for EVV, home healthcare agencies can benefit from customization, advanced features, dedicated support, innovation, and seamless integration capabilities that may not be available in state-based systems. These advantages can lead to improved patient care, enhanced efficiency, and better operational outcomes for the agency.

Custom-built system

 Building an EVV system is time-consuming and expensive, but if you are looking for features that aren’t available on the market, this may be your best option. However, some independent vendors may be able to build out the features you’re looking for, saving you time and money on complete software development. 

The benefits of using a custom-built system for EVV include:

1. Complete Customization: A custom-built EVV system is tailored to your requirements, aligning with your agency’s specific workflows, processes, and operational needs. Every aspect of the system can be designed and developed according to your unique needs, ensuring a perfect fit.
2. Scalability and Future-Proofing: With a custom-built system, you can scale and adapt the solution as your agency grows or as regulatory requirements evolve. It can easily accommodate future changes, ensuring long-term viability and reducing the need for major system overhauls.
3. Unique Functionalities: Custom-built EVV systems provide the opportunity to incorporate specific functionalities that may not be available in off-the-shelf solutions. You can prioritize features that directly address your agency’s pain points and enhance efficiency, allowing for a truly bespoke system tailored to your needs.
4. Complete Control and Ownership: A custom-built system gives you full ownership and control over the technology. This means you can make adjustments, updates, and modifications as needed without relying on external vendors or facing limitations imposed by pre-built solutions.
5. Seamless Integration: Custom-built systems can be designed to seamlessly integrate with existing software and systems already in use within your agency, such as EMR or billing systems. This integration ensures a smooth flow of data and information across different platforms, eliminating the need for manual data entry or managing multiple disconnected systems.
6. Data Security and Compliance: Custom-built systems offer enhanced data security measures tailored to your agency’s specific requirements. You can implement robust security protocols and compliance measures to protect patient data and meet regulatory requirements, giving you peace of mind.

While custom-built EVV systems require investment in time and resources, they provide unparalleled flexibility, tailored functionalities, and the ability to stay ahead of the curve. It is crucial to carefully evaluate the cost, resources, technical expertise, scalability, and long-term maintenance requirements before opting for a custom-built EVV system. 

Developing a custom-built system is the most costly and time-consuming option. It involves significant upfront expenses for software development, customization, testing, and ongoing maintenance. Building and refining the system can also extend the implementation timeline, delaying the benefits of EVV. 

Discover what’s possible with Cubhub’s EVV system

Streamlined documentation, fraud prevention, transparent care coordination, simplified billing and reimbursement, and empowerment through communication make EVV implementation a powerful tool for home healthcare providers. Careful system evaluation will lead to successful EVV implementation, improving patient care, reducing administrative burdens, and enhancing operational efficiency in the home healthcare industry. 

Cubhub is designed to make EVV implementation effortless and bring the focus back to patient care. Our experts are happy to help you get started. Visit our EVV Resource to view your state’s EVV requirements and learn how Cubhub can make EVV as easy and efficient as possible.