Electronic Visit Verification (EVV) is a technological system used in home care to electronically document and verify that scheduled in-home services were delivered to the patient. This technology captures specific data points about the visit, creating a verifiable record that replaces traditional paper-based timesheets and logs. The system ensures accountability in the delivery of personal care and home health services by providing a clear, electronic audit trail for every visit. This modernizes the tracking of care delivery as more services shift from clinical settings to the patient’s home.
Defining Electronic Visit Verification
Electronic Visit Verification systems primarily serve to increase transparency and fiscal integrity within the home care industry, particularly for services funded by Medicaid. By digitally recording service events, EVV moves documentation away from manual records, which are susceptible to errors and manipulation. The core purpose is to minimize the potential for fraud, waste, and abuse (FWA) by ensuring that payment claims align with services actually rendered to the recipient. This digital shift provides a standardized and more reliable method for government payers to validate claims before reimbursement.
The Federal Mandate Driving EVV Adoption
The requirement for states to implement EVV systems stems from federal legislation known as the 21st Century Cures Act, specifically Section 12006. This law mandates that all state Medicaid programs must use EVV for certain services that require an in-home visit by a provider. The initial deadline for implementing EVV for Medicaid-funded personal care services (PCS) was January 1, 2020, and the deadline for home health care services (HHCS) was January 1, 2023. States that fail to comply face incremental reductions in their Federal Medical Assistance Percentage (FMAP) funding.
Core Requirements: What Data Must EVV Systems Capture?
To be compliant with the federal mandate, every EVV system must electronically capture six specific data elements for each service visit. These details are used to validate the service delivery and ensure that the claim is accurate. The goal is to provide a record of the who, what, where, and when of the in-home care episode.
- Type of service performed: The system must record the specific service delivered, such as bathing, meal preparation, or medication reminders, which is typically tied to the client’s approved care plan.
- Individual receiving the service: The unique identification of the Medicaid beneficiary or client who received the personal care or home health service must be documented in the system.
- Individual providing the service: This element requires verification of the caregiver or personal care provider who delivered the service.
- Location of service delivery: The physical location where the care was provided, usually the client’s home address, must be electronically confirmed by the EVV system.
- Date of service: The calendar date on which the service visit took place needs to be accurately recorded.
- Time the service begins and ends: The system must capture the exact time the service provider arrives and departs, establishing the precise duration of the care delivered.
How EVV Technology Verifies Home Care Visits
EVV systems utilize various technologies to capture the six required data elements, reliably confirming the caregiver’s presence and the visit’s duration. One common method is the use of mobile applications on a smartphone or tablet, which often employ Global Positioning System (GPS) technology to verify the location of the caregiver at the time of check-in and check-out. Some systems use geofencing, which digitally marks the client’s home address and only allows a successful clock-in or clock-out if the device is within that specified boundary.
Another verification option is fixed telephony, where a caregiver calls a toll-free number from the client’s home landline telephone, using Interactive Voice Response (IVR) to log the start and end of the visit. The system automatically verifies the location based on the phone number from which the call originates. For clients without a landline, some states permit portable tokens or fobs, which are small devices placed in the client’s home that the caregiver interacts with to record the visit data. Regardless of the technology used, the system must transmit the data to a state-designated data aggregator for comparison against billing claims.
Compliance and Enforcement
While the federal mandate outlines the necessity of EVV, state-level authorities manage the specific requirements for compliance, including the choice of system models. States may opt for an open model, allowing providers to choose from various approved EVV vendors, or a state-mandated model, which requires all providers to use a single, state-contracted system. Compliance is mandatory for all providers delivering Medicaid-funded personal care and home health services that require an in-home visit, with exceptions for services delivered by a live-in caregiver or those provided in a facility setting.
A state’s failure to achieve compliance results in a mandatory reduction of its Federal Medical Assistance Percentage (FMAP). This financial penalty starts at 0.25 percentage points and incrementally increases each year the state remains non-compliant, reaching a maximum reduction of 1 percentage point. The Centers for Medicare & Medicaid Services (CMS) allows states to apply for a one-year exemption from penalties if they can demonstrate a good faith effort toward compliance. This financial pressure ultimately trickles down to home care agencies, which face claim denials if they do not accurately use a compliant EVV system.
Benefits and Challenges of Using EVV
The implementation of EVV introduces organizational benefits for agencies by streamlining administrative processes and enhancing operational oversight. Electronic time capture leads to faster, more accurate billing cycles and expedites reimbursement from payers, minimizing manual data entry errors and reducing administrative burden. The systems also offer enhanced safety checks for caregivers by providing real-time visit information, allowing agencies to quickly identify and follow up on missed or late visits. For the client, EVV provides assurance that the scheduled care is delivered as authorized, improving service reliability.
The adoption of EVV is not without challenges. Initial system costs, including hardware and software procurement, can present a financial hurdle for home care providers. Caregivers have expressed concerns about privacy due to the location-tracking features. Clients may also have privacy concerns related to the technology being housed in their homes, while technical issues such as poor cellular service or internet connectivity in rural areas can complicate the mandatory electronic check-in and check-out process.