Home Health, Skilled Nursing Facility

Implement Electronic Visit Verification to comply with 21st Century Cures Act

Home care agencies offering personal care, homemaking, respite and other non-medical services funded by Medicaid will soon be required to implement Electronic Visit Verification (EVV). Agencies should take note of available options and best practices to stay in compliance and avoid penalties.

This change primarily impacts Medicaid for now, but will be coming later for Medicare and likely will be required for private duty agencies if they get institutional customers, like hospitals.

EVV for Medicaid-funded home care is mandated by the 21st Century Cures Act, which passed through the U.S. Congress with strong bipartisan support and was signed into law in December 2016.

Agencies providing personal care services that don’t comply will face a federal medical assistance percentage reduction of 0.25% starting in 2019 and up to 1% after 2023. Payment reductions for Medicaid-funded home health will begin in 2023. It’s crucial to implement some form of EVV to avoid these penalties.

EVV systems range in price from $8 to $12 per client, per month. That cost is generally well below the 1% penalty, especially when skilled care is provided.

The implication of these EVV mandates is that agencies need to use technology to prove caregivers performed home care visits. This legislation was crafted because the home care industry has a bad historical reputation for fraudulent activity, where some bad apples submitted claims for work that wasn’t actually done. Congress has sent a strong message that if you’re going to charge for home care work, you have to do the work and prove that you did it.

Implementing EVV typically has the added benefit of increasing speed for processing billing and payroll.

It also has helped agencies understand the exact amount of time that caregivers spend at patients’ homes. Most Medicaid programs have agencies bill personal care visits in 15-minute units. Some programs only pay for completed 15-minute units, while others employ rounding rules.

Understand available EVV options

EVV can be achieved in several ways, including through use of telephony, a mobile app with GPS, a “fob” in the home, a kiosk or with a voice signature.

While costs average roughly $10 per month per active client, additional charges may include the one-time cost of a fob, which is about $15, or a transaction fee for voice verifications.

When kiosks are mandated, they are often provided by a program that includes the hardware, such as a $100 Android tablet, a data plan for about $10 per month and the logistics costs for deploying and servicing the devices.

Because it’s inexpensive, voice telephony is still the most prevalent solution in non-medical home care. Many caregivers have not had smart phones until recently, and even those that do are reluctant to use their data plans. Most agencies don’t have the budget to provide phones to caregivers.

Even so, more and more agencies are moving over to mobile apps.

The mobile option is the second and fastest-growing EVV solution. A mobile app compares the GPS location of the phone at the time of clock in and clock out with the with the GPS location where the staff member is supposed to be.

The fob option is often considered a necessary evil and is only deployed when the caregiver doesn’t have a smart phone or the client doesn’t have a home phone or doesn’t want the phone used.

The fob is a fixed object placed in the client’s home and physically connected in some way, for example, to a drawer-pull in the kitchen.

Customers from Ankota, a home health care technology company, generally use fobs in situations when clients don’t have a home phone and caregivers don’t use a smart phone.

Each fob creates a new, unique six-digit code every minute which are used to track when the caregiver arrives and leaves. This code, combined with a unique fob crypto code, allow the software to determine the caregiver’s arrival and departure times.

The kiosk concept is good in theory, but requires the purchase of a tablet and an internet plan for each client and the overhead associated with that method can add up quickly.

Implement these EVV best practices

Explore options through software vendors.

  • Your vendor may be able to provide EVV capability for your agency. In non-medical home care, providing EVV capability is one of the major functions your software should offer. So check in with your vendor about their EVV offerings.

Remember that reported times will no longer be perfect.

  • When you’re not using EVV, your time sheets will generally be “perfect.” A caregiver’s visit scheduled from 8 a.m. to 10 a.m. will be recorded as arrived exactly at 8 a.m. and departed exactly at 10 a.m. When EVV is added, these times will no longer be perfect. For example, caregivers might arrive at 7:56 a.m. and leave at 9:53 a.m.
  • Each agency must create its own policy for how to charge clients when time sheets don’t precisely match the time promised a client. For example, some agencies will charge less if they’re under the time promise, but won’t charge for more than the agreed upon duration.

Make usability and training a priority.

  • In a typical organization, 20% of your workers will embrace EVV right away because clocking in and out in real time is more convenient than filling out a paper time sheet, getting it signed and returning it to the office on deadline. About 60% of employees will be just fine with it, but the last 20% will be unhappy about it and come along kicking and screaming.
  • The best thing you can do to prevent this is to make sure that the EVV system is easy to use and that you provide training and hand-holding in the early days.

Be prepared for caregiver mistakes.

  • In the early days of your implementation, caregivers will forget to clock in or clock out or make other mistakes. When mistakes are made, it is likely that a timesheet signed by the client will be required.


About the author: Paul Hirsch has been an attorney at Pearson & Bernard, PSC in Edgewood, Ky., since 2012. He focuses on working with home health and hospice providers regarding State/Federal licensing and compliance; contract review and drafting; and the development and implementation of comprehensive policies and procedures of all types.