Electronic Visit Verification (EVV)

Written by: EZClaim Contributor 

Is Electronic Visit Verification (EVV) a buzz word or is there really something that must be followed? It is not just a buzz word in the market so if you have not already dug into it we suggest you do so soon. It is a rule that goes into effect in less than a month. If you provide personal care services you need to understand what to do so that you do not have a disruption in your revenue stream.

Section 12006(a) of the 21st Century Cures Act mandates that states implement Electronic Visit Verification (EVV) for Medicaid personal care services (PCS) and home healthcare services (HHCS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2020, and HHCS by January 1, 2023. State Medicaid programs providing PCS and HHCS will be required to submit data that will electronically verify 6 elements of the service:

  1. Type of Service
  2. Individual receiving service
  3. Date(s) of Service
  4. Place of Service
  5. Who Rendered the Service
  6. Time Service began and time service ended

Electronic visit verification was created to help cut down on fraud and ensure that people receive the documented care they need and was designed to help verify that services billed are for actual visits made. Any state that fails to comply with the Cures Act EVV requirements will be subjected to up to a 1% reduction in payments. Each individual state can choose how they implement an EVV system. The Centers for Medicare and Medicaid Services (CMS) do not endorse any one type of system and states may choose to implement more than one EVV system. States can choose to either build and manage their own EVV system or they can select an external vendor, each at their own cost. Some states are allowing providers to choose a state-sponsored vendor or one of their own choice. Providers will need to contact their state to see what model they will be implementing.

Some states are using a model that allows providers to submit EVV information on electronic data interchange (EDI) 837p claims. If your state has selected this option, EZClaim Premier along with its partners can accommodate the EVV requirements and you will be able to send your information on your electronic claims. Please contact your state for what your EVV reporting requirements are and how they will be implemented.  For additional information and resources, visit the EVV Guidance page at Medicaid.gov.

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