The Role of Electronic Visit Verification and Medicaid Compliance

Electronic Visit Verification (EVV) has become a critical tool in ensuring the integrity and efficiency of Medicaid-funded home health services. As a federally mandated system, EVV helps verify that home health visits occur as billed, reducing fraud, improving patient care, and ensuring providers receive accurate reimbursement. Direct Care Innovations‘ EVV mobile application is designed to track time and ensure electronic visit verification (EVV) compliance for services delivered remotely in homes or community settings.

The Cost of Non-Compliance

According to a CNY Central report, between January 2021 and March 2023, New York state paid more than $14 billion for Medicaid home care services that lacked verification and were not compliant. Although the system included a feature designed to block payments for claims without a corresponding EVV record, auditors discovered that this feature was not activated. This led to a high volume of payments that did not align with state records. Without proper EVV compliance, agencies risk payment delays, claim denials, and potential legal consequences.

Ensuring Accurate Service Delivery

One of the primary benefits of EVV is its ability to confirm that home health services are delivered as scheduled. Through GPS tracking, phone verification, or biometric authentication, EVV systems document the date, time, location, and duration of caregiver visits. This ensures that Medicaid only pays for services that were actually provided, preventing fraudulent claims and billing errors. By verifying visits electronically, states can reduce improper payments and strengthen oversight of Medicaid expenditures.

Reducing Fraud and Abuse

Medicaid fraud has been a persistent issue in the home healthcare industry. It often involves falsified service claims, ghost patients, or caregivers logging visits that never occurred. EVV helps combat these fraudulent practices by requiring real-time proof of service. If a caregiver fails to check in or out, the system flags discrepancies, allowing agencies and Medicaid administrators to investigate potential issues. This not only protects taxpayer dollars but also ensures that vulnerable patients receive the care they need.

Improving Efficiency and Compliance

EVV streamlines administrative processes and reduces paperwork for home health agencies. Traditional manual recordkeeping is prone to errors and time-consuming audits. EVV automates visit tracking, making it easier for agencies to submit accurate claims and comply with Medicaid regulations. Many states have implemented automated payment systems that cross-check EVV records with claims, ensuring faster reimbursements and fewer denials.

Enhancing Patient Care

Beyond financial and regulatory benefits, EVV also improves patient care by ensuring accountability in service delivery. With real-time tracking, agencies can monitor caregiver timeliness, detect missed visits, and promptly address scheduling issues. This helps ensure that patients receive consistent and reliable care, reducing health risks and hospital readmissions.

The Future of EVV in Home Healthcare

EVV plays a vital role in maintaining the integrity of the Medicaid program by preventing fraud, improving efficiency, and ensuring timely patient care. The right EVV technology can help home healthcare agencies meet regulatory requirements, increase operational efficiency, and improve caregiver accountability, thus delivering better care services. Contact DCI at (480) 295-3307 or request a sales demo to learn how our technology solutions can help your business stay competitive.