Addressing Medicaid Budget Short Falls and Program Integrity with Electronic Visit Verification Solutions
It is no secret that Medicaid budgets are severely strained and that program integrity is on the front-burner. Every state is challenged to address both issues without restricting low-income patient access to vital healthcare services.
One of these services, home-based healthcare, has been growing significantly of late and, consequently, has become attractive to parties intent on gaming, at a minimum, or blatantly stealing from, at worst, a system designed to use public dollars to provide healthcare to low-income persons. Nationally, over 12 million Americans received healthcare services in their homes last year, delivered by over 33,000 home-based healthcare provider businesses.
When home visits are documented manually, it is easier to bill Medicaid for care that was never delivered, if that is one’s intent. To thwart such efforts, there are numerous available Electronic Visit Verification systems (EVV) that are extremely difficult to fool. They have the potential to provide significant benefit to all stakeholders, including payers, healthcare providers and recipients.
EVV systems electronically verify the time and location of the person claiming to have provided home care services. They facilitate electronic documentation needed to record those services and capture a patient’s signature, in the process helping home care providers move toward EHR use. For the past year, the EVV Standards Workgroup has been diligently working to help Medicaid officials appreciate the advantages of EVV and to create policies that will most efficiently make the universe of available EVV systems available in their states. We hold that EVV is the most impactful strategy they can implement to improve program integrity while at the same time reducing costs and maintaining beneficiary access.
Unfortunately, some states have mistakenly rushed recently to a policy under which the state mandates a “one-size-fits-all” approach. In these isolated cases, the state is courted by an EVV vendor, issues an RFP, selects that vendor and then mandates its use by all home care providers doing business with the state.
The EVV Standards Workgroup has been created to help states develop a better solution, one which establishes technical and functional EVV standards and requires only that providers select a system that meets those standards.
This policy approach enables providers to choose the EVV system which best meets their needs. It provides assurances to the state that any system selected will feature strong technical controls that guarantee visit verification, thereby minimizing fraud and abuse. More importantly, it relieves the state from having to incur the upfront costs and risks associated with selecting a single source EVV system and forcing all providers to use it, including providers that already have another EVV system in place.
Adding the technology and personnel required to support a single system creates unnecessary costs and places all of the risks of managing a system on the state, thus compounding their already strapped budgets. Conversely, simply setting minimum standards and letting EVV systems vendors compete in the free market creates price advantages and spurs innovation. We believe this results in higher provider adoption rates, greater provider satisfaction and the elimination of unnecessary costs.
The handful of states that have already contracted with a single vendor are seeing a negative impact on efficiency and profitability among home care and hospice providers that already had competent EVV systems in place. They suddenly have to manage two parallel systems, a logistical nightmare with repercussions in employee morale and productivity.
We invite all state Medicaid officials to hear testimony from home care providers directly affected by EVV-related policy. Recently at the National HCAHPS Convention in Washington, DC, several homecare and hospice provider executives engaged in a panel discussion on the merits of EVV systems and the pitfalls of a mandated, one-size-must-fit-all policy approach. All participants endorsed a standards based approach that unleashes the benefits of the free market system while simultaneously meeting the jurisdictions’ need to curtail fraud and abuse and directly addressing budget shortfalls.
The EVV Workgroup strongly encourages all affected parties to click on “EVV VIDEOS” to see excerpts from the HCAHPS session. Once you have viewed these compelling video segments, you are also encouraged to spend time reviewing the other educational and informative materials posted within the EVV Workgroup site. They are designed to help state Medicaid officials improve program integrity and control both state and provider costs without circumventing the free market.
About the EVV Standards Workgroup:
The mission of EVV Standards Workgroup for Home Care is to provide education and raise awareness on the merits and advantages of available full-featured EVV solutions to stakeholders including payers, back-office software vendors, homecare and hospice providers, and home care recipients. On behalf of the industry Carewatch, CellTrak Technologies, Dial-n-Document and Sansio are founding members of the Electronic Visit Verification (EVV) workgroup. For more information please visit: http://www.evvworkgroup.org
Home Care Technology Report Editorial: Electronic Visit Verification Might Have Prevented the Texas Medicare/Medicaid Fraud Conspiracy
The six-year long, $375 million Medicare and Medicaid fraud fiasco that was revealed last month, allegedly perpetrated by Dr. Jacques Roy and 500 conspiring Texas home health care organizations, could have been prevented.
Will Texas and other states and U.S. territories learn from the experience or will Roy-like racketeers continue to thrive until hundreds of millions more taxpayer dollars are lost? State legislatures and their appointed or civil service rulemakers have long had the option to either forbid, permit or require the use of a technology that can virtually eliminate paying for home health care visits that never happened. More…
While verification of a visit using EVV (Electronic Visit Verification) is important, it doesn’t universally address the scope of the data set that is collected or the timely integration with the provider’s EMR system. EVD (Electronic Visit Documentation) includes EVV-related date, time, and location, but also services, tasks, and other discipline specific information that makes up a complete record of the patient encounter.
Because EVD solutions integrate tightly with a provider’s EMR system, timely management of field staff can occur, enabling providers to effectively respond to scheduling, clinical, or service exceptions. EVD also yields precise productivity reporting, efficient payroll processing, and allows providers to generate accurate, timely claims.
This article, published in Caring Magazine in July, 2011, describes how EVD can help facilitate a proactive approach to combating fraud and abuse and discusses payer models that best enable home health agencies to provide accurate, accountable services.
The Fiscal Times: Medicare Fraud: A $70 Billion Taxpayer Ripoff
Medicare could wrench as much as $70 billion a year in savings by cracking down on fraud, experts told Congress … . But the key is preventing scam artists and fake firms from doing business with the senior citizen health care program in the first place – not chasing them down after the fact. … Providers selling Medicare durable medical equipment like motorized wheelchairs and fraudulent billing by home health agencies are major abusers of the system, especially in areas with huge senior populations like south Florida, southern California and the New York-New Jersey metroplex (Goozner, 3/10).
The article emphasizes a key point of getting ahead of fraud rather than chasing them down after the fact. The EVV Workgroup believes Electronic Visit Documentation methods represent a viable solution in line with getting ahead of the problem by verifying visits electronically.
The Pennsylvania Department of Aging issued a bulletin on 11/23/2010 confirming their acceptance and encouragement of Telephony. The language in this policy clarification bulletin replaced language in a previous bulletin, notably adding that the OLTL “strongly encourages telephony” instead of just “will accept telephony“.
In response to what they consider disturbing mandates issued by Medicaid officials in two states and parts of two others, a collection of home care and hospice industry telephony vendors, providers, technology vendors and state associations has formed a new organization, “The Electronic Visit Verification Standards Workgroup.”
The organization’s members believe rules established by Medicaid officials in South Carolina, Tennessee, Florida and Texas infringe on free market trade and will have far-reaching, detrimental consequences should other states follow suit.