Electronic visit verification

Electronic visit verification (often referred to as "EVV") was patented and invented by a nurse who also is a technologist, entrepreneur and Home Health Care Consultant and Domain Expert. In 1996 Michelle Boasten, RN designed and created the first clinical documentation information system for Home Health, Home Care and Hospice. EVV was one part of an overall and comprehensive design for the industry that sits under the umbrella term of "Home Health Care". Her invention and work are well documented. The exhaustive patent can be reviewed at the US Patent and Trademark website.

In 1999, Thomas Hoyer, the senior and Chief Policy Maker for Post-Acute Regulations for the Center for Medicare and Medicaid Services (CMS, formerly HCFA) invited Michelle Boasten, RN to the Baltimore CMS offices to demonstrate EVV. At that meeting, he congratulated the invention and predicted that it would take two decades to see EVV legislation requiring EVV to be mandated as a practice within every Medicare and Medicaid agency providing publicly funded home visits to Medicare and Medicaid beneficiaries. Mr. Hoyer's testimony regarding his work in Post-Acute Regulatory Policy can be found in the CMS Oral History Project that documents the design and implementation of all Medicare and Medicaid Regulations. This 874-page document at the CMS Website helps to explain to any reader the history of Medicare and Medicaid's design by those who created, drafted and authored the system.

Recognizing that EVV was a critical part of the entire documentation process, the patent covers the entire scope of the work. EVV has been sectioned out because of its enormous impact on bringing accountability to the industry. Indeed EVV is a method used to verify visit activity for Home Health (Skilled Service), Home Care (Personal Care Service) and Hospice (End-of-life Service) . This accountability measure will help to ensure that patients are not neglected. EVV can and should cut down on fraudulently documented home visits, and is the means of electronically verifying that a caregiver is physically present with the patient.^[1] EVV monitors locations of caregivers and is mandated by certain states, including Texas and Illinois.^[2] Other states do not mandate it, but use it as part of its Medicaid fraud oversight created by the passing of the Affordable Care Act in 2010.^[3] It is also widely used by employers of home healthcare providers to verify employee's locations and hours of work as well as document patient care.^[4] Today, most states and other payers rely on EVV as a more effective monitoring tool than a hand-signed document.

Electronic Visit Documentation | Caring Magazine Article^[5]

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 generates accurate,and 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.

History

Healthcare spending in the United States as a percentage of gross domestic product (GDP).

Electronic visit verification was created to help cut down on fraud and ensure that people receive the documented care they need. EVV was designed to help verify that services billed for home healthcare are for actual visits made.^[6] The passing of the Affordable Care Act signed into law in 2010 made provisions for the cut down of fraud and over-payments, requiring states to stop Medicaid payments to providers when there is credible evidence of fraud.^[3] At least 10 states implemented an office of inspector general to oversee Medicaid fraud investigations, with many moving towards a system of verifying home healthcare visits in order to help reduce fraud.^[3]

President Obama signing the Patient Protection and Affordable Care Act on March 23, 2010.

Several states have introduced electronic visit verification with some mandating it for home healthcare.^[7] In January 2014, Illinois became the first state to mandate the use of EVV when the Department of Human Services required it for its home services program.^[2] As of June 1, 2015, the Texas Health and Human Services Commission mandates that electronic visit verification be used for all home healthcare visits billed to the state.^[6] The state of Ohio began the process of implementing an electronic verification system that would be used starting in 2016.^[8] It estimated the use of EVV will save the state approximately $9.5 million in its first two years of use.^[9] Other states that use but do not mandate EVV include Louisiana,^[10] Alaska,^[11] and Tennessee.^[3]

Electronic visit verification is widely used throughout the healthcare industry, not solely by government entities. Companies use it for compliance and quality assurance. Employers of home healthcare providers use it to verify employee's locations as well as document patient care.^[4] It can also be used to verify hours of work and document time sheets for healthcare workers.^[4]

Health care fraud

Health care fraud includes health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare (United States) or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always seeking new ways to circumvent the law. Damages from fraud can be recovered by use of the False Claims Act, most commonly under the qui tam provisions which rewards an individual for being a "whistleblower", or relator (law).^[12]

Tracking software

Electronic visit verification is mainly done through the use of GPS tracking and computer software. It can also include the use of telephone based systems where healthcare workers can call-in from each location.^[8] GPS can be used to track the location of nurses, or a "check-in" system can be used requiring healthcare providers to clock in when they are at a home visit.^[13]

Electronic Signature

Using an EVV solution whether a mobile device or a home telephone in electronic based visit verification caregivers authenticate themselves by entering in their unique ID and password. This ID and password are known and controlled ONLY by the caregiver. The combination of this unique ID and the calling from the patient’s phone creates this electronic signature. Some EVV companies also utilize 2-Factor security requiring yet a 3rd randomly generated code that users receive on a special One-Time password device or key chain.

Automatic Number Identification

Some companies like CareWatch Inc.^[14] that uses Automatic Number Identification (ANI) technology in order to capture the exact address of a landline phone call and the patient’s telephone number. This is the same technology that the E-911 people use because it cannot be blocked and it is delivered electronically to the system with the phone call. This allows it to be 100% reliable. The system also time-stamps every call with the exact time the call was made.

Automatic Patient Identification

Some EVV systems uses the telephone number captured from the telephone company to match the patient’s telephone number that is stored in the patient’s profile record in the database. With this match, the caregiver does not have to know or key in the patient-ID.

ANI enables EVV companies to capture the billing telephone number of patients even if the patient uses caller ID blocking because ANI delivers information electronically. This ensures that the system is 100% reliable in reporting patients’ locations. The system also time-stamps the arrival and departure calls every caregiver makes. In addition, the system uses the telephone number captured from the telephone company to match the patient’s telephone number stored in the patient’s record in your database. This feature of the system means that when caregivers call to report data, they don’t have to key in the ID number of patients.

Electronic Visit Verification Integration with Back-end systems such as EMR scheduling, billing and clinical systems

While EVV is used by employers to track employees and determine their compensation and to verify payroll of its caregivers and nurses.^[2] synchronizing key information pertinent to the visit in an almost real-time manner.^[15] This allows the caregiver to have the most up-to-date information available to them when they call in to document the visit. Collecting EVV and EVD data is very important, but once the data is collected, it has to be entered into the EMR system for documentation, billing and payroll. This is where some EVV companies like take EVV to the next level, integrating with over a dozens of the major EMR companies to seamlessly pass the collected EVV and EVD data automatically to the backend billing and payroll system. Tight integration for a seamless process is helpful in reducing the number of manual touch points a visit has to go before it can be billed.

Some of the enhance features that EVV providers offer when integrating with back-end EMR systems can include:^[16]

• Imports changed employees, patients, schedules and patient care plans into the system automatically.
• Sends completed visit information, including care plan results, to the system so that the completed visit can be verified, attended and billed.
• Delivers visit information to the EMR within minutes of the visit being completed.

Electronic visit verification software integrates with payroll systems that allow companies such as Axxess Technology Solutions, employs a cloud-based system that integrates with a mobile app to coordinate schedules, billing, payroll, communication, and patient documentation.^[17] Nurses can update patient files with the system while also submitting working hours to their employers.^[17] In contrast, companies such as First Data provide a telephone and computer-based system for verification,^[10] similar to the system implemented in the state of Texas in 2015.^[18] Another company, CareWatch Inc., has three telephony EVV options including an on-site, server-based system and a hosted Internet-based solution both of which can integrate with billing, scheduling and payroll home health systems. A third option, EVV Pro, is a cloud-based, fully comprehensive mobile EVV solution which is accessible from most current web browsers and integrates mobile devices and GPS tracking.

References

External links

• EVV Inventor and Founder Patent Reference page
• Illinois Department of Human Services EVV program page
• Texas Department of Aging and Disability Services EVV program page