Electronic Visit Verification (EVV) is a process that uses electronic means to verify information related to home health care visits that are covered by U.S. Medicaid. EVV is intended to ensure clients are receiving the care they are entitled to and to reduce the number of fraudulent care claims submitted.
The EVV workflows in AlayaCare allow organizations to go through a visit verification process to determine whether any visits funded by electronic billing payors are in violation of the EVV requirements configured for your organization. If any EVV exceptions are found during the verification process, you will need to review the visits in violation and, where required, select the correct reason and resolution codes before you can approve the bill and pay quantities for the visit and proceed to claim generation and payroll. The visit verification information is exported and sent to a third-party aggregator.
Please note that the EVV feature must be enabled for your organization by AlayaCare before you can use the new features. You must also have the required permissions. To learn more, see the attached EVV configuration guide.
Configuring EVV settings
Before you can use the visit verification process to identify visits that are in violation of EVV requirements, you must complete the following steps to configure the various EVV-related accounting settings:
- Set up rounding rules to use for calculating the approved time for visits during visit verification.
- Create the reasons, resolutions, and associations that will be used to account for exceptions found during visit verification.
- Create exception lists with different exception types and attach them to service codes and electronic billing payors.
Verifying and approving visits
The visit verification and approval process for visits funded by electronic billing payors is completed from the EVV tab in schedules>workforce management.
To verify recently completed visits, set your verification criteria and select verify and approve from the not approved tab.
You will then be able to review visits with exceptions from the in violation tab. Once all exceptions on a visit have been resolved, you will be able to approve the bill and pay quantities so that the visit can be approved for electronic billing and payroll.
To learn more, see How do I verify and approve visits using EVV?
The EVV exports tab under accounting>billing>electronic billing summary v2 allows you to view information about various exports containing required EVV data that have been sent from AlayaCare to your state aggregator. This feature will only be available once the EVV file transfer process has been set up for your organization.
The new EVV workflow brings a few other notable changes to the visit approval process:
- It is no longer possible to edit the clock-in and clock-out times of a work session for visits funded by electronic billing payors.
- All time approval fields in the visit dialogue are disabled for visits funded by electronic billing payors.
- Visits funded by electronic billing payors are excluded from all legacy visit approval pages (within billing cycle, payroll period, and workforce management) as they now go through the new workflow.
For more information on EVV, please see the attached user guides.