Visit Verification (VV) is a process that automates most of the visit approval workflow, by comparing completed visits against a set of configurable rules, to flag any issues that require review or further investigation. You can review these visits in detail and document the actions to validate compliance.
Within the U.S. market, VV helps organizations to electronically verify information related to home health care visits covered by Medicaid. VV helps organizations ensure that clients are receiving care accordingly and reduce the number of fraudulent care claims submitted.
The VV workflows in AlayaCare allow organizations to determine whether any visits funded by electronic billing payors are in violation of the VV requirements configured for your organization. If any VV 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 then exported and sent to a third-party aggregator.
Please note that AlayaCare must first enable your organization's VV feature, and you must also have required permissions before you can use these features. Refer to the attached VV configuration guide for more information.
Configuring VV settings
You must first configure your VV accounting settings before using VV to identify visits that in violation of related requirements:
- Set up rounding rules to calculate approved time for visits during visit verification.
- Create the reasons, resolutions and associations that will be used to identify exceptions found during visit verification.
- Set your desired unit for distance thresholds in Settings>Locale>Unit of distance
- Create exception lists with different exception types and attach them to service codes, payors and branches.
Verifying and approving visits
To complete visit verification and approval processes for visits funded by electronic billing payors, go to Schedules>Visit Verification.
To verify recently completed visits, set your verification criteria and select verify and approve from the not approved tab.
You can now review visits with exceptions from the in violation tab. Once all exceptions on a visit have been resolved, you can approve the bill, pay quantities, and have the visit approved for billing and payroll.
To learn more, read this article.
The new VV workflow brings additional notable changes to the visit approval process:
- You can no longer 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 VV, please see the attached user guides.