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 can then be 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.
For more details on how to configure these accounting settings for EVV, please see the attached EVV configuration guide.
Setting criteria and running visit verification
To verify and approve visits according to the EVV requirements in effect for your organization, go to Schedules>Workforce Management>EVV.
Under EVV, you will see three tabs: not approved, in violation, and approved & rejected.
To begin the verification and approval process, use the fields provided to select the visits you wish to verify and approve.
When you have selected the criteria you wish to apply, select verify and approve.
Any visits for which no exceptions were found will be automatically approved for the bill and pay quantities determined by the rounding rules set on the bill and pay code in effect for the service. You can review approved visits and, if necessary, override the bill and pay quantities for the visit by going to the approved and rejected visits tab.
Within this new workflow, a visit gets locked when its status changes to approved or rejected. The visit will become unlocked again if its status is changed to not approved.
Also note that this locking applies the reject all batch action on the vacant visits page, but only for visits where funder type is electronic billing payor.
Reviewing visits in violation and resolving exceptions
Select the in violation tab to review the exceptions found during the verification process. You can filter the list of exceptions.
Select resolve for the visit you wish to review.
If you have the required permissions, you can edit the status of the visit from in violation to not approved or rejected from the edit status dropdown.
In the work session information section, you will see information about the total duration of the visit based on the clock-in and clock-out times as well as information about the location of the visit.
The exception list section will display the exceptions to the EVV requirements that were identified for the visit. For details about the various exception types, please see the user guide for more information on the exception types.
For each exception, you must select from the dropdown in the reasons column to resolve the exception. If required, enter comments in the comment(s) field and click save. The status of the exceptions will change to resolved.
Approving visits for electronic billing and payroll
Once all exceptions on the visit have been resolved, you can review the bill and pay quantities and approve the visit so it can be included on electronic billing claims and running payroll, if you have the required ACLs.
If required, you can edit the bill and pay quantities that have been entered for the visit based on the rounding rules, before approving it. Once you click approve, the visit’s status will be changed to approved.
Reviewing approved and rejected visits
To review visits that have already been approved or rejected, select the approved and rejected visits tab and select review to view the visit details.
You can manually change the status of an approved visit to rejected or not approved. You can also set a rejected visit back to not approved status.
In the exception list section for an approved visit, you can edit the selected reasons and resolutions for the exceptions. Click save to save your changes.
If you wish to override approved bill and pay quantities calculated during visit verification for an approved visit, adjust the values in the bill quantity or pay quantity field and then select override in the time approval section. Note that you must have the required permissions to override bill and pay quantities for an approved visit.
On a rejected visit, you will not be able to edit the exception list or time approval sections.
This new workflow brings a few other notable changes:
- It is no longer possible to edit the clock in and clock out times of a work session for visits of funder type electronic billing payor.
- All time approval fields in the visit dialogue are disabled for visits with funder type electronic billing payor.
- Visits with funder type electronic billing payor 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.