Feature Overview: Visit Verification (VV)

Visit Verification (VV) is a process that automates most of the visit approval workflow. It is done by comparing completed visits against a set of configurable rules, which will then flag any issue 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 electronically verify information related to home health care visits covered by Medicaid. VV ensures that clients are receiving care accordingly and reduces the number of fraudulent care claims submitted.

The VV workflows in AlayaCare allow organizations to determine whether any visits 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 that have failed verification. Where required, you will select the correct reason and resolution codes before you can approve the bill, pay quantities for the visit, and proceed to billing/claim generation and payroll. When required, 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 prior to using VV. 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 are 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 resolve exceptions found during visit verification.
• Set your desired unit for distance thresholds in Settings>Locale>Unit of distance
• Create rule sets with different rule types and attach them to service codes, payors and branches.

Transitioning over from the legacy workflow

If you are transitioning over from the legacy workflow, make sure to clean up past visits by rejecting them, so that they aren't considered by verification.

Verifying and approving visits

To complete visit verification and approval processes for visits, go to Schedules>Visit Verification. 

To verify recently completed visits, set your verification criteria and select run verification from the unverified tab.

You can now review visits with exceptions from the failed verification tab. When all exceptions on a visit are resolved, you can approve the bill, pay quantities, and have the visit approved for billing and payroll. 

To learn more, read this article.

To do so, users must:

1. Navigate to Accounting Settings > Verification Rule Sets > select rule set to be modified, or create a new rule set

2. Select + Add rule

3. From Rule Type select Visit Notes

4. Determine Required Action:

   1. Acknowledgement required

   2. Reasons required > Add Reasons

Once rule has been configured and added, it will flag any visits with a visit note and require either acknowledgement or reason and/or comment, depending on rule setup.

Other implications

The new VV workflow brings these additional changes to the visit approval process:

• You can no longer edit the clock-in and clock-out times of a work session.
• All time approval fields in the visit dialogue are disabled for visits. 
• Visits will be locked upon Approval
• Legacy visit approval page remains accessible, but all approval actions are removed.

For more information on Visit Verification, please see the attached user guides.