Electronic Visit Verification (EVV) was established as law in 2016 under the 21st Century Cures Act to address fraud and abuse in home-based care delivery. The law provides federal guidelines, but individual states can determine which service codes are included. However, years after nationwide implementation, EVV still remains a burden for home care providers.

Simply put, EVV confirms the details of in-home visits. It holds caregivers accountable for their schedules, ensuring that their work is completed on time and in its entirety. Typically, caregivers work within a mobile app to conduct the EVV process. The app sends the necessary information from their devices to their agency’s home care software.

Six data points are captured at the point of care to verify the facts of a home care visit in real time.

Collecting this basic information in home care settings helps providers and states ensure that authorized care is provided and that caregivers deliver the proper care at the right time. When this verified visit data is collected and analyzed, states can use it to help identify and reduce Medicaid fraud, which drains resources from the system and hinders care delivery to those in need.

There was initial confusion because the act required states to implement EVV for at-home visits conducted by Medicaid personal care providers and home health agencies. However, each group had different go-live dates. Medicaid-funded personal care services were required to comply with EVV statutes by Jan. 1, 2020, and home health agencies by Jan. 1, 2023. However, delays and exemptions made compliance anything but simple.

Further, the federal government has passed legislation regarding EVV, but its implementation varies at the state level. States are categorized as “open” or “closed” models. Home health agencies have the freedom to choose their EVV provider in open states, while in closed states, they must work with a vendor selected by the state.

According to Matt Kroll, practice president of Assistive Care & Assistive Care State Programs at Bayada Home Health Care, despite challenges, Bayada has found that EVV helps prevent false claims.

“It allows us to monitor caregivers in real-time, verify service delivery, and allow for faster issue resolution,” he told Home Health Care News. “For example, if a check-in is late or a caregiver indicates that the client is showing signs of a larger issue, we can see that in real time and detect and prevent adverse events before they lead to a larger medical issue or hospitalization.”

Headquartered in Moorestown, New Jersey, Bayada provides in-home clinical care and support services in 21 states and five countries.

“We believe that we will be able to leverage some care documentation data points to help improve the quality of care we provide our clients and, over time, industry-wide data points may improve the industry as a whole,” Kroll said.

Kroll explained that Bayada supports efforts to prevent fraud, waste and abuse, with the caveat that overregulation can actually hurt the industry in some instances.

“We do feel that overburdensome requirements and unfunded mandates can deter agencies from providing Medicaid-based services, which is detrimental to those populations who already struggle to access the care they need to stay safely at home,” he said.

EVV still a pain point for providers

Because EVV varies by state, its challenges differ by market.

“EVV is still a pain point for providers for various reasons – and they vary by state,” Tim Nyberg, senior vice president of strategy at Sandata, told HHCN. “These can include variance in education from states to providers, the provider’s experience in onboarding and implementing EVV systems, how caregivers are educated on EVV, and whether they understand its purpose and benefits.”

Sandata, based in Port Washington, New York, provides agency management software, systems, and services to optimize billing and claims processing and streamline administrative processes.

“Additionally, some caregivers cite privacy issues in using their personal cell phones to clock in and out of shifts and having their location tracked,” Nyberg said. “Some clients and family members share those same concerns.”

Although all states have worked to implement effective EVV programs, some have needed help with clear and open communication regarding their policies, transparent enforcement timelines and timely responses to questions and concerns from the provider community.

“EVV continues to present challenges for providers primarily due to its complex integration into existing workflows,” John Atkinson, chief technology officer at AxisCare, told HHCN. “The additional effort required is not just about submitting claims, but also ensuring that EVV data is accurately collected and transmitted to the aggregator. This process requires meticulous attention to detail, often adding layers of administrative tasks to an already burdened system. Providers must balance maintaining the quality of care and adapting to new technological requirements, often leading to frustrations. While EVV aims to streamline and enhance transparency, the transition and implementation phase continues to be arduous.”

Founded in 2013, AxisCare is a full-service home care software company based in Waco, Texas.

“Bayada has made every effort to ensure that the transition to EVV compliance is as easy as possible for our caregivers and as least disruptive to client care as possible,” Kroll said. “However, pain points persist. Most notably, cost, lack of standardization across states, technology issues for caregivers and lack of cell service in rural areas.”

Providers who fail to comply with Medicaid rules risk not being paid for their work. Non-compliance with Medicaid rules and policies may also result in the provider’s inability to do business under the Medicaid program.

Apart from the stricter compliance issues, there are also significant downstream impacts. When caregivers fail to clock in at a client’s home, the home care agency cannot verify the services provided, especially in the case of a fall or hospitalization during or after a shift.

There is a continued lack of clarity regarding the consequences of non-compliance, according to Kroll.

States and payers each have a compliance threshold that needs to be met, and most – but not all – states have published this information. Non-compliance could result in payment penalties, loss of referrals, audits, and additional penalties and corrective action plans.

The future of EVV

States that have a burdensome EVV system run the risk of losing providers that may be otherwise interested in conducting business there.

“Looking ahead, the future of EVV will be marked by increasingly stringent standards and tighter tolerances,” Atkinson said. “We anticipate a future where the manual entry of EVV data will become largely unacceptable as states demand greater accuracy and efficiency.”

He emphasized the importance of proactively creating a culture of compliance and ensuring that staff are well-prepared to meet changing standards. This includes adopting technology and simplifying processes to enable smooth data transfer to aggregators.

“By staying ahead of these developments, providers can enhance operational efficiency and continue to meet regulatory requirements effectively,” Atkinson said. “Above all, EVV will enhance the accurate delivery of care to seniors, ensuring they receive the attention and services they need when needed.”

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A previously announced joint venture between BAYADA Home Health Care, a privately-held home care company that operates in 21 states, and Inspira Health Network, a major health network in New Jersey, is launching in three south Jersey counties.

The joint venture allows the health system to serve more patients in their homes. The partnership will offer home care and hospice services to patients in Cumberland, Gloucester and Salem counties from offices in Woodbury and Millville, New Jersey.

Kindred Completes Credit Amendment, Loan Syndication

The nation’s largest home health provider, Kindred Healthcare, Inc. (NYSE: KND), has completed syndication and pricing of an incremental $200 million term loan, which will be used to repay outstanding borrowings under the company’s existing $900 million senior secured asset-based revolving credit facility.

The borrowing will have the same terms with the outstanding $1.18 billion of terms loans under Kindred’s existing senior secured term loan credit facility.

Kindred also received consent from the required lenders under the term loan facility and the asset-based revolving credit facility to amend certain provisions of those credit facilities, including allowance for a broader range of joint venture activity, increasing the company’s financial flexibility and other changes to better align the terms with Kindred’s strategic plans.

J.P. Morgan Securities LLC is acting as sold lead arranger and sole book runner for the incremental term loan. JPMorgan Chase Bank, N.A. is the administrative agent and collateral agent for the term loan facility, under which the incremental term loan will be borrowed.

Partnership for Quality Home Healthcare Names Executive Vice President

The Partnership for Quality Home Healthcare—a coalition of home health providers dedicated to improving the integrity, quality and efficiency of home health care—has named Colin Roskey as executive vice president.

In his new role, Roskey will oversee the organizational operations and advocacy programs for the Partnership. Roskey has more than 15 years of experience in the health law and policy fields and is currently a health care lawyer and partner at Alston & Bird, LLP. He has counseled Medicare certified home health agencies and large national home health trade associations since 2004. He also previously served as a health policy adviser and counsel to the Senate Finance Committee from 2001 to 2004.

“We are happy to welcome Colin to the Partnership and look forward to advancing our advocacy objectives under his leadership,” Keith Myers, chairman of the Partnership, said in a statement. “His tireless advocacy work on behalf of the home-cased care community and his experience working on virtually all aspects of the home health prospective payment system and its regulatory environment will add enormous value to our organization.”

ExactCare Pharmacy Welcomes April Anthony to Board of Directors

ExactCare Pharmacy, a full-service pharmacy that specializes in medication management for patients with multiple diagnoses and medications, announced April Anthony has joined its board of directors.

Anthony is CEO of Encompass Health Care, Inc. and Homecare Homebase, LLC. Encompass, which was founded by Anthony and acquired by HealthSouth in 2014, has more than 200 locations in 24 states. Anthony also founded Homecare Homebase in 2001 as a spin-off from Encompass, and it has grown to serve seven of the top 10 home health and hospice agencies nationally with its software. Homecare Homebase was acquired by Hearst Corporation in 2013.

Mary Free Bed at Home Joint Venture Formed 

Mary Free Bed Rehabilitation Hospital and Residential Home Health have created a new joint venture called Mary Free Bed at Home in West Michigan to provide home health services to patients in that region.

Under the joint venture, Mary Free Bed, a not-for-profit acute care hospital based in Grand Rapids, Michigan, owns a 60/40 share of all Residential Home operations in West Michigan. Resident Home serves more than 3,250 home health and hospice patients in 34 counties in the Lower Peninsula of Michigan and in six counties in the Chicago area. Roughly 650 of its 825 employees are in Michigan.

Mary Free Bed has been seeking for a joint venture for certified home health services for about a year, Crain’s Detroit Business reported [link?]. Mary Free Bed at Home will operate with “more medical acuity, like a hospital on wheels,” Michelle Chapie, director of contract services and home health for Mary Free Bed, told Crain’s.

The Mary Free Bed Rehabilitation Network includes 26 general acute care hospital members.

Companion Connection Senior Care Partners with AxisCare

Companion Connection Senior Care (CCSC), a company that assists individuals with starting their own home care and home health companies, has partnered with AxisCare, Inc. to provide its AxisCare Home Care Management Software to CCSC members.

The software provides administrative, marketing, caregiver management, billing and reporting tools. CCSC is one of the largest home care membership organizations in the United States and has more than 100 member agencies.

Written by Amy Baxter

The post Business Briefs: BAYADA, Inspira Joint Venture Launches appeared first on Home Health Care News.

The partnership between the two companies will integrate Home Care Pulse’s Quality Satisfaction Management program with AxisCare’s home care management software. 

The companies expect that integrating each of their propriety softwares will enhance the abilities of home care providers to manage and monitor their businesses by allowing them to view, in a single location, all of the business tools and reports offered by both Home Care Pulse and AxisCare.

“Through AxisCare and Home Care Pulse, agencies combine powerful marketing components, easy scheduling workflow, and more, with strategic benchmarking intelligence and proof of quality certifications to help them stand out amongst their competitors,” said Todd Allen, president of AxisCare. 

AxisCare’s web-based software allows users the ability to manage their home care agency from any device, providing features that help users keep track of their leads, referral sources, marketing appointments, brochure orders, as well as the revenue generated by each referral source. 

The software also tracks caregiver’s work schedules and manages what certifications or evaluations must be completed by the individual, while also providing family care portals and the opportunity to customize certain features, so a home health agency may tailor the software to its own operations.

Home Care Pulse is a firm focusing on research centered on satisfaction and quality assurance within the home health industry. The company is also nationally recognized for its proprietary Best of Home Care Awards. 

“We are excited about the many advantages our customers will have with this integration between our two companies,” said Erik Madsen, COO of Home Care Pulse. “Together, Home Care Pulse and AxisCare will be able to better assist home care providers as they focus on delivering the best in-home care possible.” 

Written by Jason Oliva

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