According to a new Government Accountability Office (GAO) report, Health and Human Services (HHS) made approximately $90 billion in improper payments to Medicaid and Medicare programs in 2017. Improper payments are often made due to undocumented services, uncertified personal care assistant (PCA) workers, and services billed while members were institutionalized and therefore not authorized to receive services. Signed into law by former president Barack Obama, the 21st Century CURES Act mandates the use of Electronic Visit Verification (EVV) for in-home visits for home care and personal care visits. EVV is a critical tool to combat potential improper payments and gaps in care – systemic problems that plague this industry.
Section 12006 of the bill requires an EVV solution be put into place for all Medicaid-provided personal care services and home health services prior to Jan 1, 2020 to avoid a tiered penalty in FMAP funding. System requirements listed within the EVV requirements listed within the bill state the following must be verified:
- Date of service
- Location of service
- Individual providing service
- Type of service
- Individual receiving services; and
- Time the service begins and ends.
Although this is a good start to ensure the care and safety of the members, we look forward to contributing to the ongoing conversation about EVV best practices.
Interested in learning more about the benefits of designing your own EVV system? Let's talk. HealthStar is pioneering an innovative, compliance-conscious approach to EVV that virtually eliminates improper payments while offering better protection for members.