EVV Guidelines
EVV Guidelines: The Complete Guide
Medicaid-funded personal care and home health services include an important component, which is Electronic Visit Verification (EVV). It produces an electronic document of a qualifying service visit, and aids states and providers in ensuring the documented service has taken place as reported.
Under Section 12006 of the 21st Century Cures Act, states are required to implement EVV for Medicaid-funded personal care services that require an in-home visit and for certain home health services requiring an in-home visit. The EVV systems as required by CMS must record certain details of the service, person receiving care, the provider, time and place.
In the case of the provider, working according to EVV guidelines is not only about the in-checking in and out. The staff should be familiar with the system that is being used and they should record visits correctly, explain the exceptions, preserve the personal information and maintain the EVV entries as consistent with service documentation and claims.
Table of Content
- Definition & Purpose of EVV Guidelines
- Understanding When to Use EVV & What to Expect
- What EVV Means
- Who Should Follow EVV Guidelines & When?
- EVV Guidelines Breakdown
- The Four Stages of EVV Compliance
- How the EVV Process Works
- Supporting Direct Care Workers and Care Teams
- Costs, Coverage & Care Settings
- Preparing for EVV Compliance
- FAQs
Definition & Purpose of EVV Guidelines
EVV is an electronic system employed in verifying some of the services provided by Medicaid-funded visitations to the home. Federal standards create six basic data elements which should be counter-measured electronically: the nature of the service, the recipient of the service, the person providing the service, the date of the service, the start and the termination of the service and place of service delivery.
EVV is designed to establish dependable service logs and enhance accountability of Medicaid-funded services. The implementation of EVV is flexible, thus, certain procedures, systems, exemptions and documentation requirements may differ among states and programs.
Understanding When to Use EVV & What to Expect
EVV requirements generally apply to Medicaid-funded personal care services and certain home health services that require an in-home visit. Federal implementation deadlines were January 1, 2020 for personal care services and January 1, 2023 for home health services, subject to applicable extensions and good-faith-effort provisions.
EVV may be required when
- A qualifying Medicaid personal care service is provided during an in-home visit.
- A qualifying Medicaid home health service requires an in-home visit.
- The state Medicaid program requires EVV for the specific service.
- A managed care or waiver program incorporates EVV requirements.
- The provider must electronically document the start and end of a qualifying visit.
The exact services subject to EVV and the operational rules for recording visits are determined through applicable federal and state requirements. Providers should follow the EVV system and instructions established by their state Medicaid program.
What EVV Means
Electronic Visit Verification is a method of electronically documenting and verifying qualifying healthcare or personal care visits. Rather than relying solely on paper timesheets or manual records, an EVV system creates an electronic record containing required visit information.
CMS does not require every state to use one specific EVV technology. States have discretion to select systems that meet federal requirements, and a state may use more than one EVV system when appropriate. CMS also states that GPS is not federally required; different technologies may be used to meet the required verification criteria.
An EVV system may involve a mobile application, telephone-based verification, or another approved technology. The available options depend on the state program and its implementation.
Who Should Follow EVV Guidelines & When?
EVV responsibilities can involve several people within a healthcare organization.
Direct care workers: Teams providing qualifying services generally need to record visits according to the applicable EVV process.
Care coordinators and supervisors: They may monitor visit records, identify exceptions, and follow up on discrepancies.
Agency administrators: They may be responsible for ensuring organizational compliance with state EVV requirements.
Billing teams: EVV records may need to align with claims and service documentation.
Patients and participants: Depending on the system, the person receiving services may participate in or facilitate certain verification procedures.
Compliance Teams: They may review EVV records, policies, and exception patterns.
Responsibilities can differ according to the state, payer, service program, and provider structure
EVV Guidelines Breakdown
Effective EVV compliance depends on accurate recording, timely correction of exceptions, appropriate documentation, and consistent practices.
Core EVV considerations typically include
Required Visit Information
The EVV record must contain the federally required elements: service type, individual receiving the service, individual providing the service, date, start and end times, and service location.
Accurate Check-In and Check-Out
Direct care should follow the approved procedure for recording the beginning and ending of a visit. Incorrect times can create discrepancies between EVV records and other documentation.
Correct Service Information
The service recorded in EVV should correspond with the service actually provided and the applicable authorization or service plan.
Location Verification
Location is one of the federally required EVV elements. However, CMS does not require providers to use GPS specifically. States may determine how location information is captured.
Exception Management
Missed check-ins, missed check-outs, incorrect times, technical problems, or other unusual circumstances may require an exception to be documented and corrected according to state procedures.
Documentation Consistency
EVV information should be consistent with applicable timesheets, progress notes, service documentation, authorizations, and claims.
Privacy and Security
EVV systems handle information about individuals receiving Medicaid services. CMS guidance emphasizes compliance with applicable privacy and security requirements, including HIPAA where applicable.
Claim and Payment Coordination
EVV information may be used in connection with claims and encounter data. CMS states that EVV systems must capture the required information and use the data in processes related to claims and encounter review.
The Four Stages of EVV Compliance
Step 1 – Prepare the Systems
Providers establish the appropriate EVV system, enroll, and train workers on the required procedures. Training should address check-in, check-out, exceptions, documentation, and privacy.
Step 2 – Record the Visit
During a qualifying service visit, the worker follows the approved process to electronically record the required information, including the beginning and ending times and location information required by the state system.
Step 3 – Review and Correct Exceptions
Supervisors or designated review records for missing or inconsistent information. When an exception occurs, it should be handled according to applicable state and organizational procedures.
Step 4 – Reconcile and Maintain Records
EVV records are reviewed alongside service documentation and billing information. Consistent records support accurate claims processing and ongoing compliance.
How the EVV Process Works
Although specific systems differ by state, a typical workflow includes six steps.
Step 1: Confirm the Authorized Service
Before providing care, team members should understand the service they are authorized or scheduled to provide and the applicable EVV requirements.
Step 2: Begin the Visit
The direct care worker uses the approved EVV method to record the start of the visit. The system may capture information such as the worker, participant, service, time, and location.
Step 3: Provide the Scheduled Service
The worker delivers services according to the applicable care plan, authorization, service requirements, and provider procedures.
Step 4: End the Visit
The worker records the end of the visit through the approved EVV system. The recorded duration should accurately reflect the service provided.
Step 5: Review Exceptions
If a check-in or check-out was missed, the application malfunctioned, or another discrepancy occurred, staff should follow the state-approved exception process. Corrections should accurately explain what happened rather than creating unsupported information.
Step 6: Reconcile EVV With Documentation
The provider reviews EVV records against other relevant records before billing or claim submission, where required. Differences should be investigated and resolved according to applicable procedures.
Supporting Direct Care Workers and Care Teams
Successful EVV implementation depends on understanding why the system is used and how to operate it correctly.
Providing Practical Training
The team should receive training on the specific EVV system used by the organization. Training can cover login procedures, check-in and check-out, technical problems, exception reporting, and privacy expectations.
Creating Clear Exception Procedures
Workers should know what to do when they cannot record a visit normally. For example, a device failure or connectivity issue may require a specific alternative procedure established by the state or provider.
Monitoring Records
Supervisors can review EVV records for missing visits, unusual patterns, duplicate entries, or discrepancies that require follow-up.
Protecting Participant Privacy
EVV information should be handled appropriately. Staff should avoid sharing login credentials or using another person’s account to record a visit, unless the applicable system explicitly permits a particular process.
Costs, Coverage & Care Settings
EVV is primarily associated with applicable Medicaid-funded personal care and home health services rather than every healthcare service.
Important considerations include
Medicaid program: Federal EVV requirements apply to specified Medicaid-funded services.
Service type: Not every service is automatically subject to EVV.
State requirements: States determine many operational aspects of their EVV programs.
Home-based care: Federal EVV requirements focus on qualifying services involving an in-home visit.
Technology: States may use different EVV technologies and implementation models.
Payer requirements: Managed care arrangements may include additional procedures.
Claims: EVV information may be connected with claim review and payment processes.
Privacy: Providers must follow applicable privacy and security requirements.
CMS maintains state-specific EVV compliance information, reflecting differences in implementation across states and territories.
Preparing for EVV Compliance
Providers can reduce avoidable errors by establishing clear procedures before the team begin using an EVV system.
Helpful preparation steps include
- Identify which services are subject to EVV
- Confirm the state-approved EVV system
- Enroll and train
- Explain check-in and check-out requirements
- Establish a process for missed or incorrect visits
- Review EVV records regularly
- Reconcile EVV information with service documentation
- Protect login credentials and participant information
- Keep current authorization and service information available
- Monitor changes to state Medicaid EVV requirements
Ask questions such as
- Which services require EVV?
- Which EVV system does our state require?
- Who is responsible for recording each visit?
- What should a worker do if the system is unavailable?
- How should a missed check-in or check-out be corrected?
- Who reviews EVV exceptions?
- How are EVV records reconciled with claims?
- What documentation must be retained?
- How is participant location information handled?
- What privacy and security requirements apply?
CMS notes that states have flexibility in choosing EVV models and technologies, so providers should not assume that procedures used in one state apply everywhere.
FAQs
What is EVV?
EVV stands for Electronic Visit Verification. It is an electronic method for verifying certain Medicaid-funded personal care and home health visits.
What information does EVV have to verify?
Federal law identifies six required elements: the type of service, individual receiving the service, individual providing the service, date of service, start and end times, and location of service delivery.
Is GPS required for EVV?
No. CMS does not require GPS specifically. States can use different technologies as long as their EVV approach meets applicable requirements.
What happens if a caregiver forgets to check in or out?
The provider should follow the applicable state and organizational exception process. The missing information should be corrected and documented according to established procedures.
Does EVV apply to every healthcare service?
No. Federal EVV requirements specifically address certain Medicaid-funded personal care and home health services that require an in-home visit. State programs may establish additional requirements.
Can EVV records affect billing?
Yes. EVV information can be used in processes involving claims and encounter data, and discrepancies between EVV and billing records may require review.
Why is accurate EVV documentation important?
Accurate records help demonstrate when, where, by whom, and what type of qualifying service was provided. They can also support appropriate claims processing and program oversight.
Are EVV rules the same in every state?
No. Federal law establishes the core requirements, while states have significant flexibility in selecting and operating EVV systems. Providers should follow the requirements of the state Medicaid program in which they operate.
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