How Florida Home Health Agencies Can Reduce EVV-Related Claim Problems

Most EVV-related claim problems come from a small number of causes, and almost all of them start during the visit, long before the claim. This guide walks through each one and the checks that catch it early.

Why EVV and claims are connected

Federal law requires states to use EVV for Medicaid personal care and home health services that involve an in-home visit. States had to require EVV for personal care by January 1, 2020 and for home health care services by January 1, 2023.^[1]

In Florida's fee-for-service program, AHCA lets providers use the State's contracted EVV system at no cost, or an Agency-approved third-party system. Third-party systems must be interoperable with the Agency's EVV claims system for billing purposes.^[2] AHCA has also applied EVV compliance requirements to managed care plans since January 1, 2020.^[2] If your visit data is weak, your claims will show it.

The six elements behind every visit

Every EVV system must verify six elements for each visit:^[3]

1. Type of service performed
2. Individual receiving the service
3. Date of the service
4. Location of service delivery
5. Individual providing the service
6. Time the service begins and ends

Each problem below is a failure in one or more of these six. Fix the element and you fix the problem.

1. Missing visit data

What happens: A caregiver forgets to check in or out, or the visit is never captured. Prevention:

• Run a same-day report of scheduled visits that have no check-in/check-out
• Follow up while the caregiver still remembers the visit, not at billing time

2. Incorrect times

What happens: Recorded start or end times don't match the schedule, the authorization or reality. Prevention:

• Flag visits far outside scheduled times for supervisor review
• Require a documented reason whenever a time is manually edited

3. Location discrepancies

What happens: The visit location doesn't match the patient's service address. Prevention:

• Keep patient service addresses current
• Review location exceptions daily

CMS has stated that web-based electronic timesheets alone are not a permissible form of EVV, because they don't give the state auditable confirmation. CMS notes that most states' systems use GPS and/or landlines to capture location.^[4]

4. Caregiver mismatch

What happens: The caregiver on the EVV record isn't the caregiver who was scheduled or credentialed for the visit. Prevention:

• Record shift swaps in the system before the visit, not after
• Block assignment of caregivers whose required credentials have lapsed (see Caregiver Credential Tracking)

5. Service mismatch

What happens: The service recorded doesn't match the authorized service or the service billed. Prevention:

• Tie each visit to a specific authorized service before it starts
• Compare the visit service to the claim line before submission

6. Documentation problems

What happens: The EVV record is clean, but the visit note is missing, unsigned or contradicts it. Prevention:

• Treat "visit verified, note missing" as an open item, not a finished visit
• Spot-check that notes agree with EVV on date, time and service

Build an exception workflow

Exceptions will happen. What matters is that each one is handled the same way:

1. Detect: daily exception report
2. Assign: one owner per exception
3. Resolve: correct the record with a documented reason
4. Prevent: track repeat causes by caregiver, patient and service

Validate before you submit

Before any claim goes out, confirm that every billed line has a matching visit, and that the visit has all six elements verified. Then check that dates, services and units agree with the authorization. For the claim side, see 837P Claims for Home Health Agencies and 835 Remittance Advice Explained.

General information for agency operators, not legal or billing advice. Confirm current requirements with AHCA, your managed care plans and HHAeXchange.