The term “Electronic Visit Verification” has jumped to the forefront of many alerts sent out to ABA practitioners. The barrage comes from both industry news feeds, periodicals, colleagues and team members who are concerned about compliance, yet aren’t sure where to look for more information.
In this article, we will take a closer look at the nuts and bolts details of electronic visit verification for ABA therapy, as well as try to answer some of the more frequently asked questions.
The Electronic Visit Verification Mandate
Section 12006(a) of the 21st Century Cures Act, directly states that electronic visit verification is required for “All Medicaid personal care services as well as home health services that require an in-home visit by a provider.”
Each State is required to submit electronic visit verification for all federally funded services that fall under PCS (Personal Care Services) and HHCS (Home Health Services). However, this specific mandate does not include applied behavioral analysis (ABA) services. Yet states may be more vigorous in applying standards and regulations in order to add ABA to their specific requirements.
For the moment, Colorado and Florida are the only states requiring EVV for ABA providers, though this is likely to change as time goes on.
What we have seen from these states is that they are working to help ABA practitioners by providing enhanced training, as well as putting in place timelines for a soft launch. The goal being to help ABA practitioners to acclimate to electronic visit verification standards. This process is likely to be followed in other states, which prompts some key questions.
What is Electronic Visit Verification?
It is the documentation process that most providers use to schedule visits, as well as note check in and check out of service and delivery. It plays a critical role in the submission process to public institutions like Medicaid where the practitioner is filing a claim for payment.
Also known as “EVV” it’s become increasingly popular throughout the United States in a variety of health care services as a sort of safeguard for the integrity of funding, as well as helping to reduce the overall paperwork burden, while also helping to standardize data collection.
What Is the Primary Function Of The EVV System?
The Electronic Visit Verification system is designed to collect data as part of the claim creation process. It is essential for submitting claims to public payer institutions like the state Medicaid Management Information System. All of the data collected includes key elements like:
- The Provider Information
- The Recipient’s Information
- The Location Of Service Delivery
- All Pertinent Procedure Codes
- The Tasks & Any Applicable Notes
Having all this key information collated in one documentation process, makes it easy to match the data against information submitted when obtaining prior authorization. The system also ensures that the right services are being rendered to the right recipients at the right times and at the correct location. This further helps streamline the claims process to ensure that the recipient receives the approved services and reduces abhorrent billing practices.
Who Is Required To Use Electronic Visit Verification?
EVV has been given a soft launch as a pilot for recipients with a residential address in Regions 9, through 11. It tends to be most for behavior analysis services. It is not used as much for assessments or reevaluations.
How Long Is The EVV Pilot Program Expected To Last?
Currently, the mandate has no defined end date, as it is likely to expand the roll out rather than be repealed.
Is There A Fee For Using The EVV System?
At this time, there is no cost or fee for using the EVV system.
What Services Are Required To Bill Via the Electronic Visit Verification System?
When it comes to behavior analysis services the following procedure codes are required to be billed in the EVV system:
- H2012 BA
- H2014 BA
- H2014 BA GK
- H2019 BA.
Does The EVV System Place A Limit On The Number Of System Administrators In A Practice?
At this time, there is no limit to the number of system administrators a single practice can have.
Can I use An Alternative EVV System?
Currently ABA practitioners and other providers may use an alternative EVV system. Though you might want to contact the payer organization or institution in advance to ensure that the system you are considering is indeed compatible.
Is There A Grace Period For Using The Electronic Visit Verification System To Help Providers Prepare?
Unfortunately, there is no stated grace period for when the pilot program goes to a full roll out. This is what makes preparation and training so important at this stage for ABA therapists and related practitioners.
Will I Still Need To Get Prior Authorization For Current Patients?
A prior authorization still needs to be requested from the Agency’s Quality Improvement Organization before any scheduled services can be rendered.
How Will Practitioners Get Paid For Services Rendered To Medicaid Recipients?
The practitioner rendering services can bill using the Electronic Visit Verification system as part of the medical coding process. This makes for a more streamline revenue stream in the long-term.
When Will EVV Training Be Available?
Most training opportunities on the Electronic Visit Verification system are available via a Webinar.
Who Needs EVV System Training?
It is recommended that all providers who are new to BA EVV should avail themselves of the training available.
Is EVV Used For Home Care Professionals?
As a timekeeping system EVV is very helpful for home care professionals who need to use it to verify when, where, and who the service was provided to. It also generates data to ensure care plan compliance. This makes it far more effective than the previous phone-based system used by home care providers in the past.
Is It Possible To Attend More Than One Session?
Practitioners who are interested in training on multiple topics can indeed sign up for multiple sessions. This is especially helpful for practices with interdisciplinary professionals with different specialties.