February 2020
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EVV is it a Saint or Sinner?

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EVV is it a saint or sinner???  Medicaid fraud and waste are a multimillion dollar problem on the state and federal level.  To help with this problem the State of Texas implemented the Electronic Visit Verification known as EVV.  EVV is a telephone and computer-based system that electronically verify service visits and documents the precise time services begin and end.  Now that you guys know what EVV is and what it is use for, let’s see if it works?

EVV with the roll out of StarKids has been a curse to agencies.  The two major and only choices for EVV services is Vesta and MEDsys, neither were ready for the StarKids roll out.  The changes in the service codes and modifiers were not uploaded in the system until December of 2016.  Once the codes were added it was the agencies responsibility to change the codes, back dating from November of 2016.  All of this happening while we were trying to get paid from the manage care organizations known as MCO’s.

MCO’s use the EVV to recoup millions of dollars from agencies who did not get their EVV reopened within a 30 day span.  When the recoup letters were sent to the agencies, the recoupment was already in effect, causing many agencies to close their doors.  The MCO’s would not reopen the system for the agencies to fix the problem.  Now MCO’s are changing the services codes and modifiers on new authorizations and if an agency is not paying attention they can fall into this trap again. 

The State of Texas has been saying for years that agencies that offer private duty nursing will start using EVV.  They have pushed the date back for years.  My fear is, that the two EVV companies will not be able handle the volume and thus cause many agencies to struggle.  The MCO’s will use EVV to recoup money from the agencies and again forcing agencies to close their doors. Which brings me to my initial question is EVV a saint or sinner? Has it helped to lower the amount of Medicaid fraud or is it used by the insurance companies to avoid paying claims and or recoup monies from  claims already paid?

 

Comments

  1. D. Williams

    February 22, 2018

    Great question!

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