Key Terms in Homecare

Homecare

Professional services enabling individuals to live safely and comfortably at home. These services often include Activities of Daily Living (ADLs) such as grooming, bathing, meal preparation, and companionship. Known also as In HomeCare Services (IHS) or Personal Care Services (PCS), these services are foundational to elder care and senior care.

Electronic Visit Verification (EVV)

A federally mandated system to verify that care services are delivered as planned. EVV tracks key details such as caregiver clock-in/out times, client location, and tasks performed. EVV ensures Medicaid compliance and is essential for billing and audits. Tools like Sandata and HHAexchange, as state aggregators, facilitate data submission for compliance.

Methods of EVV include:

• Mobile Apps: GPS-enabled apps for location verification, such as Vesta EVV Mobile App.

• Telephony: Verifying visits using the client’s home phone.

• Fixed Devices: In-home tokens generating codes for manual clock-in/out.

Caregiver

The person providing homecare services, also referred to as Home Care Aide (HCA) or Worker. Family Caregivers (or Preferred Caregivers) provide care to family members, often subject to stricter rules to prevent fraud.

Client

The individual receiving homecare services. Also known as Participant, Consumer, or Patient in Medicaid programs like the Community Care Program (CCP).

Case/File

A record containing all information related to the caregiver and client. These are managed electronically in systems like ECCPIS or HHAexchange.

Care Plan (Plan of Care/POC)

A detailed outline of the client’s needs, including tasks, max hours, and the schedule for services. The Care Plan ensures that services align with the client’s health and safety goals.

Billing and Compliance Terms:

1. Authorization

Approval from a payor (e.g., Medicaid or a managed care organization (MCO)) that allows services to begin. This document specifies tasks, hours, and the service duration outlined in the Care Plan.

2. Accounts Receivable, Billing, and Claims

• Accounts Receivable (AR): Refers to payments owed to the provider for rendered services.

• Claims: Submissions made to payors for reimbursement, often filed using CMS1500 forms or Electronic Data Interchange (EDI) formats like 837/835 files.

• Clearing Houses: Services like Availity, Trizetto, or Change Healthcare that process and submit claims to payors.

Schedules and Units

1. Schedule

Blocks of time during which a caregiver provides services:

• Permanent Schedule: Recurring weekly template.

• Temporary Schedule: Ad-hoc or non-recurring schedules.

2. Unit

A measurement of service time, typically defined as 1 unit = 15 minutes (4 units per hour). Used for billing and reporting purposes.

Technological Advancements in Homecare

1. Participant Search Screen (PSS)

A digital tool for locating client or caregiver data in systems like ECCPIS.

2. Training Tracking System (TTP)

Software used to manage caregiver training and certification compliance.

3. Audit Compliance

Ensures all service data aligns with Medicaid and state requirements. Systems like HHAexchange and Sandata Technologies EVV support accurate data submission for state audits.

Additional Services and Tools

1. Adult Day Service (ADS)

Daytime programs offering supervision and activities for seniors outside their homes. Often complements in-home care for clients in programs like CCP.

2. Max Hours

The maximum hours of service allowed, as specified in the Care Plan or Authorization.

3. Clock In/Out

Caregivers record visit start and end times using tools like mobile apps or telephony, ensuring EVV compliance.

Importance of EVV Systems in Homecare

EVV systems, like Verveware's offerings, simplify compliance and enhance the quality of care. By integrating with state aggregators such as HHAexchange or Sandata, EVV systems ensure Medicaid providers meet state-specific requirements while improving transparency and accountability.