Key Compliance Areas in Home Care

1. Electronic Visit Verification (EVV) Mandates

The federal government requires Electronic Visit Verification (EVV) for all Medicaid-funded Personal Care Services (PCS) and Home Health Care Services (HHCS). These systems verify:

• Who provided the service.

• Who received the service.

• When the service started and ended.

• Where the service was provided.

• What type of service was delivered.

Updates to Watch:

• States continue to refine EVV mandates, with unique state-specific requirements for data collection and reporting.

• Integration with state aggregators like Sandata and HHAexchange is mandatory for Medicaid compliance in many regions, including Illinois under the Illinois Department on Aging (IDOA).

2. Medicaid Audit Preparedness

Medicaid agencies are increasing the frequency of compliance audits, focusing on:

• Accurate documentation of Care Plans (POCs) and service delivery.

• Verification of caregiver qualifications and training.

• Billing compliance using tools like CMS1500 forms and Electronic Data Interchange (EDI) files (e.g., 837/835 files).

Updates to Watch:

• Agencies must ensure all billing data aligns with EVV records.

• Training tracking systems (like TTP) are increasingly required to validate caregiver certifications.

3. Managed Care Organization (MCO) Requirements

Many Medicaid services are administered through Managed Care Organizations (MCOs), which impose their own compliance requirements, such as:

• Timely submission of visit data.

• Enhanced reporting of client outcomes.

• Adherence to maximum hours allowed under Care Plans.

Updates to Watch:

• MCOs are adopting stricter timelines for submitting claims and supporting documentation.

How Verveware Helps:
Verveware’s scheduling and billing solutions ensure accurate tracking of service hours, task completion, and adherence to MCO timelines, reducing claim denials and delays.

4. Technology Integration and Security

As the industry adopts more digital tools, agencies must ensure:

• Compliance with data privacy laws like HIPAA.

• Secure integration with third-party tools such as Participant Search Screens (PSS) and clearinghouses like Availity and Change Healthcare.

Updates to Watch:

• Increased scrutiny on data encryption and secure transmission during EVV integration.

How Verveware Helps:

Our system provides end-to-end encryption, secure data sharing, and seamless integration with EVV aggregators and billing platforms.

Why Staying Compliant is Crucial

Non-compliance can lead to:

• Denied Medicaid claims.

• Financial penalties and loss of funding.

• Damage to reputation and client trust.

By staying informed about updates and leveraging tools like Verveware’s compliance-focused solutions, your agency can mitigate risks and maintain high standards of care.

Verveware: Your Partner in Compliance

At Verveware, we prioritize compliance so you can focus on delivering exceptional care. Here’s how we support your agency:

1. EVV Integration

We ensure your agency meets all EVV requirements, whether it’s tracking visits, submitting data to state aggregators, or aligning with Medicaid waiver programs like the Community Care Program (CCP).

2. Audit-Ready Tools

Verveware simplifies audit preparation with tools that consolidate EVV data, billing submissions, and caregiver schedules in one platform.

3. Real-Time Insights

Our dashboard provides a comprehensive view of compliance metrics, from caregiver tasks to client outcomes.

4. Customizable Solutions

Every agency is unique. Verveware’s platform adapts to your specific needs, whether you’re managing schedules, documenting care plans, or processing claims.