axiscare home care software

Understanding EVV: The How, When, & Why of Electronic Visit Verification


Being a home health care provider is nothing like working a traditional nine-to-five. Caregivers are on the road for most of the day, jumping between appointments based on a carefully coordinated schedule.

With so many variables at play, maintaining time sheets and ensuring accountability can be challenging – which is why the industry utilizes Electronic Visit Verification (EVV).

What is Electronic Visit Verification (EVV)?

What is EVV? EVV software is utilized by home care agencies and their caregivers to electronically record the start and end times of home-based healthcare services. The 21st Century Cures Act mandates the use of EVV for health care provided at home or in the community, aiming to prevent fraud by verifying that the services billed for were actually rendered.

The Evolution of EVV

Early Manual Systems (Pre-2000)

Before the new millennium, EVV was still in its infancy. Early systems relied mostly on analog inputs like paper-based documentation and manual reporting.

Telephony-Based Solutions (Early 2000s)

In the early 00s, change came calling. Caregivers could use landlines or mobile phones to clock in and out of visits, which helped automate the verification process.

Mobile Technology Integration (Mid-2000s)

A few years later, caregivers began using smartphones and more advanced mobile devices to log their visits, allowing for increased flexibility and real-time data transmission during visits.

Regulatory Mandates (2010s)

The 21st Century Cures Act was signed into law in December 2016, mandating the use of EVV for Medicaid-funded personal care services and home health care services.

Comprehensive EVV Solutions (2015-2020)

EVV solutions began integrating complementary technologies like caregiver mobile apps, including GPS tracking, electronic signatures, and digital documentation, creating more comprehensive and powerful toolkits.

How Does EVV Work?

These days, caregivers typically use smartphones and tablets to engage with EVV solutions and track their visits while on the move. Here’s what a typical workflow looks like:

Initiating a Visit (Check-In)

Caregivers use their devices to log into their EVV-enabled point-of-care software. This creates an exact timestamp to mark the start of the at-home session.

Authentication & Identification

Caregivers enter a password, PIN, or use biometric verification such as a fingerprint scan or Face ID on their device to confirm their identity.

Location Tracking

EVV uses GPS technology to track and record caregivers’ locations, providing real-time information about their presence at the designated service location.

Task Documentation

Caregivers record every task performed during their visit, including specific care details like medications administered and client notes.

Integration With EHR

EVV systems typically integrate with Electronic Health Records (EHR), creating a link between at-home care documentation and the client’s overall healthcare record.

Compliance Checks

EVV systems routinely perform compliance checks to ensure that the care provided meets regulatory requirements for uses such as Medicaid billing and that the visit adheres to the applicable care plan.

Caregiver Check-Out

Once a visit is complete, caregivers clock out in the same way they started the session, marking the exact end time and confirming all necessary services have been rendered.

Real-Time Reporting

EVV systems generate reports that provide immediate access to visit data, helping agencies monitor, bill, and verify caregiver activities.

Regulatory Overview of EVV

The 21st Century Cures Act & EVV

The 21st Century Cures Act was written into law in 2016 to mandate the use of EVV. Its goal is to enhance caregiver accountability, reduce fraud, and improve the overall quality of care using technology to track and verify services rendered.

Service Type

These regulations apply to Medicaid-funded personal and health care services delivered at home and in community-based settings. For Medicaid billing in most states, the following must be captured in order for home care agencies to receive compensation for the visit being completed:

  • Individual Receiving the Service
  • Date of Service
  • Location of Service Delivery
  • Individual Providing Services
  • Beginning and End Times of Service
State-Specific Mandates for EVV

While the Cures Act and CARES Act legislate at the federal level, some states have implemented additional requirements for EVV.

Open Model State:
In an Open Model State, Medicaid providers can choose from a variety of approved EVV systems that meet the state’s requirements. This approach allows for a more diverse and adaptable landscape for EVV solutions, promoting innovation and accommodating different healthcare providers’ preferences.

Closed Model States:
Closed Model States take a more centralized approach. They will typically choose a single EVV system to be used by all Medicaid providers in that state or create one themselves. This aims to simplify implementation, facilitate standardized reporting, and keep things consistent across the state’s healthcare system.

Understanding Aggregators:
An EVV aggregator is a third-party platform that collects and verifies information from state-level Medicaid data sources. This information includes services rendered, billing claims, and client records, which are transmitted to the specific payer.

Applications of EVV in Healthcare

It may be clear by now that EVV is far more than just a tool for clocking in and out of a client visit. This technology can be used in countless ways across the entire care ecosystem, all of which contribute to a more efficient and productive workflow.

Medicaid-Funded Personal Care Services

As previously mentioned, EVV is the standard for Medicaid-funded care environments, ensuring accurate tracking and verification as mandated by federal and state legislation.

Home & Community-Based Services (HCBS)

EVV helps community-based caregivers manage and document a wide range of services, enabling them to coordinate care and preserve accountability outside of a traditional healthcare setting.

Remote Patient Monitoring

EVV can also be used to track and verify caregiver interactions for services administered virtually or remotely – an increasingly valuable feature as telehealth continues to become more prevalent in the home health care industry.

Chronic Care Management

EVV helps monitor and document recurring healthcare services (both in-person and remote), ensuring clients with chronic conditions receive consistent and timely care.

Hospitalization Care

After a hospitalization occurs, hybrid programs like transitional care and hospital-at-home initiatives can be tracked using EVV technology.

Hospice Care

EVV can be used to log hospice care being provided at home, ensuring comfort and support for individuals who are navigating the final stages of life.

Benefits of EVV Compliance

Aside from remaining in good standing with government regulations, there are plenty of ways that EVV usage benefits agencies and providers. Like most leaps toward automation, perks include a boost in efficiency and less busy work for employees. EVV also lends a hand in creating a heightened level of trust between agencies and their clients since they know services will be rendered and documented.

Improved Productivity

By automating routine tasks that used to be completed manually – like time tracking and reporting – EVV gives caregivers more time and energy to focus on delivering care.

Faster Payments

EVV can accelerate the billing cycle by immediately verifying and logging visit information, which, in turn, leads to faster reimbursements for healthcare providers.

Better Client Outcomes

EVV helps agencies and other providers adhere to care plans and deliver timely care by amalgamating critical information in a single spot, all in real-time.

Reduced Errors & Fraud

As a system designed to increase transparency and accountability, EVV is the best way to ensure caregivers track their services in a fair and accurate way while verifying that resources are used efficiently.

Improved Access of Information

Digitizing and centralizing client data makes it easy for all relevant stakeholders to retrieve client records, care plans, and visit details. In turn, this contributes to more informed decision-making.

Enhanced Caregiver Experience

The use of EVV and mobile apps offers caregivers a more seamless visit experience by eliminating administrative burdens, improving communication with their employer, and ensuring timely pay as their clock-in and out times are documented with ease digitally.

Considerations for Implementation

Data-Driven Insights Risk Mitigation

EVV mitigates risk by facilitating compliance with regulations, reducing billing discrepancies, and increasing transparency. This helps agencies and providers avoid legal and financial issues associated with non-compliance or documentation errors.

Understand State Requirements

As we mentioned above, different states may have their own set of regulations governing the use of EVV, like the open versus closed model framework. Conduct a thorough assessment to make sure you understand your specific local requirements so you can remain on the right side of the law.

Compliance With EVV Regulations

No matter how you use your EVV solution, it will need to strictly adhere to both federal and state EVV regulations, such as those put forth in the 21st Century Cures Act. By remaining in compliance with these rules, you can avoid potential penalties and maintain eligibility for critical Medicaid funding.

Verify Software Features

Get to know your EVV solution’s features in-depth to make sure they align with your needs. Key synergies to look out for include real-time reporting, seamless integration with Electronic Health Records (EHR), and compatibility with your existing home care software and tech suite.

Provide Training & Support

Every time you onboard a new software, you’ll need to teach stakeholders how to use it. Establishing an EVV training program for caregivers and staff is a must for successful adoption, coupled with ongoing support mechanisms that will help them solve future issues as they arise.

Case Study

Before AxisCare, CDM Caregiving Services was using a software provider that wasn’t on top of impending EVV compliance deadlines. With CDM’s client base being 90% Medicaid, the pressure was on to find a provider that took their concerns seriously and had compliance solutions in place.

CDM chose AxisCare for our user-friendly EVV-compliant Mobile App and our eagerness to understand their state’s EVV complexities. Now, CDM not only uses AxisCare to track and bill Medicaid clients but also to manage and run the adult day center where seniors in their community can come for physical therapy, companionship, and socialization.


Thanks to EVV, home health care has come a long way from manual note-taking and documentation systems. Agencies have lots to gain from implementing an EVV-enabled solution, from drastically reducing their administrative burden to avoiding human error and boosting accountability.

Implementing your own EVV solution requires a deep understanding of state requirements and evolving compliance features – so nothing compares to collaborating with an industry pro like AxisCare. Book a demo with one of our experts to learn everything you need to know about our EVV integrations, our app, and other useful features for home care agencies.

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