Electronic Visit Verification (EVV) Public Meeting April 24, 2020 4/24/2020 1
Welcome • All phone lines are muted • Questions should be submitted through the chat feature • We will not be answering submitted questions during today’s presentation • Questions will be addressed after the presentation through a Listserv communication – Please reference the slide number in your question 4/24/2020 2
EVV Implementation • Section 12006 of the 21 st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services that require an in-home visit • EVV must be implemented for personal care services (PCS) by January 1, 2020 and for home health care services by January 1, 2023 4/24/2020 3
EVV Implementation • DHS applied for and received the Good Faith Effort Exemption from CMS. • Allows for up to an additional year for EVV implementation • The exemption expires January 1, 2021 • Providers are still expected to implement and use EVV now. • As of October 1, 2020, provider payments will be denied without corresponding EVV data. 4/24/2020 4
EVV Implementation EVV Visit Data Submission During Soft Launch 4/24/2020 5
EVV Implementation • The DHS Sandata EVV system is live – The system is free and available for use by Fee-For- Service (FFS) providers – If FFS providers are intending to use this system, they must take the online training and receive a Welcome Kit which will provide their access to the system • Alternate EVV systems must be integrated with the DHS Aggregator and submitting visit data no later than October 1, 2020 for provider agencies to be compliant 4/24/2020 6
EVV Implementation • The EVV Compliance Survey for providers is now due by June 1, 2020. • Link to survey: www.surveymonkey.com/r/WVBZHZN • We need every provider to complete this survey. • Providers should complete for each MPI#. • This information allows us to determine what assistance providers may need prior to October 1, 2020. • The survey is approximately 6 questions and should take 10 minutes to complete. 4/24/2020 7
EVV Compliance Survey Results • 274 responses to date 86% of respondents are currently using EVV 4/24/2020 8
EVV Compliance Survey 4/24/2020 9
EVV Compliance Survey 4/24/2020 10
EVV Implementation • Office of Medical Assistance Programs (OMAP) – PCS are home health aide or certified nurse assistant services provided to individuals under 21 years of age by a home health agency. – OMAP will continue to provide updates and will communicate with providers. 4/24/2020 11
EVV Implementation • ODP Participant-Directed Services – Go live for EVV with Palco is July 5, 2020 – All Participant-Directed Services will require EVV compliance – EVV Options with Palco are: • Mobile app via smart device or • Telephony/IVR via the participant’s landline – EVV Training Materials are published on the Palco website – EVV communication, training materials and registration forms will be mailed soon – Training will begin in May 2020 • Training will occur via webinar and phone 4/24/2020 12
EVV Implementation • OLTL Participant-Directed Services – OLTL’s Vendor Fiscal Agent, Public Partnerships, LLC (PPL), is using an Alternate EVV system, Time4Care – This system is already integrated with PPL’s timesheet and payment system as well as their participant and direct care worker online portals – Time4Care is live and any questions should be directed to PPL 4/24/2020 13
EVV Implementation • OLTL -- CHC Providers – The three CHC Managed Care Organizations (CHC-MCOs) are utilizing HHAeXchange for EVV. – Providers using Alternate EVV systems in CHC will need to send their EVV data to the CHC-MCOs. – Providers should contact HHAeXchange at EDIsupport@hhaexchange.com to complete third party system integration activities for CHC – Questions about HHAeXchange should be directed to the CHC-MCOs 4/24/2020 14
EVV Signature Requirements • OLTL – Common Law Employer – PPL system – Requires signature • ODP – Common Law Employer – Palco system – Requires signature for EVV services and non-EVV services • ODP – Managing Employer – Sandata/Alternate EVV Providers – Do not need signatures for PCS and non-PCS services if that service goes through an EVV system. Only non-PCS services will require a signature if that service does not go through an EVV system. 4/24/2020 15
Manual Corrections • If a provider has to manipulate data or add missing data or change data in any way after the service is delivered, this is deemed a manual edit. • Manual corrections should be done on an exception basis only. • Manual entries may need to occur in those situations when EVV visit capture modalities are unavailable at the point of care. – These are still considered manual corrections. 4/24/2020 16
Manual Corrections • Manual corrections in EVV are accepted but should never be the primary source of visit capture information. • Supporting hard copy documentation should be kept for manual corrections. • Hard copy documentation is a paper copy. 4/24/2020 17
Manual Corrections • Even if a visit is captured electronically but an exception sets and is corrected, the record would be classified as a manual correction. • EVV compliance is still being discussed internally and we will share updates in the future through the release of a bulletin. • Compliance thresholds are not being enforced at this time but, per CMS guidance, DHS is monitoring providers and may be contacting them to provide technical assistance. 4/24/2020 18
Manual Corrections 4/24/2020 19
EVV Implementation • Edits for ODP FFS went into effect for claims submitted beginning November 1, 2019 for dates of service November 1, 2019 and after. • Edits for OLTL FFS went into effect for claims submitted beginning December 13 for dates of service November 1, 2019 and after. • Edits for OLTL CHC went into effect for claims submitted beginning March 3, 2020 for dates of service January 1, 2020 and after. • OMAP FFS and MCO are in development stages and announcements will be made when these programs are available. 4/24/2020 20
EVV Error Status Codes • Error Status Codes (ESCs) may be found on the DHS EVV website and were also sent out via Listserv communications. – https://www.dhs.pa.gov/providers/Billing- Info/Pages/EVV.aspx • ESCs 925-931 are EVV edits; they are not HCSIS codes • As of October 1, 2020, these ESCs will cause claim lines to not be paid. 4/24/2020 21
EVV Error Status Codes ESC 927 - Units billed exceed units verified in EVV • When the provider sees this ESC set, the claim detail line denied because the allowed units on the claim detail are greater than the units found on the EVV record in the DHS Aggregator. 4/24/2020 22
EVV Error Status Codes ESC 927 - Units billed exceed units verified in EVV • Providers should determine if the units on the claim detail line or the units found in the EVV record need to be corrected. • The provider should make corrections as applicable and resubmit the claim, ensuring the units found in the EVV aggregator are equal to or greater than the units submitted on the claim. • While performing claims resolution analysis, provider agencies are encouraged to review the rounding rules and/or the calculation rules found in the ODP Guidance, make corrections accordingly and resubmit claim. 4/24/2020 23
EVV Error Status Codes ESC 928 - EVV Visit Not Found • When this ESC sets either: – No EVV record was found in the DHS Aggregator at the time the claim was processed; or – Mismatch was found between either the date of service, recipient MA ID (10 digits), procedure code/modifier and/or MPI (9 digit) code that is found on the claim versus what is found in the EVV record at the time the claim was processed. 4/24/2020 24
EVV Error Status Codes ESC 928 - EVV Visit Not Found • To correct this error, verify if the claim was submitted and processed BEFORE the visit information was successfully sent to the DHS Aggregator. • If so, providers should ensure the EVV record is found in the DHS Aggregator in a verified or processed status, and it contains valid data and then resubmit claim. 4/24/2020 25
EVV Error Status Codes ESC 928 - EVV Visit Not Found • If the EVV record is found in the DHS Aggregator but contains a mismatch between one or more data elements on the claim, review the EVV record received by the DHS Aggregator and manually validate if the data elements found in the DHS Aggregator record(s) contains the appropriate values as specified in the Alternate EVV interface requirements, technical specifications and addendums: http://www.dhs.pa.gov/provider/billinginformation/electronicvisitverifi cation/ • If the EVV record is accurate, validate the information that was sent on the claim(s) transactions is accurate, make corrections as needed and resubmit the claim. 4/24/2020 26
EVV Error Status Codes • If an EVV record in the DHS Aggregator is in any status other than verified or processed, it will fail EVV validation. • All records should be in verified or processed status in order to be validated against. Any other status will set ESC 928 - “EVV Record Not Found” 4/24/2020 27
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