The 5.3 Release provides tools to help our customers towards compliance of the 21st Century Cures Act, which includes a requirement for Electronic Visit Verification (EVV) in all Medicaid Personal Care Services ("PCS") programs by January 1, 2020. Preventing insurance fraud and ensuring that proper services are performed is at the core of CentralReach’s overall mission of producing better outcomes.
While the 21st Century Cures Act is a U.S. federal mandate, it is up to each U.S. state to ensure the proper systems are in place for verification. Currently, the majority of states that have filed for a good faith effort exemption, which extends the deadline to January 1, 2021.
If your state is not on the exemption list above and you would like to activate the visit verification feature, please contact our CR Essentials Helpdesk for further assistance.
NOTE: Prior to the update, it is strongly recommended that Scout users transfer all offline data back to the server, log out of the app, and clear the browser storage data. Please see this quick help guide for detailed steps.
The following general updates have been released:
- The generic and "California Visit Verification" reports have been moved from the Patient's Collect page to the Charts & Reports module under the Administrative section.
- The new "Visit Verification Detailed Export" is also available in the Administrative section of the Charts & Reports module, which allows the transfer of visit data to a third-party system for external verification of visits.
- The "Employee Name" field will always be present above the "Employee Signature" field in the Scout Lock screen.
- The "Guardian Name" field is now selectable within the "Guardian Signature" box and can be disabled via the CUSTSETTING_SCOUT_GUARDIANSELECT company setting.
The following updates are for users enabling visit verification:
- In order for visit verification to work:
- The Practice Management license needs to be active.
- The Clinical license needs to be active.
- The CUSTSETTING_VISITVERIFICATION company setting needs to be enabled.
- The permissions below provide access to the following reports:
- The "Report: Visit Verification Report" permission is for the "Visit Verification Report."
- The "Report: California Visit Verification Report" permission is for the "California Visit Verification Report."
- The "Visit Verification Detailed Export" permission is for the "Visit Verification Detailed Export."
- The distance threshold for the verification of the appointment's location in Scout is configurable via the CUSTSETTING_EVVGEOFENCERADIUS setting, which has a default value of 50 meters.
- The exceptions caught by EVV can be bypassed in the Bill Events screen by enabling the CUSTSETTING_BYPASS_EVV_EXCEPTIONS company setting.
After enabling EVV, the steps below explain the required workflow:
- Appointment is created in CR Essentials' Web app.
- The score sheet is attached to the appointment.
- The appointment is completed using Scout.
- Any EVV exceptions are managed in the "Bill Events" page.
- Visit reports are viewed in the "Administrative" section of Charts & Reports.
- A new "Start Appt Timer" button is available on appointments that will electronically document the therapy time and location both at the beginning of the appointment (Events screen) and at the end of the appointment (Signature screen).
- If the device's location exceeds the distance threshold, a soft warning message will appear, notifying the user that the recorded location does not match the appointment's location.
- The detection of the address will still work in Offline Mode as long as the device can reach the server.
- If the "Start Appt Timer" is used, these additional fields will appear within the Signature screen:
- Scheduled Address
- Recorded Start and End Locations
- Recorded Start and End Times
- Please note, the times are not editable if EVV is enabled.
- The times will automatically update the appointment's times on the calendar and display the original ("source of truth") as "Scheduled Date" on the appointment screen.
- If the appointment has "Place of Service" set to "Home", a change reason will need to be provided if the following fields are modified:
- Bill Codes
- An additional note is required if one of the following change reasons are selected:
- Location captured is incorrect
- Manual entry of EVV
- A completed appointment will be flagged as "Failed Visit Verification," if:
- The completed appointment's duration is greater or less than the scheduled appointment's duration. The threshold for this duration is set to 10 minutes by default, via the CUSTSETTING_APPT_DURATION_EVV_THRESHOLD company setting.
- The completed appointment's start or end location is different than the scheduled appointment's location, as determined by the distance threshold via the CUSTSETTING_EVVGEOFENCERADIUS company setting.
- The completed appointment is missing the employee or guardian's signature.
- Users can still manually update the event's status from "Failed Visit Verification" to "Ready to Bill" or "Ready to Review."
- Reasons must be applied for exceptions prior to billing the event, unless the CUSTSETTING_BYPASS_EVV_EXCEPTIONS company setting is enabled. To apply an exception reason, select an event that contains an exception and use the "Apply Exception Reasons" option within the ellipsis menu.
- A new "Include Failed Visit Verification" filter has been added to the Bill Events page.
- Similar to editing existing appointments, a change reason will need to be provided if the following fields are modified when re-billing a claim that has a "Place of Service" set as "Home":
- Bill Codes
Charts & Reports
- The generic "Visit Verification Report" has been rebranded, and includes:
- Recorded start and end locations
- Recorded start and end times
- Change reasons
- Dates of signature
- Signer's first and last names
- Location fields have been updated to include actual street addresses, if detected, instead of geographic coordinate numerals.
- Event dates and times, automatically being updated via the visit verification Appt Timer in Scout, will be reflected in the following reports. If Visit Verification is disabled, the following reports will use the Session datetime for the event:
- Session Summary
- Signed Event Audit
- Event Audit
- California Visit Verification Report
- Since data entered via the Post-Facto feature cannot be electronically verified, a note on the "Post-Facto Details" window will state, "Please be aware that any data entered Post-Facto is not subject to visit verification and could result in a denial from the Payor."