The fight against healthcare fraud and non-compliance is becoming a major issue that needs to be addressed.
According to a report by OIG in 2016, nearly 5% of home health care providers (about 500 agencies in the US) are at potential risk of failing due to compliance and fraudulent activities in their billing processes.
Government agencies are putting increased scrutiny on Providers’ billing practices to improve compliance, reduce human errors, and mitigate fraud.
These agencies are leveraging modern digital tools to detect fraud and error patterns in billing practices to improve the clients’ at home health care experience.
Organizations such as ACFE point to some common patterns across most compliance failures e.g. incorrect reporting of diagnoses, billing for services not rendered, etc. Human errors, mistakes in documentation, and misrepresentation of field activities can lead to compliance failures and loss of revenue for providers – even if these mistakes are not intentional.
These issues can be easily addressed with the help of modern digital technologies and processes – mobile phone apps, cloud-hosted business planning software, and automated field operations workflow.
One of these new ideas is Electronic Visit Verification (EVV) software. EVV software allows for the electronic verification of in-home care visits. This can be done through a variety of methods, such as GPS tracking, geofencing, and time tracking. EVV software can also digitize patient records and provide real-time tracking of the homecare service.
Using an EVV system for home care is a major step forward in preventing fraud and ensuring that everyone is doing their part. It is superior to the outdated practice of manually recording and checking visits. It helps us to trust that the right things are being done, and it also ensures that people are following key compliance regulations.
In the following sections of this article, we will explore the meanings of healthcare fraud and compliance, how to prevent healthcare fraud and abuse with an EVV software, how an EVV app works and the many benefits it provides. So, let’s take a look at how this innovative technology is making healthcare safer and more reliable for everyone.
Understanding Healthcare Fraud and Compliance
Healthcare fraud involves deceitful practices aimed at obtaining unauthorized benefits from insurance providers, government programs, or patients. Compliance, on the other hand, entails adhering to regulations, policies, and ethical standards to ensure the quality of care and financial integrity. Both healthcare fraud and non-compliance can have severe consequences, eroding trust and straining resources within the healthcare ecosystem.
Here are some of the healthcare frauds conducted around the industry:
Billing for Services not Rendered
This is the most common type of healthcare fraud. It occurs when a healthcare provider bills for services that were never actually provided to a patient. This can be done by falsifying medical records, submitting false claims to insurance companies, or providing unnecessary or duplicative services.
Misrepresenting Dates of Service
When a healthcare provider bills for services that were provided on a different date than the one that is documented in the patient’s medical record. This can be done to increase the reimbursement rate for the services or to falsely inflate the number of services provided.
Misrepresenting Locations of Service
A healthcare provider may bill for services that were provided in a different location than the one that is documented in the patient’s medical record. This can be done to increase the reimbursement rate for the services or to make it appear that the services were provided when they were not.
Introducing Electronic Visit Verification (EVV)
There are many benefits of EVV software. But first, let us understand- What is EVV system for home care?
EVV software is designed to validate the delivery of in-home healthcare services. Through GPS, biometric verification, and timestamps, it ensures that the services were indeed provided during the scheduled visits. This technology not only prevents fraudulent claims for services not rendered but also ensures accurate billing and compliance with regulations.
What Are The Benefits of EVV Software Apart From Preventing Healthcare Fraud?
The implementation of EVV software offers a range of benefits. It significantly reduces the chances of medical billing fraud by providing concrete evidence of services rendered. This, in turn, leads to fewer billing errors and disputes. Additionally, the transparency provided by EVV enhances accountability and builds trust among patients, caregivers, and payers. Here is a way how EVV can benefit homecare service providers:
Increased accountability: EVV software can help to ensure that care visits are being conducted as scheduled and that the services being provided are accurate. This can help to reduce fraud and abuse.
Improved efficiency: EVV software can help to streamline the process of scheduling and tracking care visits. This can free up staff time to focus on providing care.
Enhanced communication: EVV software can help to improve communication between care providers, patients, and families. This can help to ensure that everyone is on the same page about care plans and goals.
Increased safety: EVV software can help to improve the safety of care recipients by tracking the location of care providers and notifying them if they are outside of a designated area.
How EVV Can Prevent Healthcare Fraud?
Addressing Billing for Services: EVV app enables attendants to collect digital signatures and notes during each visit, providing proof of service in real time.
Ensuring Accurate Dates of Service: Mobile time and attendance apps, combined with plans-of-care forms, ensure accurate data logging at the time of service, reducing errors in claims submission.
Enhancing Location Accuracy and Timely Care Delivery: Mobile apps can geotag activities and create alerts for scheduled events, enhancing location accuracy and ensuring timely care delivery.
Easy-to-Generate Attendance Logs: Smartphone apps, Text, and IVR can generate accurate attendance logs, billing reports, and audit files, improving compliance with State and Federal requirements and preventing fraud.
Reduce paper form records: EVV can help to reduce paper form usage by digitizing the process of verifying visits. This can make it more difficult for fraudsters to alter or destroy records.
Increase transparency: EVV can increase transparency by providing real-time data on the delivery of care. This can make it easier for regulators and law enforcement to identify and investigate potential cases of fraud.
Improve compliance: EVV can help to improve compliance with state and federal regulations by automating the process of verifying visits. This can reduce the risk of human error and ensure that providers comply with the law.
Protect patient privacy: EVV can protect patient privacy by encrypting data and restricting access to authorized personnel. This can help to prevent fraudsters from accessing sensitive patient information.
Steps to Successfully Implement EVV Software for Preventing Healthcare Fraud
1. Assessment and Planning: Before implementation, assess the organization’s unique needs and identify the most suitable EVV software provider.
2. Training and Education: Train staff, caregivers, and patients on using the software effectively to ensure accurate data collection.
3. Integration with Existing Systems: Seamlessly integrate the EVV software with other healthcare systems to avoid disruptions.
4. Data Security and Privacy: Implement robust security measures to safeguard patient data and comply with regulations.
5. Testing and Quality Assurance: Rigorously test the software and conduct quality checks to identify and rectify any issues.
6. Rollout and Continuous Monitoring: Gradually introduce the software across the organization and continuously monitor its performance and user feedback.
Conclusion
In a healthcare landscape plagued by fraud and non-compliance, the integration of EVV software marks a significant step forward. By leveraging mobile technology, organizations can prevent healthcare fraud, ensure compliance, and ultimately enhance patient care and trust. Staying vigilant against unethical medical billing practices is crucial for the integrity of the healthcare industry.
The best EVV system for home care is one that streamlines your unique business requirements, and helps you achieve all of these goals- GPS tracking, geofencing, and time tracking to verify that care visits are being conducted as scheduled and that the services being provided are accurate. It should also generate real-time reports and analytics that can be used to identify and investigate potential cases of fraud. Here are the things to consider while choosing EVV software.
In addition to preventing fraud, EVV app can also help organizations improve compliance with state and federal regulations. The software’s automated workflows can help to reduce the risk of human error and ensure that providers comply with the law.
By adopting this mobile technology, you can stay vigilant against healthcare fraud. Protect the integrity of the healthcare industry using EVV.