Often, home care agencies use clearinghouses to exchange their data or information to settle claims, verify eligibility, benefits and check the status of claims. And every clearinghouse accepts data files as per their set standard format. Based on it, home care agencies submit information to settle claims and get reimbursed for Medicaid and other third-party payers.
Claim submission with the state-appointed clearinghouses is itself a huge task, as home care businesses deal with a large quantity of service-related data and verify information regularly. Agencies need to ensure that all the data is collected, punched in, verified, and billed from multiple sources, this also in different formats before submitting for payment.
Managing and processing of error-free data is a monumental challenge for both small and large-scale private-duty home care businesses. Thus, the data which forms the foundation of the revenue generation for agencies requires efficiency, speed and accuracy at all the stages of collection. Maintaining and processing is a never-ending process.
Since the introduction of EVV (Electronic Visit Verification) as a mandatory compliance for all home care service providers tobe paid through Medicaid, service providers need a platform to streamline and channel the claim submissions and reimbursement process.
EDI – Electronic Data Interchange
EDI refers to the electronic communication interface, designed in a manner that helps in transmitting the data files between computer systems using established formats between service providers and payers.
Benefits of EDI for Home Care Agencies
EDI benefits care providers as well as payers by allowing them to send and receive information and verify data faster, quite often at a lower cost. Here are various other benefits of the EDI:
- Quick transfer of data: EDI helps in saving time, money and energy as turn-around times are comparatively quicker than manual processing. For instance: A payer can receive the claim the same day the homecare agency sends it.
- Avoid delays: The process happens electronically, so delays of any sort in the processing are automatically avoided. The electronic claims are automatically checked for the payer-specific requirements at the clearinghouse and payer levels. Such an automated data verification process cannot be performed via paper claims.
- Fewer denials: Claims that are submitted as per the guidelines and pre-defined formats including verified data and accurate information have fewer chances of getting denied. This means claims are submitted successfully every time and agencies can expect faster payments.
- Reduced extra administrative expense: Through EDI, agencies can cut down on the purchase of paper, postage and other supplies. Also, a large amount of time is saved in faxing, preparing envelopes, printing, and sorting.
Setting up an EDI System
If you are a private-duty home care business and want to learn how to set up an EDI profile, here are the steps you can follow to prepare for a successful creation:
- Set up a profile for each clearinghouse that your company uses. For this, the agency will have to adhere to the format as agreed upon by both businesses. Connect each payer to the clearinghouse and the agency.
- Another important step is to add authorizations to the client’s profile. This step must be done before adding client schedules.
- The next step requires caregivers to clock in/out using a mobile application. Clocking-in/out manually will leave caregivers vulnerable to being audited for not complying with the mandated EVV. This might also lead to significant delays and denials of claims.
- After clocking in and out, make sure all the visits are verified and approved.
- Creating invoices is one of the last steps before an EDI file is created and allows the agency to initiate claim submission.
EVV – Electronic Visit Verification
EVV is the Electronic Visit Verification solution required by government-funded programs to reduce fraud.
As per the Centers for Medicare and Medicaid Services (CMS), “Every service that demands an in-home visit provided they are included in the claims beneath the personal care and home care services are undeniably subject to EVV implementation.”
In simple words, if personal care services are offered at home and are covered under Medicaid or Medicare for claims, EVV is mandatory.
EVV helps in capturing key information, such as:
- Types of services performed by the caregiver.
- Information on the client receiving the service.
- Detailed information of the service provider.
- Date and time of the service offered.
- Time duration of the service provided (clock-in and clock-out).
- The location where the service was delivered.
EVV facilitates an error-free and hack-proof workflow that makes life easier for agencies, clients and caregivers. It helps to:
- Automate workflows
- Generate verified data
- Avoid errors and duplication
- Reduce operational costs
- Eliminate manual data entry
- Centralize the workflow of all (caregivers, clients, agency)
Instead of a stand-alone solution, EVV is integrated within the agency’s business management software and mobile application. It works like a tool to ensure services were delivered as per the care plan and care needs. It helps to maintain a higher level of control on the caregivers working in the field.
For caregivers, it takes the hassle out of filing paperwork at the end of the day. They can clock-in and clock-out by using the mobile app for caregivers while arriving and leaving the location of service delivery. Telephony is another way of sending information to the agency by punching in their ID, in case they do not have a device to access the mobile app.
With CareSmartz360, Creating and Setting up EVV/EDI is Simple
CareSmartz360 is the ideal home care agency management software which allows businesses to focus on their goals, while its intelligent features handle processes and data efficiently. It is integrated with EVV/EDI and advanced capabilities to ensure agency owners stay compliant and deliver quality care. In addition, the software also supports both 837P (professional) and 837I (institutional) file formats to send claims to payers based on their required format.
With EVV and EDI systems embedded in the home care software, operations and functionality of services have been made easy and smooth. These modern tools prove to be a boon for both the home caregivers and the home care provider agencies.
Related blog posts:Why there is a Growing Demand of EVV in Home Care Industry?
Simple Steps to get Compliance for Home Care Agencies