Congress is considering changes that could halt the electronic visit verification (EVV) process, and home health billing companies are paying attention – providers should be too.
This is because the next version of the 21st Century Cures Act is set up to prioritize privacy by not allowing EVV systems to leverage GPS. For many home health companies who have already invested significant amounts in EVV upgrades, the bill passing as written could mean a loss of millions of dollars. Here’s what you need to know today.
What the EVV GPS Bill Includes
The bill in question contains a provision which says that it “prohibits the use of geographic tracking features and biometrics within EVV systems.” Advocates in the disability community argue that mandating GPS in EVV violates the privacy rights of people who have disabilities.
Damon Terzaghi, senior director of long-term services for ADvancing States (an organization that offers guidance and leadership to aging and disability agencies at the state level) explains the organization’s position.
“We as a culture have made some value-based judgments that we’re willing to sacrifice some of our privacy for the convenience of our cell phone telling us what products or services that we like are nearby. We have the option to turn off GPS or not use our phones if we so decide. The argument they would make – which I don’t necessarily disagree with – is by virtue of having a disability, they’re being told that you don’t have this option, that you must accept to be tracked in order to receive services that, in many cases, are necessary for them to live.” 
Another issue is that the people who care for disabled patients are often women of color and immigrants, who have been noted as feeling under suspicion and surveillance.
How GPS and EVV Work
Lots of home health companies, including home health billing and coding companies, are very interested in EVV. This is because those who manage expanding home and community-based services (HCBS) have unique challenges as they provide services to Medicaid beneficiaries in their homes or in places in the community outside facilities. They face a need to be able to manage cash flow and home health billing outcomes faster than they ever have. This is why real-time information that GPS in EVV provides is so valuable. They’re tracking elements including :
- Authorized services in plans of care
- Trying to balance under and over services their clients
- Managing overtime for home care workers
- Preventing schedule silos that ignore part-time employees and incur avoidable overtime costs
- Complex payroll and billing
GPS in EVV can help address some of these challenges in terms of quality assurance, verifying employee location, streamlining home health billing and payroll, compliance, and verifying hours of work.
Most companies use one of two technologies in their EVV system: Telephone Timekeeping with Caller-ID verification or Web Clock with GPS verification. Both of these options require an employee to use a unique ID to clock in instead of using their name and signature that would be used on a paper time sheet.
Web Clock, though, is favored in many cases because it does not require a landline phone being present. To verify services, GPS on a smartphone is accepted. If an employee is using a smartphone, GPS is enabled, with the agency usually providing the smartphone to guarantee usage and GPS monitoring.
Challenges with EVV and GPS
EVV implementation hasn’t been completely smooth .
While some states and larger providers progressed smoothly, the majority of states and smaller providers were left behind. Still, even with the impact of the COVID-19 pandemic, providers across the country started to transition to EVV. GPS was included in their transition, largely because of the U.S. Centers for Medicare & Medicaid Services (CMS). Their guidance pushed states to use GPS in their EVV systems, with those who tried to use other methods being told that the verification of location wasn’t legitimate.
This approach to GPS was part of EVV’s goal to stop abuse, fraud, and waste in home-based care, but now, EVV is required for states to gain full access to their federal funding. As things stand under the Cures Act, states must use EVV for all of their Medicaid-funded home health services by January 1, 2023. If the GPS element is cut, many providers will likely be thrown off. For example, consider organizations and home care agencies that have used technology to create a decentralized workforce that uses GPS.
As expected, some states are pushing back, a potential relief to providers as well as home health coding companies. Multiple state associations have requested that lawmakers remove the ban on use of biometric and geolocation features in federally mandated EVV – highlighting the issue of implementation dates being unchanged in the draft text, and saying that it would cause serious compliance challenges and imposed costs for the states that have already done the work of designing and implementing systems.
How Home Health Billing and Home Health Coding Are Impacted
GPS is a critical part of EVV and home health billing. Since paper time sheets are often no longer used, some organizations have opted to tie EVV to the billing system. If the GPS element is shut down, many companies will have to revamp their home health billing and coding processes.
As this next version of the Cures Act develops, home health companies should consider talking to home health billing and coding companies who are used to keeping up with these types of changes. We would like to help you as you review your EVV and GPS strategy and invite you to contact us to get started.
 P. Filbin, “Why Eliminating GPS from EVV Could Cost Millions, Force ‘Massive’ Step Backward,” Home Health Care News, 11 May 2022. Available: https://homehealthcarenews.com/2022/05/why-eliminating-gps-from-evv-could-cost-millions-force-massive-step-backward/.
 MITC, “All You Need To Know About Electronic Visit Verification And How EVV Benefits Agencies,” Available: http://www.rcpaconference.org/wp-content/uploads/2017/09/W15_All-You-Need-to-Know-About-EVV.pdf.