Removing Fraud and Improving Point-of-Care Compliance in Healthcare

Special Report from CellTrak

Home and community care’s distributed delivery environment makes accountability of visits and services more challenging than in centralized, facility-based care models. The benefits of home-based care delivery are extreme, from both a cost savings and a patient results perspective. Electronic Visit Verification (EVV), when combined with manageable policies and procedures can significantly improve accountability to assure that services are being delivered to care recipients when and where providers claim they are and providers are able to manage this service delivery with reasonable, sustainable expense.

Today the biggest challenge for the healthcare systems is that the vast majority of care planning and visit verification along with transaction processing, payments, tracking and payroll is done via paper.

Mobile Technology: A Starting Point for the Future of Healthcare

Mobile technology is inevitably changing and shaking up the healthcare world. Technology is shaping every aspect of our lives today. Mobile Applications (apps) are able to tell us at the push of a button where you can find a restaurant open at any hour of the day, what a person can eat by to calorie amount, map the entire days travels and now electronically verify and document care in a home and community care setting. Home health care is inescapably being transformed through technology. These new powerful tools driven by integrated mobile applications fundamentally change the work that can be accomplished by staff and most importantly position the health care industry at an important transitional step for providing better care to citizens everywhere.

Mobile technology brings additional resources to the fingertips of nurses and homecare professionals at the frontline to support their clinical decision-making and contribute to improved client outcomes. With day to day changing patient needs, there is increasing evidence that mobile technology and applications will transform the industry and facilitate faster and better communications, as well as rapidly providing integrated outcome data to the entire care team.

Vertically integrated mobile applications work where your staff work and where care needs to be delivered. Mobile solutions offer 24*7 availability, in and out of cellular or network coverage areas and within an environment that is highly secured and supports the requirements for privacy and data related to personal healthcare information. Enforcement of Electronic Visit Verification (EVV) encompassed solutions are becoming one area an agency can not ignore. While many agencies are aware of this need and some state enforcement, few are integrated and providing the value of the connectivity, mobile work force and the data gathered.

Complying and Documenting at the Point of Care

The introduction of mobile devices as documentation tools has provided the advantages of accessibility and readability of information as well as the capability to capture the information at the POC. With most mobile devices now GPS enabled tracking, monitoring and alerting is streamlined though agencies daily processes. This means an agency can now use a GPS device to verify a visit. GPS enabled Mobile devices are lightweight, powerful and readily accepted by care teams and patients alike. The process can now be accurately handled at the actual point of care. GPS monitoring/verification provides accurate tracking of the exact location of homecare staff and recording the actual mileage and visit time for each visit on a mobile device. Mobile Technologies are changing how healthcare staff delivers care. With new powerful integrated solutions available for the healthcare staff, workers can now provide care to more patients with more complex conditions in a secured fashion that empowers the workers to have anytime, anywhere and any device tools with schedules and patient specific care plan data at their fingertips. With the introduction of mobile GPS enabled devices, documentation previously completed at the end of the day, can now be tracked and completed immediately at the actual point of care.

Electronic Visit Verification and the Importance

Electronic Visit Verification systems electronically verify the time and location of the person claiming to have provided home care services. They facilitate electronic documentation needed to record those services and capture a patient’s signature, in the process helping home care providers better maintain 100% compliance, protection against fraudulent claims, and ultimately better patient care. Why are EVV solutions important?

  • Fraud and abuse costs payers and taxpayers billions of dollars annually
  • The benefits of home-based care delivery are extreme, from both a cost savings and a patient results perspectives
  • EVV can significantly improve accountability to assure that services are being delivered to care recipients when and where providers claim they are
  • EVV can set the foundation for improved outcomes across the healthcare continuum

Imagine your staff’s day starting with a mobile solution. No extra trips to the office, knowing exactly where they are located and the assurance of complete visit compliance. Mobile technology tools will alert your care coordinators if your staff is outside of compliance in real-time. Your staff is what creates your agency, your reputation and your level of care. Could you possibly imagine going to an audit without a tool that supplies the confirmation of a compliant visit audit?

Medicare, Medicaid and medical claim fraud compose the largest numbers of investigated insurance fraud cases in the United States. With nearly $60 billion dollars lost annually to fraud, Medicare and Medicaid fraud cases include questionable activities on the parts of patients and healthcare related providers. Medical claim fraud depletes government-funded healthcare, costs taxpayers billions, and drives up private insurance rates. Fraud schemes can be greatly minimized or even eliminated by using these mobile EVV solutions.

Why is this important? When home visits are documented manually, it is easier to bill Medicaid, Medicare or private payers for care that was never delivered. , To thwart such efforts, there are numerous available EVV solutions that are extremely difficult to fool. They have the potential to provide significant benefit to all stakeholders, including payers, healthcare providers and recipients.

Specifically, the mobile EVV systems electronically verify the time and location of the person claiming to have provided home care services. They facilitate electronic documentation needed to record those services and can capture a patient’s signature or other electronic proof of a visit, in the process helping home care providers move toward full EHR usage. With EVV systems, actual visit times are automatically verified at the time the service is provided and they take any guess work or estimating away from the employee. The result is exact service time recording, and by having the mobile EVV capabilities integrated with the home care agency’s scheduling and billing system, payer rounding rules can be programmatically calculated to ensure proper claims are created based on these exact service times.

Benefits of Using Mobile Solutions for Electronic Visit Verification and Documentation

  • Staff is able to verify any information immediately with the patient present.
  • Information is entered once, in real time at the point of care
  • Electronic documentation tools enforce required information and provide feedback ensuring the record is complete and avoid incomplete documentation and resubmission.
  • Accuracy of the information is increased by providing only valid selection options. This reduces the amount of rejected submissions due to incorrect information.
  • Adequate tools to search pre-verified information to consult at the POC.
  • Configurable alerts create awareness on missed or delayed visits increasing compliance.

More Than Mobile: Improved Agency Operations and Patient Outcomes

Mobile devices at the point of care for Home Healthcare eliminates duplication of effort related to visit notes and timekeeping documents for field staff translating into reduced labor expense and a greater census capacity. The solutions go beyond mobile, they allow agency owners and managers to monitor and manage information from anywhere. Whether your staff is in route to a visit, or at the point of care, CellTrak solutions are improving compliance and increasing census as part of your everyday operations. Increase revenue and margin without increasing overhead.

Time and money are easily saved in labor and mileage, with reduced administrative trips to the office with an easy-to-use, mobile app that captures the visit note, time and attendance and travel data seamlessly throughout the day. Staff potentially costing the agency time and money or causing compliance risks due to poor schedule management or incomplete documentation is immediately visible. Visit documentation cannot be submitted until it is complete, and the next visit has to be completed prior to departing a location.

Improving compliance at the point of care is a critical challenge for healthcare. Combining pre acute and post-acute processes and technology such as mobile point of care and electronic visit verification, to provide a foundation for care provider collaboration via a common approach to secured electronic healthcare records is critical to the future success of the healthcare systems. With day to day changing patient needs, there is increasing evidence that mobile technology and applications will transform the industry and facilitate faster and better communications, improved compliance as well as rapidly providing integrated outcome data to the front line field staff.

For home care, technology will indefinitely continue to shape the future of point of care compliance. No matter what the technology will be next, the most important return is in the quality of care for the patients. The foremost goals in any home healthcare agency adding on a technology solution will remain the same: manage costs, improve the quality of care and give the patient services that they need within the home and community care setting.

This article was kindly provided by Mike Wons of CellTrak Technologies. Don’t miss Mike’s session at our Annual Conference & Trade show entitled, “Managing Compliance Requirements: Proactively Leveraging Technology” on Tuesday, July 23. Click here for details.

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