Umsatzverlust durch nicht anerkannte Pflegeeinsätze

Definition

Electronic Visit Verification (EVV) or similar visit-proof systems are increasingly used to combat fraud and ensure that home care services funded by government programs were actually delivered, including time, location, and caregiver identity.[1][2][3] Where providers still rely on manual timesheets, paper signatures, or non-standardised check-ins, missed clock-ins, incorrect timestamps or incomplete records frequently cause disputes and claim rejections by payers. U.S. EVV guidance notes that every missed check‑in or incorrect timestamp can cost providers revenue because claims may be denied or delayed until corrected.[2] Australian providers working under government-funded home care packages and NDIS-equivalent support arrangements face similar proof-of-service expectations from payers and auditors, even if an explicit EVV statute like the U.S. 21st Century Cures Act does not yet apply locally.[6] If 2–5 % of billed home visits per year are challenged or disallowed for lack of robust visit evidence, a provider billing AUD 3 Mio. annually for home visits can lose AUD 60.000–150.000 of revenue each year. This is consistent with international industry statements that non-compliance or low EVV accuracy leads to claim denials and revenue leakage.[2][3] EVV-style automation with GPS, real-time timestamps and linked authorisations reduces missing data and makes it easier to defend claims in audits, turning documentation from a liability into faster reimbursements.[2][3]

Why This Matters

The Pitch: Home health care providers in Australia 🇦🇺 waste schätzungsweise AUD 50.000–150.000 pro Jahr je 100 Klienten durch abgelehnte oder gekürzte Leistungsnachweise wegen unvollständiger Besuchsdokumentation. Automation of visit capture and EVV-style verification eliminates this revenue loss.

Affected Stakeholders

Geschäftsführung von Home-Care-Organisationen, Finanzleitung / CFO, Leitung Abrechnung & Revenue Cycle, Einsatzplanung / Scheduling, IT- und Digitalisierungsverantwortliche

Related Business Risks