🇺🇸United States

Cost of Poor Visit Data Quality Leading to Rework and Corrective Actions

5 verified sources

Definition

Poor-quality EVV data (wrong member, wrong service, inconsistent times, missing locations) forces agencies to invest staff time in rework, reconciling visits, and resubmitting corrected claims. Federal oversight notes that EVV was introduced because paper-based personal care documentation had weaknesses contributing to improper payments and questionable quality of care, and providers now shoulder the burden of cleaning up bad data.

Key Findings

  • Financial Impact: Commonly manifests as 5–15 hours per week of back-office rework for every 50–100 field staff, translating to roughly $1,000–$5,000 per month in labor for a mid-sized provider, plus the revenue impact of delayed or partially paid claims.
  • Frequency: Weekly
  • Root Cause: Frontline caregivers rushing between visits, poor mobile coverage, and confusing user interfaces lead to frequent EVV exceptions; states and MCOs require clean records for payment, so agencies repeatedly investigate anomalies, obtain attestations, and correct visit records.[1][2][4][7][8]

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Services for the Elderly and Disabled.

Affected Stakeholders

Billing and claims staff, Supervisors and care coordinators, Quality/compliance analysts, Frontline caregivers (who must provide corrections or documentation)

Deep Analysis (Premium)

Financial Impact

$1,000-$3,000 monthly administrative labor plus reputational friction with providers and caregivers • $1,000-$4,000 monthly in labor rework plus delayed service authorization and member billing disputes • $1,000–$3,000 per month in supervisory time diverted from coaching and quality oversight into data cleanup, plus lost revenue where visits remain uncorrected or miss billing cutoffs.

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Current Workarounds

Caregiver Scheduler manually reconciles schedule against EVV logs, corrects schedule errors in system, phones caregivers about discrepancies, maintains shadow schedule in Excel • Caregiver Scheduler pulls EVV data manually, compares to MA authorization file (Excel export), flags exceptions, emails provider compliance team and MA plan for reconciliation • Download EVV raw visit data, dump into Excel, manually cross-check against schedules, paper timesheets, text messages, and EHR/agency management system; then adjust units and modifiers by hand and resubmit batches in the payer portal.

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Medicaid Claim Denials and Non-Payment Due to EVV Data Errors

Commonly reported in trade literature as 2–10% of billable hours at risk during EVV rollout and ongoing for agencies that do not tightly manage EVV exceptions; for a $5M Medicaid personal care provider, this equates to ~$100,000–$500,000 per year in preventable lost revenue.

Increased Administrative and IT Overhead to Maintain EVV Compliance

$50,000–$300,000 per year in extra compliance headcount, IT support, training, and vendor fees for a mid-sized multi-million-dollar Medicaid home care provider, based on typical staffing patterns described in industry EVV implementation guides.

Slower Time-to-Cash from EVV-Linked Claim Holds and Audits

Extended days-sales-outstanding (DSO) by 15–30 days during and after EVV implementation is commonly reported by agencies in industry forums; for a provider billing $400,000 per month, that locks up $200,000–$400,000 in working capital and can force reliance on credit lines.

Lost Care Capacity from EVV-Driven Administrative Burden on Field Staff

If aides lose even 10 minutes per shift to EVV-related tasks across 100 visits per day, that is ~1,000 minutes (~16.7 hours) of lost capacity daily; at $25 fully loaded cost per care hour, this is roughly $10,000 per month in capacity loss.

State and Federal EVV Non-Compliance Penalties and Funding Reductions

At the state level, FMAP reductions of up to 1% represent tens of millions of dollars in lost federal funds annually in large Medicaid programs; providers then experience recurring financial impact through underpayments, clawbacks, and exclusion from networks when they are found out of compliance.

Fraudulent or Abusive Billing Uncovered Through EVV Audits and Investigations

Fraud cases in personal care and home health routinely involve hundreds of thousands to millions of dollars in improper claims over multiple years; when EVV data is used to prove overbilling, providers can face full recoupment plus penalties, effectively wiping out years of revenue for the implicated programs.

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