Four Best Practices for State Payers to Achieve CMS Certification

Recently, the Centers for Medicare & Medicaid Services (CMS) overhauled their state payer Electronic Visit Verification (EVV) certification process. While the new process is more simplified and streamlined, it is still quite involved and can be tricky to navigate.

It also requires a significant investment of money and time, especially when you consider that a CMS certification review is only possible after you have completed your Operational Readiness Review (ORR) with CMS, and your EVV solution has been operational for at least six months.

Sandata has assisted over 20 state payer partners successfully navigate their EVV CMS certification process. Across the well over 20 implementations we have assisted with, none have failed.

We put together a list of the four most critical practices (in no order of importance) to follow, to avoid the most common pitfalls of the CMS certification process. Follow these recommendations and you will be well on your way to ensuring CMS certification approval of your EVV system on your first attempt.

 

#1 – Communicate and Meet Regularly with Your CMS State Officer

Starting as early as possible in your EVV CMS certification process – and, if possible, before you begin the process – reach out to your state’s CMS officer. Inform them of your intention to begin the certification process (or that you have begun the process, if you have done so), and plan to meet with them regularly throughout the process.

These regular meetings should occur monthly at a minimum. Your state CMS officer is going to help shepherd you through the process. And, they will be a great source of information and guidance throughout.

 

#2 – Have a Plan to Avoid Payment of Claims and Encounters that Don’t Have a Visit

To put this in the simplest terms possible, you need to demonstrate how you plan to make sure that you are not paying when services haven’t been provided. Not having this plan in place is the biggest challenge we have found in the certification process. If you are working with a vendor partner during this process, they can assist you with creating a plan that works for your unique situation and which will also meet CMS’ requirements.

 

#3 – Be Prepared to Provide Support to Non-English Speakers

Provider agency representatives, caregivers, and clients all must be able to use your system without any language or other accessibility obstacles. To accomplish this, be sure that your system is translatable into any language used by a significant number of constituents within your state’s population. And, be sure that your system provides accommodation for people with a disability.

 

#4 – Provide Communications and Training to Stakeholders

One of the most common mistakes we see states make is implementing a system that doesn’t work for stakeholders. This requires costly change orders to be executed after implementation. And, more importantly, it demonstrates a lack of respect for your stakeholders’ needs. To avoid this, States should communicate before the implementation to make sure your system meets the needs of your stakeholders. Then, provide training to them after implementation to make sure they can use your system easily and effectively.

While following the four practices above won’t guarantee your EVV CMS certification will be approved, it will help you avoid the most critical missteps in the process. If you’d like more information on how to assure approval of your EVV CMS certification, feel free to schedule a call with our team. They’ll be happy to provide more helpful tips or point you to additional resources that can be of assistance to you.

 

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