Why Home Health Agencies Need EVV and Payroll Reconciliation

For a home health agency, a single caregiver visit creates records in several places: the schedule, the electronic visit verification (EVV) system, the claim sent to the payer, and payroll. When those records agree, the agency is paid correctly for the care it delivered and pays caregivers for the time they actually worked. When they don't, the agency loses money in ways that rarely show up on a standard profit and loss statement.

What EVV records

The federal 21st Century Cures Act requires states to use EVV for Medicaid-funded personal care services and home health care services. EVV systems capture six pieces of information for each visit:

• The type of service performed
• The individual receiving the service
• The date of the service
• The location where the service was delivered
• The individual providing the service
• The time the service began and ended

Each state runs its own EVV program, so details such as which system or aggregator you use and how exceptions are handled depend on your state and your payers. What doesn't change is that EVV is the closest thing an agency has to an independent record of the time caregivers spent with clients.

Where EVV, billing, and payroll drift apart

Mismatches usually come from ordinary, day-to-day activity rather than anything deliberate:

• Visits that were verified in EVV but never billed.
• Billed units that don't match verified time because of rounding, manual edits, or late clock-ins.
• Visits delivered after an authorization ran out.
• Caregivers paid for scheduled hours rather than verified hours.
• Overtime, travel time, and manual payroll adjustments that never get compared back to visits.
• Missed or cancelled visits that were removed from billing but not from payroll.

What a three-way reconciliation shows

The most useful check compares three numbers for each caregiver, each week: hours worked (from EVV), payroll hours, and hours or units billed. Each type of difference points to a different issue:

• Paid more than worked: payroll overpayments, unapproved edits, or time that should have been non-billable.
• Worked more than billed: unbilled revenue, often visits stuck on an exception or missing an authorization.
• Billed more than worked: claims without full support, which is an audit risk to fix quickly.

In one engagement with a home health agency of about 140 caregivers in New Jersey, this kind of reconciliation surfaced over $100,000 in annualized labor cost the agency couldn't account for. See the case study.

How to build a reconciliation routine

1. Pick a weekly cadence that lines up with your payroll cycle.
2. Pull visit data from EVV, billed units from your agency management or billing system, and hours from payroll.
3. Match records by caregiver, client, and date.
4. Set a small tolerance so rounding doesn't create noise, and flag everything outside it.
5. Assign each exception to an owner, document how it was resolved, and track trends over time.

Doing this by hand in spreadsheets is possible for a small agency, but it gets hard to sustain as caregiver counts grow. That's why we built HHACFO, which performs this visit-level reconciliation automatically. Learn more about our home health agency consulting and reconciliation technology.