Where the Assumption Comes From
Electronic Visit Verification was designed with in-person service delivery in mind. The original mandate under the 21st Century Cures Act described visit verification in terms of confirming a caregiver's physical presence at a service location. QR codes, GPS check-ins, and location-based timestamps all make intuitive sense in that context.
When telehealth volume grew, especially during and after the COVID-19 public health emergency, many agencies drew a practical distinction between field visits and remote sessions. Field visits went through the EVV system. Telehealth calls were logged separately, often in an EHR or a manual call record, and billed without a corresponding EVV entry.
The logic was understandable at the time. The technology being used for EVV was built around physical presence, and applying it to a phone or video session felt like a mismatch. What agencies did not always track closely was whether that distinction held up under the actual language of the law and the expectations of their MCOs.
It does not.
What the Law Actually Requires
The 21st Century Cures Act (Section 12006) and 42 CFR 484 establish EVV requirements for all Medicaid-funded personal care services and home health care services. The law specifies six data elements that must be captured for every covered visit:
- Type of service performed
- The individual receiving the service
- Date of the service
- Location of service delivery
- The individual providing the service
- Time the service begins and ends
The location element is where agencies often get stuck on telehealth. In an in-person visit, location means the client's home address, confirmed through a GPS or QR-based check-in. In a remote session, there is no physical service location in the traditional sense.
CMS guidance has addressed this. For telehealth and phone visits, location documentation refers to the type of service setting rather than a street address. What matters is that the record reflects a verified remote session, with accurate timestamps confirming when the session started and ended, who delivered it, and what service was provided. The obligation to capture and verify that information does not disappear because the visit was remote.
Agencies that have been billing telehealth sessions without EVV-compliant documentation are carrying unverified claim exposure on a portion of their billing that may be significant, depending on how much of their service volume is remote.
How MCOs Are Applying the Standard
The enforcement mechanism that most agencies are encountering directly is the MCO compliance threshold. Managed care organizations are now holding agencies to an 85% EVV auto-verification rate across their total billable visit volume. Three consecutive months below that threshold trigger a Corrective Action Plan. Repeated non-compliance can result in termination from the MCO's network.
The threshold applies to total visit volume, not just in-person visits. If your agency delivers 40% of its services by telehealth and those sessions are not generating EVV-compliant records, that volume is contributing to your non-compliance rate before a single in-person documentation error occurs.
This is the mechanism that turns a documentation assumption into an operational risk. An agency can have clean in-person visit records and still fall below the 85% threshold if its telehealth sessions are not captured in the EVV system.
The Behavioral Health Context
Home health and behavioral health agencies are not in the same situation when it comes to telehealth volume. For behavioral health providers, remote sessions are often a primary delivery channel, not a supplemental one. Phone and video visits for therapy, care coordination, and skills training have been standard practice long before the policy conversation caught up.
That means the documentation gap, where telehealth sessions are logged outside the EVV system, is often larger in behavioral health agencies than in traditional home health settings. An agency delivering the majority of its billable hours through remote sessions and tracking those hours manually is operating with a compliance structure that was built for a service model it no longer uses.
Joseph Catan built MyVisits from 18 years inside behavioral health operations. The telehealth documentation feature in the platform reflects that background. The problem of remote sessions being treated as a compliance afterthought is not a new observation. It is a pattern that has existed since telehealth became a standard delivery method, and it is one that agencies in this vertical need to address now that enforcement has arrived.
What Compliant Remote Visit Documentation Requires
The standard for a compliant telehealth session record is not fundamentally different from the standard for an in-person visit. The record needs to be system-generated, timestamped at the time of the session, and complete across the six required data elements. What changes is how location is captured and what the verification mechanism looks like in the absence of a physical check-in.
Practically, that means:
- Session start and end times are recorded automatically by the documentation platform, not entered after the fact by the clinician
- The record identifies the service type, the individual receiving care, and the individual delivering it
- The record reflects the remote service setting rather than a physical address
- The documentation is immediately accessible to managers on the day the session occurs
Agencies that are meeting this standard have telehealth sessions feeding into their EVV compliance rate the same way in-person visits do. Agencies that are not doing this end up carrying a documentation liability on every remote session they deliver.
A Practical Question to Ask About Your Current Setup
The fastest way to assess where your agency stands is to ask a straightforward operational question: if an auditor requested timestamped, system-generated records for every telehealth session your agency delivered in the past 90 days, how long would it take to produce them, and what would those records show?
If the answer is that the records exist in the EVV system and can be pulled within minutes, your telehealth documentation is in reasonable shape. If the answer involves manually compiled call logs, EHR notes, or after-the-fact entries by clinical staff, the documentation is not audit-ready regardless of whether the services were actually delivered.
This is not a question about whether your caregivers are doing their jobs. Most documentation problems in telehealth are process problems, not performance problems. The staff is completing the sessions. The platform they have been given to document those sessions was not built to produce EVV-compliant records. The fix is a platform issue, not a staffing issue.
How MyVisits Applies EVV Standards to Remote Sessions
MyVisits treats telehealth sessions and in-person visits as equals in the documentation record. When a caregiver completes a remote session, the platform automatically logs the visit with a system-generated timestamp. The session record captures the service type, the individuals involved, and the start and end times without any manual entry from the clinician.
Managers see completed telehealth sessions in the same dashboard where they monitor in-person visit verification. There is no separate system for remote sessions and no reconciliation step at the end of the billing cycle. The compliance record for an agency using MyVisits reflects the full picture of its service delivery, in-person and remote, in one place.
The platform runs on AWS infrastructure with direct technical support from MyVisits. There is no IT setup required and no implementation project to manage. For agencies that have been tracking telehealth sessions outside their EVV workflow, the transition is straightforward.
The Compliance Window Is Now
State enforcement of EVV requirements shifted from implementation to active oversight starting in 2025. OIG audit activity is increasing. MCOs are applying the 85% threshold with more consistency than they did during the initial rollout years. The agencies that addressed their telehealth documentation gaps early are in a different position than those that are still operating on the assumption that remote sessions are a separate category.
The law does not draw that distinction. The MCO threshold does not draw that distinction. The audit record will not draw that distinction either.
If your agency delivers Medicaid-funded services by telehealth and those sessions are not generating EVV-compliant documentation, the time to close that gap is before the next compliance review, not after it.
See how MyVisits verifies telehealth sessions alongside in-person visits in a single, audit-ready record. Try the first 30 days on us.
