Sep. 05, 2017
System developed by Dr. Ed Breazeale reduces fraud, gaps in care and hospital readmissions
On Aug. 22, the United States Patent and Trademark Office issued patent No. 9,740,823 to HealthStar LLC Founder and CEO Dr. Ed Breazeale for the underlying technology used by HealthStar Visit, the company’s Electronic Visit Verification (EVV) solution.
In 2007, Dr. Breazeale designed the proprietary GPS-based technology to reduce fraud, waste and abuse in Medicaid reimbursement for services delivered in a home-based setting.
“Health care costs are a national concern,” Dr. Breazeale said. “HealthStar delivers customizable software to prohibit improper payments and increase administrative efficiency.”
According to May 2, 2017, testimony from the U.S Government Accountability Office (GAO), the U.S. Department of Health and Human Services (HHS) estimated that nearly $3.6 billion in personal care services payments were improperly paid in 2015. This was twice the error rate estimated for 2014, and an increase of $1.6 billion.
In Dec. 2016, President Barack Obama signed into law the 21st Century Cures Act, which includes provisions that require the use of EVV technology for all Medicaid-provided personal care services and home health services by Jan. 1, 2019. States failing to implement EVV face a tiered reduction in Federal Medical Assistance Percentages (FMAP) funding.
The patented technology applied by HealthStar Visit correlates the location-time data generated by a mobile electronic device with pre-approved data specified in a patient’s plan of care.
A key component is the member-assigned, HealthStar-managed tablet, which is deployed directly to the patient at their residence. These devices capture and match:
- GPS location with patient-approved address
- Credentials of the caregiver providing care with pre-assigned caregiver
- Actual date and times of service with scheduled appointment
Services documented during the visit with pre-authorized servicesAll the information is captured in real-time, and if care is delivered as prescribed, HealthStar Visit prepares a claim for payment.“
Caregivers must check in and out of member appointments and document the tasks performed during the visit,” Dr. Breazeale said. “Our system requires caregiver signature and allows for patient authentication and confirmation that services were performed as indicated. An insurance claim, otherwise automatically generated by HealthStar Visit, is disallowed if all necessary pre-determined criteria are not met.”
HealthStar Visit also:
- Requires the caregiver to answer questions related to the patient’s health status
- Alerts the care manager when scheduled services are late or missed
- Measures patient satisfaction
The patient’s signature serves as the final services verification indicator. Biometric authentication, which relies on unique biological characteristics to verify identity, is available for both the patient and caregiver, if mandated.
The original HealthStar Visit platform was constructed for the State of Tennessee, which has the most robust and developed set of EVV requirements in the country and whose approach to EVV is recognized at the national level as the model for best practices. Thanks to its modular design, HealthStar Visit remains adaptable and can easily accommodate state and health plan differences while maintaining system integrity.
In addition to its ease of use for state health plans or managed care organizations, HealthStar Visit also is convenient for caregivers in completing their administrative duties.“
Our EVV solution is web-based and requires no software installation,” Dr. Breazeale said. “The system is intuitive, easy to use, and can be readily accessed with a standard internet connection from any caregiver office.”
Because the technology translates completed EVV appointments into an industry-accepted claim format, HealthStar Visit provides an inherent revenue cycle management benefit to caregivers. The claims are transmitted directly to payers each night so caregiver agencies don’t have to use a clearinghouse or employ additional office resources for billing.
“HealthStar Visit is compliance-conscious and delivers unmatched program integrity, substantially mitigates improper payments by pre-adjudicating claims, equips payers with management tools for oversight, and provides an easy-to-use solution for providers,” Dr. Breazeale said. “It’s a win-win for everyone.”
In addition to HealthStar Visit, the company’s future applications of the patented technology include expanded use in Medicare and commercial home health services, non-emergent medical transport, telehealth, data analytics, doctor visits, outpatient surgery and hospital in-patient care.
About HealthStar, LLC
HealthStar LLC is a healthcare technology company based in Knoxville, Tennessee. HealthStar LLC Founder and CEO Dr. Ed Breazeale earned a patent for the method utilized in HealthStar Visit, the company’s electronic visit verification (EVV) solution. HealthStar Visit is customized, proprietary software, utilized by payers in the Medicaid personal services segment to reduce improper payments. For more information, visit https://myhealthstar.com.
