8000, Calculation of Bill Hours

Revision 24-1; Effective Sept. 12, 2024

Bill hours is the number of hours provided that is transmitted to the EVV Aggregator. Bill hours are used for claims matching when program providers and FMSAs submit billing through the applicable billing system. If bill hours do not match the units of service billed by the program provider or FMSA, the claim may be denied. Refer to Section 13020 Claims Matching for more information.

8010 Bill Time In and Bill Time Out

Revision 24-1; Effective Sept. 12, 2024

The clock in and clock out fields in the EVV system are automatically populated when the service provider or CDS employee enters the time in and time out using an approved clock in and clock out method. Program providers, FMSAs and CDS employers are not able to change the clock in and clock out fields regardless of any changes they need to make to the time worked, as these are the actual entries made into the EVV System. The bill time in and bill time out fields are automatically populated from the clock in and clock out fields. If the service provider fails to enter the time in or time out in the EVV system, the corresponding bill time in or bill time out field will be blank.

If program providers, FMSAs or CDS employers need to enter a time in or time out the service provider failed to enter, or they need to change the time in or time out the service provider worked, they must complete visit maintenance to make these changes. Refer to 9000 Visit Maintenance for more information.

Program providers, FMSAs and CDS employers must not change the bill time in to a value before the original clock in time, and must not change the bill time out value to a time after the original clock out time. They must create a new visit transaction for time outside of the original clock in or clock out time.

For example:

• The service provider clocked in at 8:30 a.m. but actually began work at 8 a.m. The program provider, FMSA or CDS employer must not change the bill time in to 8 a.m. because this is before the original clock in time. They must create a new visit transaction for 8 – 8:30 a.m.
• The service provider clocked out at 10 a.m. but actually ended work at 10:30 a.m. The program provider, FMSA or CDS employer may not change the bill time out to 10:30 am because this is after the original clock out time. They must create a new visit transaction for 10 – 10:30 a.m.

Refer to Section 7010 Manually Entered EVV Visits for more information.

When completing visit maintenance to change the bill time in and bill time out fields, program providers, FMSAs and CDS employers must use the most appropriate Reason Code Number and Description to indicate the reason for the entries or changes to the bill time in and bill time out. Refer to Section 10000 Reason Codes for more information.

8020 Rounding

Revision 24-1; Effective Sept. 12, 2024

The EVV system calculates bill hours on an EVV visit transaction by rounding the actual hours worked to the nearest quarter hour increment.

The EVV system rounds up to the next quarter hour increment when the actual hours worked are eight minutes or more than the previous quarter hour increment. The EVV system rounds down to the previous quarter hour increment when the actual hours worked are seven minutes or less from the previous quarter hour.

Rounding rules examples:

• If a service provider works two hours and 53 minutes of actual hours for a shift, the bill hours will round up to three hours.
• If a service provider works two hours and 52 minutes of actual hours for a shift, the bill hours will round down to 2.75 hours.
• If a service provider works four hours and 10 minutes of actual hours for a shift, the bill hours will round up to 4.25 hours.
• If a service provider works four hours and six minutes of actual hours for a shift, the bill hours will round down to four hours.

The EVV system does not round each clock in or clock out time or each bill time in or bill time out. The EVV system only rounds the total duration of the hours worked for each visit based on clock in or clock out time or bill time in or bill time out.

The program provider, FMSA or CDS employer may downward adjust bill hours if the actual hours worked, captured in the EVV system, are incorrect or if the program provider or FMSA intends to bill Medicaid for less time than actual hours worked in the EVV system.

The program provider, FMSA or CDS employer may never increase bill hours beyond the actual hours worked.

Program providers and FMSAs must bill according to the EVV Service Bill Codes Tables and follow program rules and policies, including any program or MCO requirements regarding rounding.

8030 Bill Hours

Revision 24-1; Effective Sept. 12, 2024

The EVV system calculates the bill hours by subtracting the bill time in from the bill time out, then rounding the calculation per the rounding rules in Section 8020 Rounding Rules.

Program providers, FMSAs, and CDS employers may downward adjust the bill hours to match the hours they will be billing if they are going to bill a different number of hours than the service provider actually worked. Changing the bill hours may help prevent billing errors.

If the program provider or FMSA accidentally bills for a time different than is in the bill hours, the claim will not match. Use the EVV Claim Search tab in the EVV Portal to view EVV claim matching results. An EVV claim match result code will tell you if the EVV claim was matched (EVV01) or if there was an EVV mismatch (EVV02-EVV06). A successful EVV01 match does not guarantee that the EVV claim will be paid; final claims processing is performed by your payer.

Program providers, FMSAs, and CDS employers may also enter zero hours in the bill hours field if they will not be billing for any time the service provider worked. This will allow the program provider or FMSA, if they chose, to use the clock in time and clock out time, or the bill time in and bill time in for service provider payroll.

Adjustments made directly to the bill hours field in the EVV system will not alter the values in the bill time in and bill time out fields. Program providers, FMSAs, and CDS employers may amend the bill hours as well as the bill time in and bill time out, however they must make the adjustments to these fields manually. Note that not all EVV systems will allow changes to the bill hours, bill time in and bill time out fields. Even if the EVV system allows changes to the bill hours, bill time in and bill time out, the EVV system will not automatically change the bill time in or bill time out if the bill hours are changed.