The 6 Lookups Every Home Care Agency Does Every Week — and How to Stop Wasting Time on Them

1. State EVV rules

Electronic Visit Verification (EVV) is federally mandated for Medicaid-funded personal care and home health services under the 21st Century Cures Act — but the implementation is state-by-state. Some states operate an Open Model (agencies pick their own EVV vendor). Others run a Closed Model where you must use the state's chosen system. A handful run Hybrid or Provider Choice variants.

Before taking on a new Medicaid client or expanding across state lines, confirm:

• Which EVV model your state uses
• The state aggregator or vendor (Sandata, HHAeXchange, Tellus, CareBridge, etc.)
• Whether your existing EVV system can transmit to the state's aggregator
• The specific data elements required for each visit record

Authoritative sources: CMS's EVV page and your state Medicaid agency's provider bulletins. Plan to re-check annually — states swap EVV vendors more often than you'd think.

For a deeper walkthrough, see our EVV compliance guide.

2. ICD-10, HCPCS, and CPT code lookups

Every denied claim starts with a wrong or stale code. Home care agencies most often work with:

• HCPCS G-codes and T-codes for personal care and home health visits (T1019, G0156, G0299)
• ICD-10 for diagnosis coding (Z51.5 palliative care, F03.90 unspecified dementia, I10 essential hypertension)
• CPT occasionally for skilled services

Codes change. ICD-10-CM gets an annual update every October. HCPCS updates quarterly. If your billing team is pulling from a 2023 cheat sheet, you're going to see denials.

Authoritative sources: CMS's HCPCS Quarterly Update release and the CDC's ICD-10-CM files. Free but clunky.

3. Home care acronyms

Every industry has jargon, but home care layers clinical acronyms (ADL, IADL, PRN, CHF) on top of billing acronyms (EVV, HCPCS, POC, OASIS) on top of regulatory acronyms (CMS, HIPAA, AHCCCS, DHS). New staff can't keep up, and even seasoned schedulers forget what the less-common ones mean.

Build a shared glossary on day one of hiring. Keep it searchable. Update it when a state introduces a new program acronym.

4. Caregiver and agency license verification

Before every new hire starts — and periodically after — verify that their credentials are current and unrestricted. Every state runs its own license lookup portal, and they're almost never on the same domain as the state's main Department of Health site.

What to check:

• CNA and HHA certification status (state nurse aide registry)
• LPN and RN licenses (state board of nursing)
• Agency license (state department of health or equivalent)
• Exclusion lists (OIG LEIE and SAM.gov — federally required every 30 days if you bill Medicare or Medicaid)

Skipping the OIG exclusion check is one of the most common — and most expensive — compliance misses we see at smaller agencies.

5. BLS wage data

When you're setting pay for a new role, opening a branch in a new metro, or pricing a private-pay service, the Bureau of Labor Statistics' Occupational Employment and Wage Statistics (OEWS) tables are the industry-standard benchmark. They're public, updated annually, and broken down by state and metropolitan area.

Relevant OEWS codes for home care:

• 31-1120 — Home Health and Personal Care Aides
• 29-1141 — Registered Nurses
• 29-2061 — Licensed Practical and Licensed Vocational Nurses

Pair BLS data with your local market (job boards, competitor postings) to set pay that's competitive without overshooting. See also our caregiver pay rates by state resource.

6. NPI registry lookups

The National Provider Identifier is the 10-digit number every healthcare provider needs to bill Medicare, Medicaid, and most commercial insurers. You'll look up NPIs to:

• Verify a referring physician before accepting a referral
• Confirm your own agency's Type 2 NPI on claims
• Validate that a caregiver's credentials match a billing record

Authoritative source: the CMS NPPES NPI Registry. It's free and reasonably fast, but each search opens a new tab and breaks your workflow.

One Chrome extension that handles all six

We just shipped the AveeCare Home Care Toolkit — a free Chrome extension that puts all six of these lookups one click away from your browser toolbar. No account. No tracking. No data collection.

Every reference dataset is bundled offline — only explicit NPI searches hit the network. Nothing is logged, and the extension doesn't require a login or an AveeCare account.

Free to use whether you're an AveeCare customer or not. If it saves your team an hour a week, we've done our job.

Frequently Asked Questions