Everyone in the building watches the per diem. Nobody watches the hours billed beside it.
Reeve prices programs that authorize units and bill units.
Where a payer pays a per diem or an episode instead of a unit, Reeve puts no dollar on the line from unit arithmetic and does not estimate one. Medicare fee for service is the one exception, and it is priced from the tables CMS published rather than from unit arithmetic: the CY2026 home health period rates, case mix weights and LUPA thresholds, and the FY2026 hospice per diems, labor shares and aggregate cap. The Medicare hospice benefit pays a per diem by level of care, so Reeve prices it from the per diems CMS published for FY2026 and never from a unit conversion. That is the boundary, and it belongs at the top of this page rather than the bottom. What Reeve does read is the other book. Almost every hospice runs one: Medicaid personal care and waiver hours for patients who carry a second benefit, private duty nursing, contracted hourly staffing. It is authorized in hours or quarter hours, delivered on a visit record, and billed in units. It is a small share of the revenue and it gets a smaller share of the attention, because the finance meeting is about census and level of care mix. Reeve runs in your browser on an export you provide, replaces every name with a coded reference before any math, and hands back the rows where authorized, delivered, billed, and paid stop agreeing on that book.
We price the hospice benefit only from the published per diems. We read the unit billed book beside it.
Routine home care, continuous home care, inpatient respite, general inpatient. Those are per diem levels of care, and the notice of election and the service intensity add-on ride on the same episode logic. Reeve has no verified way to turn a per diem day into an authorized unit, so it never converts on a guess. What it does read is the published table: for a Medicare fee for service day it prices the level of care from the FY2026 per diems, the published labor shares and wage index, the tier counted from the election date, the service intensity add on and the aggregate cap. Where the book carries no election date, a level of care that does not resolve, or a day in a rule year that is not final, Reeve names the gap and prices nothing. It also does not report those lines as a zero and let you read the zero as a clean bill of health.
The hourly and quarter hourly book. Medicaid personal care, waiver attendant hours, private duty nursing, and contracted staffing that a payer authorizes in units and you bill in units. Four columns, one row at a time: what was authorized, what your staff delivered, what left on the claim, and what the remittance actually paid.
Reeve never invents a rate; dollars come from the rate on your own export or the rate your own remittances actually paid most often. Where Reeve cannot find a rate in your data, the finding comes to you in hours, units, and the exact records.
Clawback exposure, lapsed authorizations, rate variance, and any row whose payer class Reeve cannot verify all appear on the report with the record attached and none of them enter the recoverable total. A set aside row is disclosed as a set aside row.
Reeve classifies every row by payer before any check runs, and the rules it holds today are Medicaid rules. A Medicare line, a commercial line, and a line whose payer the export never states are each set aside and named on the report instead of scored. If the unit billed portion of your book is Medicaid personal care, choose Home care in the review rather than Hospice, because that is the setting under which the unit checks run. Reeve reads period rows repeated per visit, adjustment and cancel claims, notice rows, expected payment columns, missed visits and summary tabs. It counts each period once, nets labelled claim activity, keeps estimates out of paid amounts, excludes visits that were not delivered and skips summary tabs.
On the unit billed book, every hour your staff work should survive four columns without changing shape. It usually does not, and the loss is quiet because no single screen holds all four at once.
A state Medicaid program or a managed care plan approves a member for a finite number of hours or quarter hour units across a dated span. That span, and the ceiling inside it, is the most important number on the page and the one least likely to be sitting next to your claim.
The visit record. Who went, when they clocked in, when they clocked out, and how long the visit actually ran. Where your state runs electronic visit verification on these services, the accepted transaction is the delivered record.
What left your building on a claim line, on which code, with which modifiers, for how many units, against which authorization.
What the remittance says came back, including the lines that paid short, the lines that denied, and the lines that were adjusted after the fact and never looked at again.
No column is wrong on its own. The loss lives in the disagreement between two of them.
- 01Delivered against billed. An hour worked and documented that never became a claim line. It never denies, because it was never filed, so it never appears in a denial report and no one goes looking for it.
- 02Authorized against billed. Units the payer approved and the span expired without your ever using them. The ceiling was real money and the calendar took it back.
- 03Billed against authorized. Hours delivered past the approved ceiling. That is not revenue, it is exposure, and Reeve reports it on its own line at zero rather than adding it to anything.
- 04Billed against paid. A line that came back short of the rate your other remittances pay most often for the same code, or came back denied and still inside the window to correct and refile.
- 05Payer against rule. A row Reeve cannot place in a payer class it has rules for. It is set aside, counted, and named, so the report never reads cleaner than the file it was built from.
These are the leak patterns Reeve looks for on the unit billed portion of a hospice book. They carry no dollar figures here on purpose. A number on a marketing page is a number somebody made up, and the only figures worth reading are the ones your own export produces.
A visit record shows an attendant worked a shift on a member with a live authorization, and no claim line exists for that member, that code, and that date. Reeve pairs the visit to the missing line and, where your export carries a rate for the code, caps the figure at what the authorization allowed.
An authorization span closes with units still on it. Reeve reports the span, the ceiling, and the units billed against it, so you can see whether the gap was a scheduling reality or a billing miss before the next span is written.
Delivery that ran beyond what the payer approved. This one is not money to collect and Reeve will not present it as such. It sits under exposure with the authorization and the delivered record side by side.
A denied balance that the filing calendar still allows you to correct and refile. Reeve reads the state window from a primary source where it has one, and where it does not, the row is surfaced without a dollar attached and marked as indeterminate rather than guessed at.
A code that your remittances usually pay at one figure came back at another on some lines. Reeve benchmarks against your own paid history rather than a published table, and it will not benchmark a code with too few paid lines behind it.
Why the second book is the one that leaks.
Attention follows revenue. The hospice benefit is the overwhelming majority of the money, so it gets the daily report, the census meeting, and the experienced biller. The hourly book is handled around the edges of that work, often by whoever has time, and a miss on it costs nobody their afternoon.
The columns live in different systems. The authorization arrives from a plan and lands in a folder or a field. The visit lands in a scheduling or verification system. The claim lands in a clearinghouse. The remittance lands in a bank file. Nothing in that chain is built to ask whether an hour that was worked ever turned into a dollar that arrived.
The failure is silent by construction. A claim that was never filed cannot be denied, so it never shows up in the one report everybody does read. It only ever appears if something reconciles delivery against billing directly, which is the one comparison the billing system has no reason to run.
Reeve is not a replacement for your biller and it does not touch your hospice claims. It reads the export you already produce and lines up the four columns on the part of the book nobody has time to line up by hand.
What you may have to give back, found while it is still fixable.
Money you can collect and money you may have to return are two different numbers, and Reeve never adds them together. Exposure is the second one, and Reeve surfaces it before the payer finds it.
- 01
Care delivered past what the authorization approved, with the authorization and the delivered record side by side.
- 02
Service and attendance records that failed the payer's visit verification system, flagged with the reason they failed.
- 03
Visits and days missing a signature or a required timestamp.
- 04
Conflicts inside one person's own delivery day: two visits by the same person whose recorded times overlap, and hours that cannot both be true.
Exposure never enters the recoverable total. It sits on its own line, with its own figure, attached to the record it came from. What you do with it is a decision for your team, not for Reeve.
Plain answers, on the record.
What Reeve reads on a hospice book, what it refuses to read, and what happens to your file.
Collect is money you never captured. Cover is money a payer can still take back.
Reeve reports the two separately and never adds them together, because only one of them is yours to go and get. The Margin Review reads both on your own export and costs nothing.
One pass over your own export, in your browser. The findings are yours to keep, with no obligation.
The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.
Everything in Collect, plus the exposure lane. Retired codes, authorizations at the end of their period, care delivered past what was approved.
Month to month, no annual contract. Read-only in every tier. Run the free review.
Run it on the half we can defend. And nothing on the half we cannot.
Export the unit billed portion of your book from the system you already use, open the review, and read the four columns side by side. The hospice benefit is left alone, and the report says so on its face.
- 01
Read-only. Reeve looks at your numbers and changes none of them.
- 02
Names coded locally. Patient names, medical record numbers, and addresses are replaced with a coded reference unique to your agency in your own browser before any math runs.
- 03
Scoped out loud. What is priced from a published table and what is refused by name are both stated before the run, not after it.
- 04
No obligation. The findings are yours to work whether or not you go further.
This page carries no dollar figures, illustrative or otherwise, because the only defensible number is the one your own export produces. Reeve is read-only: it does not file, does not appeal, does not write to an EMR, does not move money.