Maryland home care margin recovery.
You delivered the visits.
In Maryland, eligibility and MCO assignment shift month to month, a claim billed to the wrong plan denies and has to be resubmitted inside the new plan's shorter window, and EVV runs through the state's LTSSMaryland ISAS system. Reeve reads your own billing export, right in your browser, and shows you the authorized, delivered, billed, and paid columns side by side, so the gaps have a record attached.
Every dollar of personal assistance in Maryland passes through four states of being, and they do not always agree.
The payer approved a number of units. In Maryland that is a Community Personal Assistance Services authorization, a Community First Choice authorization, or a Community Options Waiver authorization, administered by the Maryland Department of Health. The clock and the ceiling both live here, and the payer of record can change from month to month with eligibility.
The people who deliver the care worked the visit and it landed in Electronic Visit Verification. Maryland runs a state proprietary system, LTSSMaryland ISAS, with IVR and mobile capture using GPS. Not Sandata, not HHAeXchange. The visit becomes an accepted ISAS transaction, or it does not.
A claim went out to the correct payer for that member for that date of service, whether fee-for-service or a Managed Care Organization, using the personal assistance codes on your Maryland fee schedule with the correct unit count. Because the payer of record can change with eligibility, billing to the wrong plan is a common quiet source of denials.
The claim matched, cleared its other edits, and remitted from the correct payer. Or it hit an eligibility or plan mismatch and denied.
The leaks live in the gaps between those four columns, and Maryland has two rules that turn a gap into lost money: an EVV-required visit has to reconcile in LTSSMaryland ISAS or the claim will not stand up, and a claim billed to the wrong plan after a monthly eligibility change denies and has to be reworked inside the new plan's shorter filing window.
- 01Delivered but never billed
- 02ISAS visit missing or unreconciled at claim time
- 03Billed to the wrong plan after a monthly eligibility change
- 04Billed fewer units than the visit shows
- 05Aged past the operative filing window, shorter under the MCOs
Every number is illustrative and synthetic. Because your own export may not carry a rate for every code, findings on this page are expressed in hours, units, and records to check against your own rate sheet, never in dollars Reeve made up.
10 claims paid clean this quarter where the accepted ISAS visit shows more delivered units than the claim billed. Example: a visit accepted for 14 units on your Maryland fee schedule code, claim billed 12. The claim matched and paid, so nothing flagged, but 3 units per visit across 10 visits is 30 units of delivered care that never turned into a claim line. Records attached, ready to check against your contracted rate.
10 denied claim lines where the member's payer of record changed month to month and the claim went to the prior payer. All 10 are workable today by resubmitting to the correct plan, but 3 of them are already close to the shorter MCO window. Records attached with the operative plan and the days remaining on each.
3 members where delivered and accepted ISAS units exceed the authorized units on file under CPAS, CFC, or the CO Waiver. This is not recoverable, and Reeve will not pretend it is. It surfaces separately as over-delivery, care the people who deliver it gave that was never authorized, so you can see the exposure and fix the auth going forward rather than quote it as money owed.
18 delivered-and-accepted ISAS visits with no matching claim found in the export, ranked by days remaining against the operative filing window, which is shorter under the MCOs than under fee-for-service. Lines closest to the window are at the top. Anything past it is marked gone.
5 visits where the aide worked the visit in your vendor system but the ISAS record is missing, incomplete, or not accepted at the time the claim was submitted. Each one is a denial waiting to happen or one that already did, with the specific visit and claim record paired so your biller can see exactly which field to correct.
Why an annual audit or the EMR alone misses this.
A once-a-year audit looks back over twelve months. In Maryland the payer of record can change every month, and the operative filing window is shorter under the MCOs than under fee-for-service. By the time an annual review names a wrong-plan denial, the new plan's window may already be shut. An annual audit tells you the size of last year's leak, which is the one thing you can no longer fix.
The EMR is not built to catch it either. Your EMR knows what it billed and to whom. LTSSMaryland ISAS knows what visit was accepted. The eligibility file knows who the payer of record was on that date of service. The remittance knows what paid. Those four live in four places, and the mismatch is in the seams between them.
The gap only shows when you put the accepted ISAS transaction, the monthly eligibility record, the claim with its payer, and the remittance in the same view and read them together. That is the one thing Reeve does. It reads across the seam.
That is what Reeve reads for in Maryland: what your EVV aggregator accepted, what the authorization allowed, what you billed, and what actually paid, read as one row rather than audited for rate.
Plain answers, on the record.
Straight answers on how the Maryland Margin Review works, what it touches, and what it will not claim.
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.
Try it yourself. Run a free Margin Review.
No sales call. No account to create. Export your data, open the review in your browser, and see your authorized, delivered, billed, and paid columns lined up in about the time it takes to read this page.
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Read-only. Reeve reads your export and does not write to your EMR, does not file a claim, does not move money.
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Names coded locally. Names and member identifiers are replaced with a coded reference in your browser before any analysis runs.
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Your file is processed in your browser, and no name is written into any output. No upload of identified data, no server holding your client list.
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Yours to keep. The findings are yours whether or not we ever work together.
Reeve reads your billing read-only and replaces its names with coded references before any math runs. Every example figure is illustrative and synthetic, method rather than results, and Reeve makes no guarantee of recovery.