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 aide 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.
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.
- 01Is Reeve going to tell me a dollar figure for what I can recover in Maryland?
- No made up numbers. Reeve prices findings off the rate on your own export or the rate your own remittances actually paid most often, and where it cannot find a rate in your data it gives you the hours, the units, and the exact records instead of a dollar figure. A rate Reeve has not verified is a rate Reeve will not quote.
- 02Does my data leave my building?
- No. The Margin Review runs in your own browser on an export you provide. Client names, Medicaid IDs, and aide names are replaced with a coded reference locally before any math runs. Nothing with a name on it is uploaded or sent anywhere. Reeve reads. It does not write to your EMR, does not file a claim, and does not move money.
- 03What Maryland rule is Reeve actually reconciling against?
- The LTSSMaryland ISAS reconciliation and the monthly eligibility and MCO assignment. A claim needs an accepted ISAS visit and it needs to go to the payer of record for that date of service. Reeve lines up the ISAS record, the eligibility file, the claim, and the remittance and shows you where any of those disagree, inside the operative filing window.
- 04Which Maryland programs does this cover?
- Community Personal Assistance Services, Community First Choice, and the Community Options Waiver, administered by the Maryland Department of Health, in both fee-for-service and MCO arrangements. Reeve refers to the specific personal assistance codes on your Maryland fee schedule rather than asserting a single code up front.
- 05We already use LTSSMaryland ISAS. Does Reeve replace it?
- No. Reeve reads the export ISAS produces and reconciles it against your claims, eligibility, and remittances. It does not replace ISAS, does not write to it, and does not change how you capture visits. It sits above your stack, read-only.
- 06How does Reeve handle the plan filing windows without inventing a number?
- It ranks findings by days remaining against the operative filing window, which is shorter under the MCOs than under fee-for-service. Delivered visits closest to the window are at the top. Anything past the operative window is marked gone.
- 07Who runs the review, and is there a catch?
- You do, yourself, for free. There is no sales call required to try it, no automated nightly scanning of your systems, and no team quietly holding your data. You provide an export, the review runs locally, and you keep the findings whether or not we ever work together.
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.
- 01
Read-only. Reeve reads your export and does not write to your EMR, does not file a claim, does not move money.
- 02
Names coded locally. Names and Medicaid IDs are replaced with a coded reference in your browser before any analysis runs.
- 03
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.
- 04
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.