How home-care agencies recover unbilled Medicaid revenue.
Some of the care you delivered was authorized, verified, and never collected. Because the claim was never sent, was denied and never reworked, or was paid at the wrong rate.
What counts, and what does not
Counts: care that was authorized and delivered but never billed. Claims that were denied and never reworked. Care that was paid below the authorized rate. All capped at the authorized ceiling.
Does not count: care delivered beyond the authorization. That is unbillable cost and compliance exposure, never recoverable, and Reeve will not pretend it is.
All of it is time-limited by the filing and appeal windows. Inside the window it is correctable. Past it, it is gone.
The four places it leaks
Unbilled authorized hours. Care delivered and documented, claim never built.
Denials never reworked. A denied claim sitting in the aging report with no work notes is the single most common form.
Rate and modifier mismatches. The claim paid, just at less than the contracted rate for that code and modifier combination.
EVV mismatches on date, units, code, or member ID. The visit happened; the record the payer holds does not match the claim, so the claim denies or recoups on audit.
How to find it
Reconcile four sources for one closed period: the authorization list from the payer or portal, the EVV-verified visits from the aggregator, the submitted claims from the billing system, and the remittances from the payer. Read across the seams. Every recoverable dollar is a mismatch between two of these sources that nobody has closed.
Why the window is the whole game
Inside the filing window, an unbilled visit is a claim you can send. Inside the appeal window, a denied claim is a claim you can rework. Past those windows, the same visit and the same denial are permanent write-offs. That is why recovery work is time-critical, and why it is done on the oldest work still inside its window first.
How Reeve recovers it, read-only
The Margin Review takes your exports from a closed period, reconciles them locally, with names replaced by coded references in the browser, and returns a ranked list of recoverable dollars with a reason on each line, capped at the authorized ceiling. Your file is processed in your browser, and no name is written into any output. It is a free review of one period.
Plain answers, on the record.
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.
Find the unbilled Medicaid on your closed period.
The Margin Review is read only, runs on your exports, replaces names with coded references locally in the browser, and returns a ranked list of recoverable dollars with a reason on each line.