Virginia home care margin recovery.
You delivered the visits. In Virginia, CCC Plus personal care is billed in whole-hour units with monthly rounding, live-in caregiver visits have to carry the right modifier or the claim finds no matching EVV visit, and the state filing window is not something to guess at. 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 care in Virginia passes through four states of being, and they do not always agree.
The payer approved a number of hours. In Virginia that is Cardinal Care personal care under the CCC Plus Waiver, agency-directed or consumer-directed, administered by DMAS. The clock and the ceiling both live here, and delivery is measured in whole hours with monthly rounding of accumulated minutes.
The aide worked the visit and it landed in Electronic Visit Verification. Virginia runs an open, provider-choice EVV model that reports to the state. Either way, the visit becomes an accepted EVV transaction, or it does not, and live-in caregiver visits have to carry the correct live-in designation for the claim to line up.
A claim went out to the payer with a Medicaid ID, date of service, NPI, a HCPCS code, its modifier, and a unit count. Agency-directed personal care rides on T1019, consumer-directed personal care rides on S5126, both in whole-hour units with accumulated minutes rounded to the hour monthly. That rounding is its own source of small mismatches.
The claim matched, cleared its other edits, and remitted. Or it hit a mismatch and denied.
The leaks live in the gaps between those four columns, and Virginia has two particular rules that turn a gap into lost money: whole-hour billing with monthly rounding creates billed-versus-delivered unit mismatches that neither the EMR nor the aggregator will flag on its own, and a live-in caregiver visit without the correct live-in designation on the claim will find no matching EVV visit and deny.
- 01Delivered but never billed
- 02Live-in caregiver visit missing the live-in designation on the claim
- 03T1019 billed where S5126 was correct, or vice versa
- 04Accumulated-minutes rounding lost track of a whole hour
- 05Aged past the DMAS filing window
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 Virginia the whole-hour rounding rule quietly reshapes every member's billed hours every month. By the time an annual review names a rounding shortfall or a live-in-designation denial, the pattern has repeated for eleven more months. An annual audit hands you a number. It does not hand it to you while DMAS will still take a corrected claim.
The EMR is not built to catch it either. Your EMR knows what it billed. Your EVV vendor knows what visit was accepted, including whether it carried the live-in designation. The remittance knows what paid. Those three live in three places, and the mismatch is in the seam between them. Whole-hour rounding is exactly the kind of mismatch that hides inside a clean-looking monthly total.
The gap only shows when you put the accepted EVV transaction, the live-in designation, the claim with its code and units, and the remittance in the same view and read them together, month by month against the authorization. That is the one thing Reeve does. It reads across the seam.
That is what Reeve reads for in Virginia: what your EVV aggregator accepted, what the authorization allowed, what you billed, and what actually paid, read as one line rather than audited for rate.
Plain answers, on the record.
Straight answers on how the Virginia 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 Virginia?
- 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 Virginia rule is Reeve actually reconciling against?
- Two: whole-hour billing with monthly rounding on CCC Plus personal care, and the live-in caregiver designation on EVV. Accumulated-minutes rounding is where small hours quietly disappear, and a live-in visit without the correct designation on the claim finds no matching EVV visit and denies. Reeve lines up the visit, the designation, the claim, and the remittance and shows you where any of those disagree.
- 04Which Virginia programs and codes does this cover?
- Cardinal Care personal care under the CCC Plus Waiver, administered by DMAS, in both agency-directed and consumer-directed models. Agency-directed personal care bills on T1019 and consumer-directed personal care bills on S5126, both in whole-hour units with monthly rounding of accumulated minutes.
- 05We use an open EVV vendor reporting to the state. Do we need to change anything?
- No. Reeve reads the export your vendor and the state EVV record produce and reconciles them against your claims and remittances. It sits above your stack, read-only, and works with whichever open-choice EVV vendor you use.
- 06How does Reeve handle the state filing window without inventing a number?
- It ranks findings by days remaining against the DMAS filing window rather than asserting a specific number. Delivered visits closest to the window are at the top. Anything past the 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.
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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.