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 people who deliver the care 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.
14 members this month where accumulated delivered minutes across the month round to at least one more whole hour than the claim billed. Example: a member with 47 delivered visits totaling 63 hours and 45 minutes, billed as 63 hours. That is one workable hour per member, at the top of the list to check against your contracted rate.
10 denied claim lines under CCC Plus where the caregiver is live-in but the claim went out without the live-in designation, so the claim found no matching EVV visit. Seven of the ten are still inside the DMAS filing window and reworkable today. The other three are past it.
3 members where delivered and accepted EVV hours exceed the authorized CCC Plus hours on file. 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.
6 claim lines where T1019 was billed on a member on consumer-directed care or S5126 was billed on a member on agency-directed care. The code has to match the delivery model on the authorization, and the miscoded lines either denied or paid at the wrong rate. Records attached.
16 delivered-and-accepted EVV visits with no matching claim found in the export, ranked by days remaining against the DMAS filing window rather than a number Reeve made up. Lines closest to the window are at the top. Anything past it is marked gone.
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.
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.