A DIY Guide to Zero Balance Review for Hospitals - 3 Tips for Success

Despite operating margins improving in healthcare, 40% of hospitals are still losing money, according to Kaufman Hall.  How can hospitals improve their bottom line?

‍

While there are many paths to increasing net revenue, one proven revenue cycle strategy is a Zero-Balance Review. 

‍

The question stands - can I do a Zero-Balance Review myself?

‍

What Are Underpayments in Healthcare?

As the name suggests, underpayments are a partial payment for the services rendered by the healthcare provider.  Whether they occur because a payer didn’t reimburse the full amount owed or because the healthcare provider didn’t fully bill for the services rendered, the result is the same – money saved by the payer, money lost by the healthcare provider.

‍

What’s the Purpose of a Zero Balance Review?

While the depth and completeness of a Zero-Balance Review can vary greatly, the objective is to confirm whether the healthcare provider received full and appropriate reimbursement for the care rendered by analyzing accounts with a zero-dollar insurance balance.

‍

What Are the Benefits of a Zero Balance Review?

When done right, a Zero-Balance Review can:

• Increase Net Revenue
• Improve Payer Compliance
• Optimize Revenue Cycle Processes
• Prevent Underpayments
• Improve Margins

‍

How to Do a Zero Balance Review Internally

Wondering if you can do a Zero-Balance Review internally?  With the right resources and skilled staff to objectively analyze zero-balance accounts, you can internally perform a zero-balance review to ensure accuracy in billing and payments while identifying potential underpayments.

‍

Here’s an overview of how to do-it-yourself (DIY):

1. Analyze Accounts - Examine all charges, payments, and adjustments on each account with a zero-balance.  In no particular order, look for common issues like:some text
   • Insurance Coverage - Was the correct insurance billed with active coverage?
   • Coding Review - Were all services coded correctly and completely?
   • Denials - Why did a denial occur and is it appropriate?
   • Payment Reconciliation - Do posted payments match the expected reimbursement?  Are any payments missing?
   • Contractual Adjustments - Were all adjustments appropriate & authorized?
2. Investigate Underpayments - If an underpayment is suspected, research to verify then assign a root cause.
3. Document Findings - Record all verified underpayments with a root cause and a corrective action plan.
4. Recover Underpayments - Prioritize verified underpayments based on value and recoverability then follow payer-specific appeal processes.
5. Process Improvements - When possible, use findings and insights to improve payer and provider-related processes causing underpayments.

‍

3 Tips for a DIY Zero Balance Review

Ready to begin reviewing your Zero-Balance Accounts? Here are three tips for a DIY Zero-Balance Review:

1. Start Small - Be strategic, don’t risk overextending your staff by trying to review all zero-balance accounts at once.  For example, below are some strategic segmentation:some text
   • Top Payer Review - With Pareto’s Principle in mind, start with your highest volume payers that make-up a significant portion of your volume.
   • Payer Type Review - Categorize by payer type (e.g., Medicare, Medicaid, Commercial, etc.).
   • Service Type Review - Segment by type of service provided (e.g., inpatient, outpatient, emergency).
   • High-Dollar Review - Isolate accounts with high(er) charges.
2. Payer Familiarity - To increase efficiency, leverage staff’s payer familiarity when reviewing, appealing, and following-up with a specific payer.
3. Review Consistently - Be diligent, don’t skip dates of service when performing a Zero-Balance Review as many factors (e.g. staffing changes, new payer contracts,  evolving processes by providers and payers, etc.) can contribute to underpayments.  

‍

Unsure whether your team is ready to perform a comprehensive Zero-Balance Review?

‍

At Boost Healthcare, we specialize in complete and comprehensive Zero-Balance Reviews - explore whether recoverable revenue is being lost with our dedicated specialists that prioritize zero-balance accounts daily.