Avoid These Common Pitfalls When Conducting A Zero Balance Review

With healthcare providers relentlessly fighting to preserve margins and wrestling with problematic payers, many revenue cycle leaders are looking for extra resources to hold payers accountable and capture their rightfully due revenue.

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What options are available that don’t require an extensive integration or a heavy lift by hospital staff?

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One proven revenue cycle strategy is a Zero-Balance Review.

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Why Do a Zero Balance Review?

While the depth and completeness of a Zero-Balance Review can vary greatly, the purpose is to confirm whether a healthcare provider received full and appropriate reimbursement for the care rendered for every account reviewed.  

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By analyzing accounts with a zero-dollar insurance balance, underpayments (which are a partial payment for the services rendered by the healthcare provider) can be identified and recovered.

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When done right, a Zero Balance Review can deliver many benefits:

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

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Common Pitfalls When Conducting a Zero Balance Review?

Despite the numerous benefits to a Zero-Balance Review, there are some common pitfalls or mistakes we see unintentionally limit a Zero-Balance Review. To help you maximize the impact of your Zero-Balance Review, here are five common pitfalls and tips to avoiding them:

1. Focused Review & Limited Scope

• Challenge: Partial review of all zero-balance accounts by focusing only on known problematic payers, potential underpayments, or inpatient claims.
• Solution: Conduct a thorough examination of all charges, payments, and adjustments for every zero-balance account, regardless of payer, service type, or charge. Common issues are often found with:
  • Insurance Coverage
  • Coding
  • Charge Capture
  • Denials
  • Payment Reconciliation
  • Contractual Adjustments

2. Ignore Lower-Dollar Underpayments

• Challenge: Neglecting lower-dollar underpayments by only reviewing and pursuing those above a certain threshold.
• Solution: Strategically categorize all underpayments, regardless of amount.  Use data analytics to identify systemic issues for bulk resolution and to implement process improvements.

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3. Overreliance on Expected Reimbursement

• Challenge: Depending solely on a tool-generated expected reimbursement that doesn’t consider unique billing and documentation requirements for every payer.
• Solution: Conduct independent zero-balance reviews and analysis of each zero-balance account to uncover previously missed variances or underpayments.

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4. Overlook Root Causes

• Challenge: Focusing solely on underpayment recovery without identifying root causes, missing opportunities to address systemic issues or avoidable underpayments.
• Solution: Assign a root cause and corrective action to each verified underpayment to improve payer and provider-related processes causing underpayments.

5. Inadequate Dedicated Resources

• Challenge: Insufficient allocation of skilled end-to-end revenue cycle experts for Zero-Balance Reviews.
• Solution: Allocate appropriately skilled revenue cycle experts to each phase of the Zero-Balance Review process.

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Wondering whether your Zero-Balance Review process is leaving uncollected underpayments on the table, not eliminating preventable underpayments, or consuming too many resources?

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At Boost Healthcare, we specialize in delivering complete and comprehensive Zero-Balance Reviews for healthcare providers.  Explore whether collectable revenue is being lost by speaking with our Zero-Balance Review specialists.