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With healthcare’s revenue cycle landscape becoming more complex with each new regulation, reimbursement methodology, and underpayment or denial reason, revenue cycle leaders often find themselves on the unending quest for financial and margin improvements. Despite the seemingly endless amount of solutions or services thrown at revenue cycle management professionals, one proven approach to improving the bottom line remains a Zero-Balance Review.
Yet, as revenue cycle professionals continue on their revenue optimization journey, the question arises:
Who could benefit from a Zero-Balance Review, and conversely, who may not?
Admittedly, we wish that, in good faith, we could recommend our Zero-Balance Review service to every healthcare provider. However, our experience suggests that not every organization is a good fit.
Who Is Not a Good Fit for Zero-Balance Review?
When reflecting on successful Zero-Balance Review engagements, there are three reasons why a healthcare provider may not be a good fit for our Zero-Balance Review:
- Low-Patient Volume - Do you have less than (1,000) discharges annually?
- High-Volume of Capitation - Is over 75% of patient volume capitated?
- Data Limitations - Is your EMR incapable of generating claims data?
Who Is a Good Fit for Zero-Balance Review?
For those still wondering if their organization may be a good fit for a Zero-Balance Review, we typically see meaningful results with healthcare providers who are looking to impact one of the following areas:
- Margins & Net Revenue - Want to recover otherwise lost and unexpected revenue from contracted and non-contracted payers?
- Payer Accountability - Unsure whether a claim may have paid correctly or if a payer may have gotten away with another underpayment or erroneous denial?
- Revenue Cycle Processes - Ready to fix and eliminate preventable underpayments?
Depending on where you are in your quest to improve your revenue cycle and financial performance, our Zero-Balance Review could be the consistent safety-net that complements your internal and outsourced revenue recovery efforts to ensure each claim is fully-reimbursed for the services and care rendered.
