July 19, 2024

Zero Balance Review: Frequently Asked Questions

Brandon Pittman
VP of Business Development
at Boost Healthcare
Zero Balance

As Zero-Balance Review specialists who work with many healthcare providers across the country, we can confirm that Zero-Balance Reviews are growing in popularity each year.

While the results achieved clearly support implementing a Zero-Balance Review in most situations, revenue cycle leaders still have many questions.

Are Zero-Balance Reviews effective?  Will my team be replaced?  What’s needed to start a Zero-Balance Review?  Who owns the recovery process?

We know because we hear these questions every day.

To help you decide if a Zero-Balance Review will work in your revenue cycle, we’ve answered the most frequently asked questions about ZBR.

Zero-Balance Review Questions & Answers

What is a Zero-Balance Review?

While the scope and quality of a Zero-Balance Review can vary, a Zero-Balance Review analyzes zero-balance insurance accounts to identify and recover previously unknown or unrecovered underpayments and denials across various payer types.

Which Healthcare Providers Can Benefit from a Zero-Balance Review?

Most providers can benefit, but it’s most effective if the following is true:

  • You have over 1,000 annual discharges
  • Less than 75% capitated patient volume
  • Your EMR is capable of generating claims data

Are Zero-Balance Reviews Useful if We Have a Contract Management Tool?

While contract management tools are effective for routine claims, Zero-Balance Reviews can catch the more complex underpayments that may bypass or be incorrectly processed by these tools.

How Often Should a Zero-Balance Review Be Completed?

Initially, a 12-24 month retrospective review is a good starting point.  From there, monthly or quarterly reviews are common, depending on provider’s size, resources, and payer agreements.

Can We Do a Zero-Balance Review Internally?

Yes, if you have the necessary technology resources, analytical resources, and dedicated skilled staff then you may be able to perform a Zero-Balance Review internally.

What’s Required to Start a Zero-Balance Review?

You’ll need to provide a data extract, payer agreements, and EMR/EHR access.

Who Manages the Appeals and Follow-up Process?

This can be handled by your team internally or by your Zero-Balance Review partner serving as an extension of your team.

Why Do a Zero-Balance Review?

By prioritizing these no-value claims and thoroughly analyzing them, benefits can include:

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

Can I Limit the Scope of a Zero-Balance Review?

While it is not recommended, it’s possible to exclude a specific payer, payer classes, or claim types if necessary.

When to Skip a Zero-Balance Review?

Consider skipping if you are highly concerned with:

  • Severe resource constraints
  • Negative staff perception
  • Sensitive payer relationships
  • Competing higher-priorities 
  • Unpredictable revenue recovery potential

Could a Zero-Balance Review benefit your organization and revenue cycle operations?  

What if your zero-balance accounts were prioritized?

At Boost Healthcare, we specialize in comprehensive Zero-Balance Reviews.  Speak with our dedicated zero-balance review specialists that prioritize zero-balance accounts daily.

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