In the complex world of healthcare revenue cycle management, where every dollar counts because financial pressures seem to never disappear, revenue cycle leaders often find themselves trying to improve their organization’s operating margin and bottom-line.
While this is often accomplished with fewer adequate and dedicated resources, too many hospitals and health systems continue to lose meaningful revenue to underpayments and inappropriately denied claims each year.
What are Underpayments?
As the name implies, underpayments are what they sound like – 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 is revenue lost by the healthcare provider.
What are Denials?
Denials are typically categorized as either a hard or soft denial and occur when a payer notifies a healthcare provider that it will not be paying all or some of the claim due to a variety of reasons that may or may not be justified.
What is a Zero-Balance Review?
Zero Balance Review retrospectively scrutinizes accounts with an insurance balance of zero to confirm whether full and appropriate reimbursement was received. As the safety-net to healthcare providers' existing revenue cycle processes and efforts, a zero-balance review identifies and recovers uncollected underpayments and denials from Commercial and Government payers.
With so many priorities focused on ‘active’ A/R, how could a Zero-Balance Review help you?
3 Benefits of a Zero-Balance Review:
1. Increase Revenue Recovery
The initial benefit of a Zero-Balance Review is the self-identification of missed underpayments and recovery of lost revenue. With the right approach, accounts that have no outstanding insurance balance may still contain opportunities to retrospectively recoup additional payment that would otherwise go uncollected.
2. Prevent Underpayments
Zero Balance Review also provides the on-going benefit of eliminating preventable underpayments. With actionable reporting detailing root-causes of underpayments and denials, your team can make meaningful revenue cycle process improvements to ensure appropriate reimbursement is received the first time.
3. Improve Payer Accountability
Between recovering payer-related underpayments and identifying data-driven payer insights with a Zero-Balance Review, you can more effectively hold your payers accountable while also aiding your team in future contract negotiations.
Why Consider a Zero-Balance Review?
Unfortunately, healthcare providers and revenue cycle leaders face a deluge of challenges daily. In no order, it could be one or two of the following today, tomorrow might be something else, and next week it could be a completely different list:
• Complex & Differing Payer Contracts
• Excessive Denials
• Increasing & Shifting Volumes
• Margin Pressures
• Payment Delays
• Skilled Staffing
As priorities evolve and resources shift to new and more important priorities, a Zero-Balance Review can be your consistent safety-net to your day-to-day revenue cycle processes to ensure proper reimbursement is received for the care rendered.
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