As healthcare revenue cycle leaders navigate persistent payer resistance, staffing gaps, and mounting operational pressures, two fundamental questions can guide the decision-making process when evaluating a zero-balance review (ZBR) program to retrospectively capture missed revenue opportunities:
- Is this revenue cycle initiative worth pursuing?
- Should we do it internally or partner with experts?
What follows is a structured approach to assess whether a zero-balance review should be part of your revenue cycle strategy.
What Is a Zero Balance Review?
While the depth and completeness of a zero-balance review can vary greatly, the objective is to confirm whether a hospital or health system received full and appropriate reimbursement for any care rendered. ZBRs help uncover revenue leakage.
Revenue leakage occurs in two primary ways: underpayments and denials. Underpayments happen when payers don’t reimburse the full amount owed for services rendered, or when providers fail to bill completely for their services. Meanwhile, denials occur when payers refuse to pay all or part of a claim, whether justified or not.
These issues create a significant drain on the operating margins of hospitals because many organizations focus primarily on active accounts receivable. These losses often go undetected in accounts showing a zero balance.
When done right, the benefits of ZBRs by scrutinizing zero-dollar insurance balance accounts can yield:
- Increased Net Revenue
- Improved Payer Compliance
- Revenue Cycle Process Optimization
- Underpayment Prevention
- Improved Margins
With those points in mind, it may become obvious whether a zero-balance review is worth pursuing. If it is, which approach to implementing the most impactful zero-balance review is right for you?
Why Do a Zero-Balance Review Internally?
When considering whether to do a zero-balance review, the first place to look is internally.
Can you answer the following questions with a firm “yes”?
- Technology Resources: Do we have the technology and system(s) to identify variances by re-pricing closed accounts and determining whether full reimbursement was received for the care rendered?
- Analytical Resources: Do we have the analytical resources to validate the variances indicating a potential underpayment and prioritize the inventory based on recoverability?
- Dedicated Skilled Staff: Is adequate revenue cycle staff available to research the variances, appeal, and incessantly follow up on each to generate recoveries?
- Commitment & Patience: Do we have the patience and time to continuously invest the resources necessary to identify, validate, and recoup the otherwise lost revenue?
- Consultative Approach: Do we have the capacity to objectively analyze the variances, recoveries, trends, and root causes at the claim and payer levels to implement process improvements with the responsible payer and within the revenue cycle?
If you’re willing to take on the unpredictable nature of zero-balance reviews—where every account presents unique pitfalls and revenue leaks can hide in countless blind spots—then attempting an internal program might be the correct path for your organization.
Some possible benefits could include:
- No Data Requests: No data to transfer—your IT colleagues will be pleased
- No Access Requests: No external access permissions required
- No Payer Contracts: No scavenger hunts for payer contracts
- No Staff Resistance: No external review, no internal resistance to manage
If you have reservations about establishing an in-house zero-balance review program using existing staff and resources, the following analysis will help determine whether expert-led solutions offer greater value and impact.
Why Outsource Zero-Balance Reviews to Experts?
If building an internal zero-balance review isn’t the obvious approach today, there are five unique advantages to partnering with experts specializing in zero-balance reviews versus an RCM organization offering one as an add-on service.
Expertise & Experience
- Skilled zero-balance professionals with specialized knowledge, not revenue cycle generalists
- Access to curated and refined zero-balance review framework with proven results
Objective & Unbiased
- Impartial deep-dive review that’s not restricted by localized knowledge
- Unbiased analysis unafraid of finding root causes and recommending process improvements
Comprehensive & Complete
- No cherry-picking of higher-dollar or easier underpayments, all are pursued on your behalf
- Multi-layered review that leverages technology without limiting results to algorithms
A Dedicated Team
- No competing revenue cycle services, a team dedicated to your zero-balance accounts
- Detailed reporting with insights to eliminate underpayments and inform payer strategy
- No underpayment is too small, your lower-dollar and more difficult claims are pursued
- Prospectively eliminate underpayments to optimize reimbursement without intervention
Revenue cycle sourcing decisions require careful analysis rather than quick judgments. This analysis should guide your strategic assessment of the optimal zero-balance review approach for your specific healthcare organization.
Given that most revenue cycle teams prioritize active accounts receivable management, hospitals possessing the three essential “C”s—Competency, Capacity, and Commitment—may find internal zero-balance review development to be their optimal strategy.
For healthcare providers seeking to maximize financial recovery and achieve substantial net revenue enhancement, partnering with industry experts who deliver comprehensive, consultative zero-balance review services often proves most effective.
Ready to discover how Aspirion’s cutting-edge AI and ML technology—bolstered by our experienced team of data scientists, healthcare-focused attorneys, clinicians, and claims specialists—can help unlock hidden revenue potential through a comprehensive zero-balance review? Let’s discuss your unique RCM challenges and objectives. Contact us today!
