May 1, 2024

Zero-Balance Review - Should Healthcare Providers Insource or Outsource?

Brandon Pittman
VP of Business Development
at Boost Healthcare
Zero Balance

For many healthcare revenue cycle leaders enduring the continued deluge of payer challenges, staffing shortages, and more, two questions can jumpstart the process when considering implementing a Zero-Balance Review that retrospectively identifies recoverable revenue.

Is this revenue cycle initiative worth pursuing?

Should we do it internally or partner with experts?

For a clear idea of how to consider whether to implement a Zero-Balance Review, read on.

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 the healthcare provider received full and appropriate reimbursement for the care rendered.

When done right, The Benefits of Zero Balance Review 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 in mind, it may become obvious whether a Zero-Balance Review is worth pursuing. If it does, 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 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?

Suppose you can embrace the mysterious nature of Zero-Balance Reviews since none are identical and it’s unknown where underpayments and denials may be hiding. 

In that case, you may be able to operationalize an internal Zero-Balance Review with ease and enjoy these key benefits:

No Data Requests - No data to transfer, your IT friends are ecstatic.

No Access Requests - No external access requests to grant, your team is smiling.

No Payer Contracts - No scavenger hunts for payer contracts, your staff is relieved.

No Staff Resistance - No external review, no internal resistance or sabotage efforts to manage.

However, if you are still uncertain whether it’s the right time to build an internal Zero-Balance Review process with existing resources and staff then read on to decide whether a Zero-Balance Review by experts may be the most impactful approach.

Why Outsource Zero-Balance Review to Experts?

If building an internal Zero-Balance Review isn’t the obvious approach today, there are five unique advantages to partnering with an organization specializing in Zero-Balance Reviews versus an RCM organization offering one as an add-on service.

Expertise & Specialization

1. Skilled zero-balance experts with specialized knowledge, not revenue cycle generalists.

2. Access to curated and refined zero-balance review framework with proven results.

Objective & Unbiased 

1. Impartial deep-dive review that’s not restricted by localized knowledge.

2. Unbiased analysis unafraid of finding root causes and recommending process improvements.

Comprehensive & Complete 

1. No cherry-picking of higher-dollar or easier underpayments, all are pursued on your behalf.

2. Multi-layered review that leverages technology without limiting results to algorithms.

Your Dedicated Team

1. No competing revenue cycle services, a team dedicated to your zero-balance accounts.

2. Detailed reporting with insights to eliminate underpayments and inform payer strategy.

Maximum Financial Impact   

1. No underpayment is too small, your lower-dollar and more difficult claims are pursued.

2. Prospectively eliminate underpayments to optimize reimbursement without intervention.

At a Glance - Zero-Balance Review Success

Real-World Case Study

Hospital Type: Stand-Alone Hospital

EMR: Meditech

Net Patient Revenue: $79M

Recoveries since 2022: $1.7M+

While decisions to insource our outsource revenue cycle functions are never easy or no-brainers, we hope this helps you thoroughly consider how to implement a Zero-Balance Review best for you.

With most revenue cycle teams focusing on active or open ‘A/R’, if you possess the (3) C’s  - Competency, Capacity, and Commitment then internally building a zero-balance review process may be the best approach.

For those aspiring to maximize financial impact and net revenue improvement, a Zero-Balance Review by experts that is comprehensive and consultative may be the best approach.

Ready to begin tapping into your zero-balance accounts for unexpected revenue and process improvements? Connect with our experts here.

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