With 40% of hospitals operating in the red, according to Kaufman Hall, healthcare organizations are seeking effective strategies to strengthen their financial health. One proven approach to improving the hospital bottom line is conducting a thorough payment review audit of zero-balance accounts.
What Is a Zero-Balance Review?
A zero-balance review acts as a critical financial safety check in healthcare revenue management. When a medical account shows no remaining balance from insurance, it may appear complete—but is it really?
This specialized audit digs deeper, examining these seemingly closed accounts to ensure the healthcare provider received every dollar they were entitled to. By meticulously analyzing these “zero-balance” accounts, hospitals and healthcare systems can often discover overlooked reimbursement opportunities and correct processing errors that left money on the table. This retrospective process helps healthcare organizations maintain financial health while ensuring accurate payment for the services they provide.
The Value of Zero-Balance Account Reviews
A comprehensive review of zero-balance accounts serves to verify whether your organization has received appropriate reimbursement for all services provided. When executed properly, these reviews can:
- Increase net revenue
- Improve payer compliance
- Streamline revenue cycle operations
- Root-cause analysis
- Reduce future underpayments
- Improve operating margins
Implementing an Internal Zero-Balance Review
Is it possible to do a zero-balance review internally? With the right resources and skilled staff to objectively analyze zero-balance accounts, you can internally perform a zero-balance review to ensure accuracy in billing and payments while identifying potential underpayments. As long as the right team and resources are in place, conducting a zero-balance review is achievable. Follow these essential steps:
1. Account Assessment: Examine all charges, payments, and adjustments on each account with a zero-balance. Look for common issues, focusing on:
- Insurance Coverage: Was the correct insurance billed with active coverage?
- Coding Review: Were all services coded correctly and completely?
- Denials: Why did a denial occur and is it appropriate?
- Payment Reconciliation: Do posted payments match the expected reimbursement? Are any payments missing?
- Contractual Adjustments: Were all adjustments appropriate and authorized?
2. Investigate Underpayments: When underpayments are identified, conduct detailed research to confirm the underpayment and determine its root cause.
3. Document Findings: Create comprehensive records of verified underpayments, including root cause analysis and planned corrective actions.
4. Recover Underpayments: Prioritize confirmed underpayments based on value and likelihood of recovery, then pursue reimbursement through payer-specific appeal processes.
5. System Enhancement: Apply insights gained to improve payer and provider processes and prevent future underpayments.
Keys to Success: 3 Tips for Internal Zero-Balance Reviews
Consider these three strategies when launching your payment review program:
1. Start Small: Avoid overwhelming your team by taking a targeted approach. Don’t review all zero-balance accounts at the same time. Consider focusing on:
- Major payers that represent significant revenue volume. Start with your highest volume payers that make up a significant portion of your volume
- Specific payer categories (e.g., Medicare, Medicaid, commercial)
- Particular service lines (e.g., inpatient, outpatient, emergency)
- High-value accounts. Pinpoint accounts with higher charges
2. Leverage Staff Expertise: Assign staff members to review accounts from payers they’re most familiar with to increase efficiency in the review and appeal process.
3. Review Consistently: Don’t skip any dates of service during your review. Be diligent. Various factors like staff turnover, contract changes, and evolving payer and provider procedures can lead to underpayments.
Consider Partnering with an Expert Vendor
If you’re uncertain about your team’s capacity to conduct a thorough zero-balance review, consider partnering with specialists who uniquely focus on zero-balance account audits. Experts like Aspirion with proprietary AI technology can help ensure you’re not leaving recoverable revenue unclaimed—and allow your staff to work at the top of their license.
Unlock the hidden revenue in your zero-balance accounts. Our powerhouse team combines legal, clinical, and technical expertise with advanced AI to maximize your rightful reimbursement. Start your revenue recovery journey—reach out today!
