Zero-balance reviews (ZBRs) have emerged as a powerful tool for recovering missed revenue opportunities. As ZBR experts who partner with healthcare providers nationwide, we’ve witnessed the growing need for this strategic approach.
While the financial benefits clearly justify implementing a Zero-Balance Review program, many revenue cycle leaders still have important questions about the process: 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 hear these questions every day from hospitals and healthcare systems considering this approach. To help you evaluate whether a zero-balance review would strengthen your revenue cycle, we’ve compiled answers to the most frequently asked questions about ZBRs.
Zero-Balance Review Questions & Answers
Q: What Is a Zero-Balance Review?
A: A ZBR is a specialized audit that examines closed insurance accounts to uncover and reclaim overlooked underpayments and denials from multiple payer sources. While the scope and quality of a ZBR can vary, it analyzes zero-balance insurance accounts to identify and recover previously unknown or unrecovered underpayments and denials.
Q: Which Healthcare Providers Can Benefit from a Zero-Balance Review?
A: Most providers can benefit, but it’s most effective if the following is true:
- Your organization has over 1,000 annual discharges
- It has less than 75% capitated patient volume
- Your health system’s EMR is capable of generating claims data
Q: Are Zero-Balance Reviews Useful if We Have a Contract Management Tool?
A: Contract management systems can handle standard claims well enough, but zero-balance reviews excel at finding sophisticated underpayments that often slip through automated systems or get incorrectly processed.
Q: How Often Should a Zero-Balance Review Be Completed?
A: We typically recommend beginning with a look-back period of 12-24 months, then transitioning to regular monthly or quarterly reviews based on your hospital’s specific needs and capabilities, such as size, resources, and payer agreements.
Q: Can We Do a Zero-Balance Review Internally?
A: Yes, an internal ZBR is possible if your healthcare system has robust technology infrastructure, advanced analytical capabilities, and specialized staff dedicated to the process.
Q: What’s Required to Start a Zero-Balance Review?
A: You’ll need to provide a data extract, payer agreements, and EMR/EHR access.
Q: Who Manages the Appeals and Follow-up Process?
A: This can be handled by your team internally or by your ZBR partner serving as an extension of your team.
Q: Why Do a Zero-Balance Review?
A: Conducting a comprehensive analysis of these seemingly closed accounts can deliver multiple advantages to your organization. By prioritizing these claims, benefits can include:
- Increased Net Revenue
- Improved Payer Compliance
- Enhanced Revenue Cycle Processes
- Mitigated or Prevented Underpayments
- Optimized Margins
Q: Can I Limit the Scope of a Zero-Balance Review?
A: Although we typically recommend a comprehensive approach, we can tailor the review to exclude certain payers, payer categories, or claim types based on your specific requirements.
Q: When to Skip a Zero-Balance Review?
A: Though ZBRs benefit most providers, hospitals might choose to delay implementation if they face significant challenges related to:
- 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 Aspirion, we specialize in comprehensive zero-balance reviews. To speak with our dedicated ZBR specialists that prioritize zero-balance accounts daily, contact us here!
