In healthcare, getting from billed to correctly paid can be a long, difficult journey. And if you’re one of the 250+ hospitals forced to furlough staff due to the COVID-19 crisis, it’s even more challenging. As elective procedures return, staff must quickly get back up to speed to handle new accounts — alongside significant A/R backlog — otherwise you risk losing track of some earned revenue.
A zero balance review can help find money you’ve missed along the way. The process analyzes payer reimbursements at an account level to identify exactly how much is left to be paid, and why the payer underpaid or thinks the paid amount is justified.
A good zero balance outsourcing partner should offer:
Transparency: While health systems have a responsibility to provide Aged Trial Balance (ATB), 835 Remit transactions, 837 claims and payer contracts, a good partner needs to share the long-term, preventive insights gained during the process. Many outsourcing partners may find reimbursements but fail to help you avoid future losses.
Contract modeling expertise: Your outsourcing partner should be able to correctly interpret payer contracts and provide continuous monitoring for pricing and contractual terms changes. Whether you’re building your own models or borrowing expertise from outsourced vendors, if you’re spending more than four days to model a contract, you might want to reconsider the process or your vendor.
Integration into your revenue cycle: A good partner can decipher underpayment trend root causes and provide guidance on how to fine tune your patient accounting or contract management systems to reduce the payment variance. They should provide the technology and expertise needed to integrate payment variance detection into your revenue cycle management.
TransUnion Healthcare offers extended business office review services for many organizations’ zero balance accounts, and through our successes — for example, helping an $8 billion health system increase its recovery rate by 70% — we’ve repeatedly come across these common issues:
Timely filing: You can’t delay performing payment variance analysis. From the last remittance date within 30 days, you must dispatch account inventory to a zero balance partner or review the trends in-house. Depending on your payer contractual agreements, failing to submit timely accounts for zero balance review after all available insurance has paid severely affects your time to review and appeal underpaid claims.
Lack of necessary data (Claim 837 and Remit 835): The most effective zero balance approach uses data to sift through the large account volume to identify those not reimbursed correctly. Claim and remit data must be available for each account so you can efficiently identify underpayments and work lower-dollar-variance accounts in bulk.
Lack of accurate contracts: Your contract modeling is only as good as the most recent available contract and fee schedule updates. If you fail to modify contracts whenever payers provide updates, reviews of accounts with newer dates of service can return false underpaid or overpaid results.
To learn more about how to improve your zero balance efforts, visit our Account Receivable Recovery and Denial Management page.