ZERO BALANCE REVIEWSOur specialty focus
After claims are closed, most hospitals and health systems – many with six figures' worth of claims annually – simply forget about them. They are missing a source of significant revenue.
Reviewing these accounts offers the opportunity to find out how accurately payers are paying their bills. These reviews find many claims that can be reopened to recoup lost revenue. Even if it is too late to claw back payments, zero balance lookbacks open up vast opportunities to improve processes to ensure higher future revenue.
We categorize appealed claims as payer or process issues. Payer issues are usually reimbursement issues, such as:
- Missing outlier payments
- Failure to retrospectively adjust payments when hospital assessment factors change
- Missing education and capital add-on payments
Process issues are underpayments that would have been paid had the business office processed/followed-up on claims differently. This is highly specific to each organization and the payers it works with. For example, it might be claims with multiple errors being sent by the provider based on poor documentation or lower-than-expected payments that nevertheless matched the claim, which may signal that the claim lacked a modifier or a field was filled in wrong.
Salud provides the right mix of proper mix of people, processes and technology to mine zero balance accounts for higher collections and insights needed to correct ongoing errors.
“Salud has not only produced more than $4.6 million for Community Health Network through its zero-balance review program, it has identified other revenue cycle opportunities that extend well beyond the core component of the program. Our strategic partnership has given us confidence that we can maximize reimbursement amid ever-changing payer regulations. This is a working relationship with lasting value.”
Chad Bills, Network Vice President Revenue Cycle/Patient Accounts, Community Health Network, Indianapolis
For a three-hospital integrated delivery system, Salud discovered $10.6 million in revenue leakage in 9 months and recovered $6 million.
For a nine-hospital regional health system, Salud collected over $3 million in just six months through a focused review of Medicaid MCOs.
SALUD AT WORK:
Early success drives expansion of zero balance reviews
What started as a modest review of settled claims within a 10-hospital health system gained traction quickly, especially after Salud was able to recover $10 million in the first year for the system. The system is part of a statewide purchasing consortium.
Salud’s payments models include reimbursement calculators designed to ensure complete account payment for services performed, not just what was billed. As each system hospital was added, a review of coding, billing and write-offs fixed a host of broken processes.
- $43 million in underpayments identified
- $26 million appealed
- $21 million recovered