BETTER Zero Balance Audit & Recovery
FOR OUR CLIENTS, BETTER RCM STARTS WITH BETTER ZERO BALANCE
According to the American Medical Association, commercial health insurers experience claim-processing error rates as high as 20%. These errors can translate into millions of dollars in lost revenue. In an ideal world, health care providers and insurers would routinely audit paid (zero balance) claims for underpayment. But the problem is made quite complex due to factors such as:
Different in-network vs. out-of-network coverage
Zero balance audit and recovery ensures that you’re being paid everything that you deserve. In some cases, the zero balance audit process can be used to identify outright claim rejections, and recognize and recoup lost revenue from services that your hospital or medical practice could have billed for.
For other cases, the audit will reveal instances where insurance claims have been underpaid, resulting in the kind of lost revenue that plagues modern healthcare systems. Zero balance recovery refers to the process of reclaiming the money that is rightfully yours.
It’s not that hospitals and healthcare systems are incapable of zero balance auditing and recovery on their own. This is a complex process and external support and expertise can be beneficial to ensure all revenue is collected in a timely manner.
TITAN HEALTH ZERO BALANCE AND RECOVERY APPROACH
At Titan Health, our experienced auditors use state-of-the-art METIS analytics software to review your claims data, identify underpayment trends, and highlight suspicious claims.
Our team will look at the data and ask such questions as:
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Were the claims processed in accordance with contract terms?
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Were all of the services captured and coded correctly?
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Were any revenue opportunities overlooked or missed?
For example, Titan auditors can uncover problems in your health system’s Charge Description Master (CDM), identifying revenue code/CPT code combinations that are incompatible with UHC reimbursement policies. This type of error can result in untold numbers of claims being underpaid or even rejected outright.
Some health systems may simply ignore these errors, believing that the cost of recovery prevents them from investing in this sort of process. But if you leave the problem unaddressed, your problems could add up fast. It might be better to ask, “What are the costs of not performing a zero-balance audit?”
Here’s what you get when you partner with Titan Health:
We Get Paid When You Do
First, our zero balance audit fees depend on the money we collect from your unpaid or underpaid accounts. This approach means that there’s little risk to your organization if our team fails to collect.
When you contact Titan Health, you have nothing to lose and stand to gain considerably from a thorough audit and zero balance recovery.
Address Systemic Errors
Errors won’t go away on their own. Having a skilled team look over your claims data can help you identify specific, systemic issues and will provide guidance on eliminating those issues to prevent lost revenue in the future.
Enhance Patient Care
Your patients deserve the very best. To help deliver the highest quality care you need to bill for procedures patients need — and ensure claims are not, rejected outright. Ensuring financial accuracy will benefit more than just your budget. It will help you deliver a superior quality of patient care.
Our results speak for themselves. At just one hospital, our zero balance recovery team uncovered $2.9 million in lost revenue stemming from 970 accounts that had been incorrectly billed. Since 2002, we’ve created a solid reputation for helping hospitals and health systems improve their bottom lines.
But most importantly, we’re proud of our record of correcting errors to ensure all revenue is collected.
As a healthcare provider, you understand how easily administrative tasks and billing pile up. Titan Health can help you pinpoint sources of error and ensure a smooth process for patients and providers alike.
SCHEDULE A FREE CONSULTATION
SEE WHAT BETTER RCM CAN LOOK LIKE FOR YOUR ORGANIZATION
WE DELIVER RESULTS THAT MATTER
Secondary Review, Primary Results
$3 MILLION
Identified in missed revenue as a secondary vendor for a large Southwest Hospital, reviewing 920 accounts in just 7 months.
Partnership That Delivers
$36 MILLION
Recovered over 10 years for a Southwest health system, including $8M in 2023 alone.
Focused Commercial Claims
$17 MILLION
Recovered from commercial claims only, averaging $1-2M annually for a large Midwest medical center.
Specialized Solutions
$750,000
Recovered in one year
for a Midwest hospital, focusing solely on coordination of benefits claims.