If you’re not performing Zero Balance Reviews (ZBRs), you could be leaving money on the table. Worse yet, you might be missing patterns of underpayment, denials, or contractual misinterpretations that cost your organization thousands or more.
In this blog, we’ll walk you through what zero balance reviews are, why they matter, and how they can be a powerful tool for claims management and revenue cycle improvement.
What Are Zero Balance Reviews?
A Zero Balance Review is a retrospective audit of paid claims that appear to have a $0 remaining balance. This review doesn’t just verify that the claim is “closed” – it confirms that it was paid correctly and completely.
Zero balance does not automatically mean:
- The claim was paid in full
- The payment aligned with contract terms
- The claim was properly adjusted or written off
Instead, a $0 balance could hide:
- Underpayments
- Missed secondary payments
- Inappropriate denials
- Coding errors
- Contractual discrepancies
So, while a claim may look resolved, it may actually need a second look.
Our team of experts at Legacy Consulting Services has uncovered and recovered millions of dollars in missed revenue for clients by conducting thorough Zero Balance Reviews. From catching chronic underpayments to identifying recurring denial patterns, we’ve helped healthcare providers transform what looked like closed accounts into real revenue – often without adding extra strain to their internal billing teams.
Why Billing Specialists Should Care
You’re juggling aging reports, appeals, payer calls, and endless follow-ups. The idea of auditing already “paid” claims might feel like another thing on your ever-growing to-do list. But here’s why you and your practice should care:
1. Catch Underpayments
Many commercial payers underpay claims more frequently than you think. Without ZBRs, these underpayments go unnoticed and unchallenged.
2. Identify coding errors and documentation inefficiencies
Zero balance reviews help identify consistent underpayments and billing or coding issues, as well as denials from specific payers. This gives you leverage to correct the claim if appropriate or appeal as needed
3. Reduce Inappropriate Writeoffs
By identifying inaccurately-closed claims or claims adjusted improperly, ZBRs open the possibility of recovering dollars that were denied through appeals, medical necessity documentation and so much more.
4. Enhance Revenue Cycle Improvement
A single error caught through a ZBR can lead to policy changes that improve accuracy and cash flow organization-wide.
The High Cost of Ignoring Zero Balance Reviews
Let’s talk dollars and sense.
Healthcare organizations lose millions each year to denied and underpaid claims. For hospitals, denial rates are on the rise, increasing more than 20 percent over the past five years, with average claims denial rates reaching 10 percent or more.
By skipping ZBRs, you may unknowingly:
- Miss out on recoverable revenue
- Allow patterns of errors to persist
- Risk compliance penalties for misreporting
- Leave unresolved claims sitting idle.
What’s Involved in a Zero Balance Review?
Conducting an effective ZBR requires more than a glance at your claim history. Here’s a breakdown of a thorough review process:
1. Claim Selection
Focus on claims with high-dollar value, frequent denial codes, or those from payers with a history of underpayment.
2. Contract Review
Compare actual reimbursement with what your contract outlines. Are you being paid what you’re owed?
3. Coding & Documentation Check
Was the claim coded properly? Are all supporting documents in order?
4. Denial Management
If the claim was denied but marked as resolved or adjusted off, was that action correct?
5. Recovery Opportunities
If you uncover discrepancies, submit corrected claims or appeals, where appropriate.
How ZBRs Fit into Strong Claims Management
You can’t talk about claims management without talking about accuracy, oversight, and follow-through.
Zero balance reviews act as a safety net, ensuring that what’s been processed is also correct. They empower you to:
- Validate payer compliance
- Optimize contract negotiations
- Train your billing team on error trends
- Improve KPIs like first-pass resolution and days in A/R
Think of ZBRs as your post-game analysis: it’s how you get better with every play.
Signs Your Organization Needs Zero Balance Reviews ASAP
If any of these sound familiar, it’s time to prioritize Zero Balance Reviews:
- You’re consistently writing off balances without investigation
- Your denial overturn rate is low
- Revenue recovery is stagnant
- Payers are applying the same denial codes over and over
- You have a high volume of “closed” claims in the system that never went through review and appeal
How Legacy Consulting Services Can Assist
At Legacy Consulting Services, we know that your team is likely already maxed out. That’s why we offer zero balance review support that fits into your workflow.
Here’s what we bring to the table:
- Expert analysts who understand payer behavior
- Revenue recovery initiatives
- Identification and correction of systematic issues
- Continuous improvement and ongoing monitoring
- Collaboration with your internal team so knowledge is transferred, not siloed
We don’t just comb through claims: we educate, advocate, and recover.
ZBR Success Story: Small Team, Big Gains
One of our clients, a mid-sized specialty practice, had written off over $400k in claims that were marked as paid. Through our ZBR service, we identified:
- Underpayments from 3 payers
- Claims closed with denial codes that could have been appealed
- Missed coordination of benefits opportunities
- Chargemaster issue where the amount billed for two codes was less than what one payor would have paid.
Results
Claims were reviewed, reworked and then prioritized by timely filing and dollar impact. Over $120,000 in recovered revenue in 6 months and a new SOP for reviewing zero-balance claims quarterly. We also continued quarterly oversight of this process to ensure nothing was missed.
Make Zero Balance Reviews a Standard Part of Your RCM Strategy
Zero balance reviews aren’t just an optional audit: they’re a mission-critical function for anyone who wants to run a high-performing revenue cycle.
As a billing specialist, you already do a lot. But this one step – looking again at what seems “done” – can be the difference between revenue captured and revenue lost.
Here’s your checklist to get started:
- ✅ Advocate for ZBRs as part of your monthly RCM workflow
- ✅ Work with partners like Legacy to support overflow or bring in expertise
- ✅ Use ZBR data to train your team and renegotiate payer terms
- ✅ Celebrate recovered revenue like the win it is!
Let’s Turn That $0 into Something More!
If unresolved claims are stressing you out, you’re not alone and you’re not out of options.
Legacy Consulting Services is here to help you turn those zero balances into real returns. Let’s resolve more claims, recover more revenue, and rethink what “paid in full” really means.Ready to take a second look at your paid claims?
Schedule a free consult today and start your first Zero Balance Review with Legacy.