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With PDPM now live, providers need to be prepared to implement the Triple Check process under the new model, ensuring that key items are verified to ensure accurately and timely billing.

The purpose of holding a triple check meeting is to ensure that Medicare is billed accurately and in a timely manner. The process requires claims to be reviewed for accuracy by the clinical team, therapy, and the business office prior to transmission. Many providers grew used to a triple check meeting where PPS items were reviewed at one meeting on a monthly basis. Under PDPM, the interdisciplinary discussions that occur throughout the patients stay should include discussions of key components that traditionally were reviewed at Triple Check monthly. By discussing and validating these key items on a more regular basis, it will allow for the Triple Check meeting to be more efficient and seamless.

Be ready for Triple Check by incorporating the following process and interactive forms within your facility operation.

How to prepare your facility for Triple Check under PDPM

Procedure & Process

The facility is responsible for implementing an effective monthly triple-check process to

verify claims are accurate prior to submission to the Fiscal Intermediary. The facility will verify each Medicare (Part A and B) claim prior to submission.

Recommended Individuals to Attend

· Administrator


· MDS Coordinator

· Therapy Program Manager

· Business Office Manager

· Medical Records

Administrator Role

Responsible for ensuring that the meeting takes place monthly and that everyone

required to attend is present, on time and prepared.

Triple Check Form

The following checklists identify the areas that need to be verified as accurate on the

UB-04 prior to claim submission. Claims should not be submitted until all areas have

been verified and signed off as complete and accurate.

What are the key validation components of a PDPM Triple Check?

Diagnosis Coding

Primary ICD-10 as well as all other active diagnoses

Clinical Discussion

Hospital information/medical history, nursing category validation, PT/OT GG scoring, nursing GG scoring, Speech Therapy comorbidities, dietary information such as altered diet textures or trials, documentation for medical necessity

Validating the final HIPPS codes and modifiers

Validation of physician orders for skilled care received

Review of Key Dates

Hospitalization dates, admission and discharge dates, ARDs, IPA dates, and onset dates for diagnosis codes

Pertinent Billing Information

UB-04, MDS assessment, nursing/therapy documentation, Medicare certifications/ recertification, Medicare Secondary Payor Forms

What to know about the changes for Triple Check between RUGS IV to PDPM:

Under PDPM, the Triple Check Process must be revised to include critical elements that will ensure the most appropriate reimbursement for services rendered.

Click the link below to download a copy of our Quick Guide for HIPPS Codes which will assist during the Triple Check meeting in bridging the communication from the discussion of each Case Mix Group under PDPM to validating the associating HIPPS code.



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