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
· DON
· 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.