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Updated: Oct 9, 2019

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As we move towards October, providers should be discussing the changes that will be necessary to implement the Triple Check process under PDPM. It’s important for all providers to re-evaluate their current process and ensure that key items are monitored and changed in a timely fashion. Many providers have grown used to a triple check meeting where PPS items are reviewed at one meeting on a monthly basis. Under PDPM, it will be crucial for this process to occur more frequently and include a thorough discussion of each of the key components under PDPM.

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

  • 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

When preparing your facility for a PDPM Triple Check, consider the following changes from RUGS IV to PDPM:

As providers prepare for PDPM, the Triple Check Process must be revised to include critical elements that will ensure the most appropriate reimbursement for services rendered under PDPM. By preparing your facility and your team for the changes that will be necessary in the triple check process early on, you’ll ensure a smooth transition come October 1st.



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