Triple check is an internal audit billing process used by long-term care facilities to ensure reimbursement claims comply with ever-changing Medicare rules and regulations. The process involves three separate checks by a facility’s clinical, therapy, and business teams before the MDS coordinator submits the completed paperwork for a reimbursement claim.
The rigorous process reviews resident information, including a resident’s medical record, care plan, billing information, and Minimum Data Set (MDS) data. While the frequency of checks varies on account of different policies and procedures, triple check reviews are usually conducted monthly. And there is no set way to conduct a triple track. Rather, facilities should use templates with checklists and examples online to create their own personalized triple check reviews.
Organizations that fail to perform triple check reviews run the risk of submitting incomplete or incorrect documentation, impacting a facility’s financial stability. Furthermore, triple check reviews identify errors and omissions, such as incorrect coding or missing documentation. So conducting multiple checks increases the likelihood of catching mistakes while reducing the risk of payment delays, claim denials, and potential fines or penalties for non-compliance.
Here we will explore the triple check process, looking at online examples so facilities can create personalized triple check reviews to improve their process, documentation, and compliance. We will also discuss best practices for the triple check process, such as using elder care software with advanced billing capabilities to support billing efforts and ensure maximum reimbursement while providing excellent resident care.
Understanding the Triple Check Process
In a perfect world, facilities would have all team members attend triple check reviews to ensure maximum accuracy in the triple check process. While that is not feasible, at a minimum, certain staff members need to attend the monthly triple check meetings to ensure that all submitted documentation is accurate for billing and reimbursement purposes. Now let’s look at the roles and responsibilities of the staff members required to be part of the process in more detail.
Role and Responsibilities
As mentioned above, triple check requires three separate checks conducted by team members to review documentation, ensuring it is complete with no errors. Therefore, the first step of the triple check process is for a business, clinical, and therapy team member to review the documentation.
- Business office manager: Responsible for verifying resident details, including name, social security numbers, Medicare numbers, available benefit days, UB-04 form details, insurance policies, and any related financial or billing information.
- Clinical records manager: Obligated to verify all clinical nursing documentation and care given to residents, including physician orders and certification, charting, care plans, and MDS data.
- Therapy program manager: Responsible for verifying therapy minutes and ensuring the billed number of units on the UB-04 matches the therapy service log.
- MDS nurse or coordinator: Obligated to verify all documentation is accurate and in compliance with PDPM and Medicare regulations. This includes verifying UB-04 details, confirming Activities of Daily Living (ADLs) have been entered correctly, ensuring International Classification of Diseases (ICD-10) codes are correct, and determining the validation report for the MDS process is accurate.
- Administrator: Responsible for ensuring the monthly triple check meetings occur and that all the required attendees are present, on time, and prepared with the appropriate documentation.
During a triple check meeting, the data from the business, clinical, and therapy teams are passed to the MDS nurse or coordinator, who will verify the data before submitting it for reimbursement and billing. Meanwhile, the facility administrator will sit in on the meetings to ensure they are conducted properly.
Essential Items to Review
Now that we have a better understanding of who must attend triple check meetings, we will now look into the essential items to be reviewed in the triple check process:
- Billing information: This entails reviewing the UB-04 form, MDS assessment, nursing and therapy documentation, Medicare certifications, and any applicable Medicare payor forms that impact reimbursement and billing.
- Diagnosis coding: The ICD-10 and other active diagnosis codes must be verified before submission.
- HIPPS codes and modifiers: Ensure all physician orders for skilled care are validated. If facilities want to double-check their HIPPS codes, they can use the PDPM HIPPS Projector tool to calculate and validate scores.
- Clinical documentation: This includes all hospital and medical history, including nursing category validation, physical therapy (PT), occupational therapy (OT), functional ability and goals (GG) scoring notes, speech therapy notes, and dietary information.
- Key dates: This includes hospitalization dates, admission and discharge dates, IPA dates, ARDs, and diagnosis code dates.
Using the triple check process and having the appropriate team member review these critical elements ensures the facility will submit accurate documentation for services rendered, leading to timely Medicare reimbursements and avoiding unnecessary non-compliance problems.
Contact us here to see how our long-term care software can be used to improve your triple check process.
How To Create a Personalized Medicare Triple Check Form
Let’s now look at examples of the Medicare triple check form to ensure all submitted documentation meets Medicare compliance standards. Remember, there is no standardized triple check form. But facilities can use templates as a starting point to create a personalized triple check form.
In creating a personalized triple check form, facilities will want to include these essential elements:
- Resident name
- Dates of service
- Compliance standard
- UB-04 field locator
- Team member
- Review month
Here are some online examples that facilities can use to create personalized triple check forms that best meet their facility’s needs:
- Example 1 – This example includes all of the information above, plus information on pending claims that need further verification to meet Medicare’s compliance standards.
- Example 2 – This form includes additional columns for specific information, such as MDS data, rehab data, and other supporting documentation. It also includes a section allowing some checks to be completed before the triple check meeting. The remainder of the information can be verified during the meeting when the MDS coordinator and administrator are present.
Given that the triple check process requires precision, long-term care facilities now turn to elder care software to streamline the process with consistent billing and reimbursement documentation. Whether a facility creates a personalized triple check process for medication and billing or uses a predetermined form, long-term care EHR software ensures all billing documentation is automatically checked and verified to meet Medicare standards, allowing for accurate reimbursements.
Using Technology in the Triple Check Process
Even if facilities and their staff are well-versed in conducting monthly triple check reviews, there is still the risk of human error when verifying documentation. That is why using a nursing home software system with built-in billing programs is crucial, as it can identify mistakes more efficiently and give staff more confidence in the data they collect.
Other ways long-term care software improves the triple check process include the following:
- Automatic scanning tools that scan every UB-04 form for errors and inconsistencies so that facilities can identify documentation problems before submission to avoid costly mistakes.
- Enhanced coordination capabilities that seamlessly integrate clinical, financial, and therapy documentation to comply with Medicare regulations, thus ensuring compliance.
- User-friendly implementation that the team can quickly adapt and manage to improve workflow efficiency.
- Effective training and support in the form of online training and a team of clinical specialists who can advise and help facilities submit accurate documentation for billing purposes.
While it is impossible to eliminate human error, senior care software with automated processes can highlight discrepancies and deliver correction guidance so that facilities can submit more efficient and accurate documentation. So if facilities want to avoid CMS audits, suspended claims, incorrect billing payments, and false claims, adopting a reliable eMAR software system with billing programs is definitely worth the investment.
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