Improper payments continue to comprise a hefty portion of total Medicare outlays – an estimated $25.03 billion according to the Department of Health and Human Services’ 2021 Agency Financial Report. In the world of skilled nursing facility (SNF) Medicare claims, improper payments increased from 5.43 percent in 2020 to 7.79 percent in 2021 and were caused primarily by missing or insufficient documentation.
That’s a significant amount of potentially lost revenue due to avoidable errors when the solution is simple – triple check.
What is Triple Check?
Triple check is an internal audit process to ensure billing accuracy and compliance with regulatory guidelines prior to submission of claims to Medicare and Managed Care payers. The triple check process is a group effort that requires cooperation from the gamut of individuals involved in the care or assessment of a resident, including the Minimum Data Set (MDS) coordinator, financial administrator, director of nursing and any applicable social workers and therapists. This interdisciplinary team reviews every claim and supporting document and provides an important check and balance to the entire admissions and billing process for Medicare and Managed Care residents.
The triple check process is a monthly review that should be conducted once all MDSs for the closing month have been completed, submitted and accepted and within the small window of days before bills must go out. The review doesn’t need to be overly formal, but the meeting should be well documented and carried out according to a predetermined checklist.
How is Triple Check Done?
Essentially, your triple check team will sit down and review the information on each claim by following the checklist, which should be as comprehensive as possible and include the following areas:
Each area of the claim that is reviewed requires some form of supporting documentation. As your team reviews the information on the claim, they will refer to the census record, hospital transfer record, insurance authorization, Medicare Secondary Payer (MSP), vendor invoices, patient medical record and any other documentation that serves to tell the story of the resident’s status as well as the individual plan of care and treatment goals.
Why Complete a Triple Check?
The advent of PDPM and the change in reimbursement from therapy volume to clinical condition of a resident meant new requirements for completing and backing up claims. This was followed in quick succession with a global pandemic that limited SNF staffing and enabled more errors within the claims process.
The triple check process allows for those who are directly caring for a resident to ensure that the care provided is well documented and correctly reimbursed. It provides an avenue for all relevant areas of your facility to ensure that you are submitting clean claims that have adequate documentation so that you will be paid accurately for your services and ultimately keep your payments – because improper payments can be denied and required to be paid back. An effective triple check process can help your facility avoid both sizable paybacks and the potential for future audits.
Best Practices for Completing a Triple Check
Throughout our experience in helping facilities create an efficient triple check process, we’ve compiled a number of best practices that can help your organization maximize your claims reimbursements, including:
The triple check process may seem overwhelming, particularly when both available staff and available time are painfully limited, and you may prefer your status quo. While you may be prepared to count on the government missing occasional errors or omissions, survey teams are becoming increasingly more diligent and thorough and mistakes of the past won’t likely survive future audits.
Contact Richter's Skilled Nursing Consultants
Richter can help you overcome reservations you may have about implementing an effective triple check. We can review your processes and claims, help you train your staff and provide the guidance you need to start submitting clean claims and maximizing your payments.
If you would like to learn more about our skilled nursing consulting services and how we can help you create and optimize your triple check process, please call us at 866-806-0799 for a free initial consultation. You can also learn more about us by visiting https://www.richterhc.com.
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