Why Do I Need a Triple Check Process? | Richter

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:

• Patient information
• Physician certification
• MDS, therapy and skilled nursing review
• Billing information

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:

• Start the triple check process the moment a resident arrives (i.e., does their name match their insurance card?) rather than wait for the monthly triple check meeting
• Provide staff with initial and ongoing training on required processes and tasks as well as on the consequences of errors and omissions
• Appoint a reimbursement specialist or other employee as well as two backups to be in charge of both clean claims and the triple check process meeting
• Ensure that the triple check process and claims submissions are done timely in order to not fail an audit
• Review for matching information across all forms, for example, a diagnosis on a UB04 (paper claim) must match what appears on MDS and the diagnosis sheet
• Have your department heads watch areas on a regular basis to ensure all necessary tasks are being completed in a timely manner

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.

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