Functional Pathways is committed to ensuring that the therapy treatment we provide is skilled in nature as well as reasonable and necessary.  We strongly recommend and encourage our partners to include us in their triple check process.  Why?  Because we value our relationship with our customers and are passionate about care giving.

Triple Check is important to protect Medicare and Medicaid funds.  With all of the scrutiny we are under, why not take 30 minutes a week to review the UB-04, the MDS, and the medical record to avoid inaccurate claims which lead to denials or recouped payment.

It’s easy to make mistakes–let’s face it!  Mistakes happen.  Ensuring you have an effective triple check process in place will provide improved claim processing.  It doesn’t have to be a long process—make it simple!  Making it simple will increase the likelihood that the check will occur.

Where to begin?  Start by identifying the key people and then develop a triple check process. Who do we recommend?  The MDS Coordinator, Business Office Manager, Therapy Manager are our three main leads in this process.

Then what?  After you identify your triple check team, agree on a day and time each week for the triple check team to meet.  Then take a sample of your claims before they are sent in for payment.  Maybe start with 5% and if there are problems found during the triple check process, then audit more claims until you can determinate where the breakdown is.

What if a problem or trend is identified?  If it is an issue that can be immediately resolved, fix it and then train that particular department to avoid future errors.  If the problem or trend cannot be immediately fixed, develop a plan of action to fix the problem and what steps will be followed to avoid future errors.  Ensure the plan of action includes the problem, steps/processes to fix the problem, person responsible, and completion date.

If the triple check process is effective and taken seriously, you will ensure Medicare and Medicaid compliance.  We want to be an integral part of the process because we don’t want to wait until the government auditor says that we aren’t going to get paid!

If you are a Functional Pathways partner and would like more information on our Functional Pathways Triple Check policy, please contact your Regional Manager or email

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