11th Apr

Last month I blogged about therapy coding. This month, I want to talk how to ensure therapy medical and treatment diagnoses are accurate and applicable prior to submitting the claim to Medicare. This is accomplished through an effective and thorough facility Triple Check Process. Let’s look at the Who, What, When, Where, Why, and How of the Triple Check Process.

Who: The leader of the Triple Check meeting is the MDS Coordinator who has coding training and a keen eye for coding inaccuracies. Other important members of the triple check meeting include the Business Office Manager, Therapy Manager, HIM Directory, and DON.

What: The Triple Check meeting should have enough time allotted for thorough review of the following key areas:

  • Medical conditions/diagnoses and applicable ICD-10 codes must be reviewed
  • Number of days in RUG categories for skilled residents
  • Correct resident demographics including correct admit date to the facility
  • Qualifying hospitalization information
  • Medicare days available/used
  • Physician Cert/Recert information

When: The meeting frequency at a minimum is once a month but if you are provider with a high skilled census, more frequent meetings is recommended to ensure efficient, productive, and thorough review of resident cases. Therefore, meeting once a week to review new residents admitted to the facility and/or therapy within that week is best practice.

Where: Regardless of payer, triple check is an essential frequently planned meeting at the facility level.

Why: Triple check is imperative these days to ensure claims have all the necessary components to ensure accuracy of the claim and is driven by the facility. The initial check of all interdisciplinary information begins during the Triple Check Process. The ultimate goal is a ‘clean claim submission’ to avoid denials and the extensive time and resources defending the claim and possible revenue cycle implications of the appeals process.

How: All members of the Triple Check team should come prepared to discuss the residents in review. Start at the top of the list and review each resident covering the bullet point items listed above at a minimum. Go into detail regarding the medical diagnoses selected and make any corrections at that time and prior to claim submission.

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