Why is triple check so important?
- It establishes the framework for billing. A clean claim is the first line of defense toward reimbursement, passing through multiple stops to clear approval for payment. A strong triple check process (against the actual bill) will verify accuracy of condition codes, occurrence codes, dates, modifiers, diagnoses and interventions to allow smooth transition through the edit process in a manner consistent with positive cash flow.
- It verifies accuracy of source documentation for capture of PDPM components and therapeutic interventions. Verifying these elements up front allows opportunity to obtain additional records as needed (e.g., hospital documentation, signed certifications) to ensure billing requirements are satisfied.
- It provides an opportunity for collaboration among IDT members and a platform for discussion of strategies for success. Involvement of the right team participants (e.g., business office, billing, MDS, Rehab) will confirm understanding of regulations and documentation necessary for capture of services reflected on the bill, key toward substantiation of billing.
- It identifies areas of claim risk, eliminating surprise findings should selection for medical review occur in the future. Thorough risk assessment, in turn, grants ample time for organizational preparation toward any possible financial implications.
- It minimizes deviations in billing patterns. As Medicare Administrative Contractors rely on billing data analysis aberrancies in determining rationale for probe review, elimination of spikes in data trends is key.
As medical review may impact efficiency of current reimbursement, or sustenance of payment previously received, emphasizing a comprehensive triple check process will contribute to organizational integrity. Getting claims right at triple check, versus during subsequent medical review, is a compelling argument toward site specific performance and enterprise success.
