Are You Losing Revenue to Inaccurate Claims?

If you answered yes to this question, it is imperative that you review your Triple Check Billing Process.  All facilities should be conducting a Triple Check Billing Review each month verifying the accuracy of their claims to ensure accurate and timely payment.  This meeting should include a process where each claim is reviewed and a follow up process to correct each error found on the claim prior to submission is established.  While this process may seem tedious and time consuming, the benefit of a thorough triple check billing process is crucial to support your financial bottom line.

Where do you start?

The first step is to determine the process that meets your facility’s needs.  You will want to develop a process that includes reviewing all claims for each payor plan with key members of your team.  We recommend developing a checklist with the key items that need reviewed for each payor.  You will also want to develop a log for discrepancies and who is responsible for resolving any issue.  There will need to be timely resolution of any identified discrepancies as to not delay submission and thus payment of your claims. 

Who should be involved?

Success of the Triple Check Process requires that the right team members be involved.  You will need someone familiar with the billing claim/UB04.  This is typically the Business Office Manager and/or Biller for the facility.  Your MDS coordinator will provide valuable information regarding the data on the MDS as well as the clinical record.  Your admission coordinator generally is the team member that provides information to ensure accuracy of payors and that verification/criteria was met for each claim according to the payor plan.  Your Director of Therapy will need to be present to provide information regarding therapy services delivered for each claim.  Finally, your Administrator/Executive Director will direct the meeting and be responsible to ensure that each area of the claim has been reviewed and/or corrected prior to submission.

What are the key areas to review?

During the Triple Check Billing process, you will want to compare the information from the MDS, the CWF, and Therapy and other Ancillary Billing to what has been generated on the claim.  Areas of focus for review should include demographics, type of bill, facility and MD information, admission information, payor type, availability of coverage, requirements for coverage and verification/authorization information, MDS data (ARD date, HIPPS, clinical documentation support, transmission/acceptance), Service dates/coverage dates and occurrence codes, Diagnosis/ICD-10 codes, Cert/Re-certs signed and dated, therapy charges present with modifiers as applicable, and denial notices (if applicable)

At Axis HealthCare Consulting we understand that this can seem like a daunting and overwhelming task but also recognize the importance of completing a thorough and efficient Triple Check Billing Process to ensure your organization’s fiscal accountability through accurate and timely payment of claims.  This is why we have developed a system to assess your current Triple Check Process and make recommendations for improvement and/or support you in creating and implementing a Triple Check process right for your organization.