What kind of title is that? Does it make sense? If you are a facility who embraces the Triple Check process, then the title will make sense to you and maybe even give you a little chuckle!

A Triple Check meeting is imperative this day and age to ensure claims submitted have all necessary information and the documentation to support claims. It doesn’t matter if it is Medicare, Managed Care, or Medicaid claims you are reviewing. The fact is, all payer types are more savvy these days and are aggressively reviewing claims, requesting and reviewing clinical documentation, and providing invaluable education to providers to ensure documentation supports your claims. The initial check of all interdisciplinary information begins during the Triple Check process.

What does a Triple Check meeting look like?

That varies from facility to facility, provider to provider. It’s the facility who drives this process and the key members include the MDS Coordinator, Business Office Manager, Therapy Manager, HIM Director, and DON. In order for this meeting to be successful, it needs to be taken seriously with time allowed for thorough review of:

  • 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

The above noted items to review are just a starting point but you can be creative and develop your own criteria to review. 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 in order to be more efficient, productive, and thorough. Therefore, meeting once a week is best practice.


Gina Tomcsik, Director of Compliance | Functional Pathways