Key Participants in the Triple Check Process for Long-Term Care Facilities

The Triple Check process in long-term care facilities is a collaborative and interdisciplinary effort designed to ensure accuracy in billing, compliance with regulatory requirements, and the integrity of resident care documentation before submitting claims to Medicare and other payers. The following list outlines the essential team members who typically attend the Triple Check meeting, highlighting their roles and contributions to the process:

MDS Coordinator (Minimum Data Set Coordinator) or MDS Nurse:

• • Ensures that MDS assessments are accurate, complete, and timely. Reviews coding and verifies that it supports the services billed.

Billing Specialist or Billing Department Representative:

• • Responsible for preparing and submitting claims. Verifies that billing codes, resident information, and service dates are accurate and complete.

Director of Nursing (DON):

• • Provides oversight of nursing services and ensures that care provided is documented accurately and aligns with billing claims.

Nursing Staff Representatives:

• • Offer insights into the care provided to residents, including any changes in condition or services that might affect billing.

Therapy Department Representatives (Physical, Occupational, and Speech Therapy):

• • Verify that therapy services provided are accurately documented and justified in the resident’s care plan and MDS, ensuring the services are billable.

Social Services Representative:

• • Confirms that social services provided to residents are appropriately documented and, if applicable, included in the billing process.

Dietary Services Representative:

• • Ensures that nutritional services are accurately documented, especially those impacting residents’ clinical conditions that may affect billing.

Activities Director:

• • Verifies that any billable activities or services provided are accurately recorded and reflected in the resident’s care documentation.

Medical Records Coordinator:

• • Reviews and ensures all necessary documentation is in order and readily available to support services billed.

Compliance Officer or Quality Assurance Coordinator:

• • Ensures that the Triple Check process and billing practices comply with regulatory and payer requirements, aiming to reduce the risk of audits and denials.

Administrator or Facility Executive:

• • Provides leadership and oversight, ensuring the facility’s billing practices align with legal and ethical standards.

Finance Officer or CFO (Chief Financial Officer):

• • Offers insights into the financial implications of billing practices and participates in resolving reimbursement-related issues.

IT Support or Health Information Technology Specialist:

• • Assists with electronic health records (EHR) and billing software issues that may impact the accuracy of claims submission.

Conclusion

The effectiveness of the Triple Check process depends on the active participation and collaboration of these interdisciplinary team members. Each member brings a unique perspective and expertise, contributing to a comprehensive review that ensures accuracy, compliance, and optimal reimbursement for the facility. The Triple Check meeting is an essential mechanism for preventing billing errors, avoiding denials, and ensuring that residents receive the care they need while the facility remains compliant with healthcare regulations and financial practices.