Q:
How can I ensure that claims are accurate prior to billing?
A:
The key to accurate claims submission is an effective Triple Check or Clean Claim review process. The Triple Check process is an interdisciplinary self-audit that aims to reduce the risk of billing and coding errors by reconciling the claim to the medical record prior to claims submission. The elements reviewed during the triple check meeting should include the following:
- Verification of demographic and technical data on the claim including, but not limited to, the number of days billed, qualifying hospital stay dates, and from and through dates on the claim
- Verification of compliance with physician certification requirements for both Medicare and therapy claims
- Validation of the accuracy of the MDS elements that impact the PDPM score,
- Verification of MDS acceptance and submission.
- Confirmation that the MDS ARD, HIPPS code, and days billed for each PDPM assessment are accurately reflected on the claim;
- Verification that all therapy disciplines during the claim period are accurately reflected on the claim
- Review of other ancillary charges to verify charges; and
- Validation of the diagnoses codes on the claim to verify principle, and relevant secondary diagnoses are supported by the medical record and consistent with the PDPM HIPPS
A successful review process is best accomplished in conjunction with the weekly Medicare meeting, in which a review of much of the above information and Medicare coverage determination, is conducted. The Triple Check process is then the final step in the review process prior to claims submission. Claims accuracy is essential for success under Medical Review. Contact Proactive for a comprehensive review of Medicare Program compliance.
Written by:
Yetta Christian, Clinical Consultant and Christine Twombly, Senior Consultant
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