Triple Check Toolkit

Medicare billing errors don’t just create audit risk — they create overpayments, denials, and ADRs that pull your entire team away from residents. The Triple Check Toolkit gives your interdisciplinary team a complete, structured system to verify that three sources agree before every Part A claim goes out: the medical record, the MDS, and the UB-04 claim.

When all three tell the same story, the claim is accurate and defensible. When they don’t, you find out before it leaves the building — not months later in a denial letter.

What’s included — six tools, one purchase:

• ✅ IDT Training QuickInsights Resource Binder — a ready-to-use staff training guide that builds team-wide understanding of the Triple Check process, PDPM payment components, and what auditors are looking for
• ✅ Per-Resident Verification Form (printable + fillable PDF) — a comprehensive, role-assigned checklist covering eligibility, physician orders and certification, MDS accuracy and timing, all five PDPM components, UB-04 claim verification, and liability notices
• ✅ Quick Reference Guide — UB-04 claim codes, PDPM HIPPS key, and payment timing at a glance for fast verification at the meeting
• ✅ Master Corrections Log (fillable PDF) — tracks every finding, assigns owners, documents corrections and re-verification, and keeps open items visible across billing cycles
• ✅ Meeting Log (printable PDF) — records each Triple Check meeting with facilitator, attendees, claim decisions, and IDT signatures for a defensible audit trail

What it does for your facility:

Brings MDS, Business Office, Therapy, and Nursing to the same table with a shared process — so every PDPM component is verified against the chart, every UB-04 code is reconciled, and every correction is tracked from discovery to closure. The toolkit supports monthly pre-billing reviews as well as admission, IPA, and ADR/audit situations.

Whether you’re establishing your Triple Check process for the first time, tightening up an existing one, or preparing for an audit response, this toolkit gives your team the structure, the documentation, and the defensibility to do it right.

📋 Formats included: Printable PDFs · Fillable PDFs
📌 Based on CMS RAI Manual v1.20.1 (October 2025), Medicare Claims Processing Manual Ch. 6, Medicare Benefit Policy Manual Ch. 8, and NUBC UB-04 specifications.

Questions? [email protected] | www.insightmds.com