Prospective Payment System (PPS) Coordinator
Job DescriptionYou will also ensure that all Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) Documentation is complete on all patients admitted to and discharged from rehabilitation beds while meeting required timeframes per Inpatient Rehabilitation PPS rules. To help achieve our mission, you will lead, plan, develop, implement and evaluate performance improvement and regulatory compliance to support program strategic initiatives and operational priorities. Maintain working knowledge of PPS and providing education/training of rehabilitation personnel as necessary is of vital importance. As requested, you may be asked to provide ongoing chart audits and managing denials/appeals.
- Monitors all patients admitted to the rehabilitation beds and identifies assessment period and completion date for the IRF-PAI.
- Collaborates with physicians or other team members to identify correct ICD-10-CM codes for co-morbid conditions and record on Inpatient Rehabilitation Facility Patient Assessment (IRF-PAI) instruments within four days.
- Reports deficient assessments to appropriate team members and/or leaders to effect immediate improvement.
- Identifies all patients admitted to the rehabilitation beds and identifies assessment period and completion date for the IRF-PAI daily tracking of admissions and discharge to rehabilitation beds.
- Submit completed IRF-PAI documents to medical records and/or Medicare Administrative Contractor (MAC) within required timeframe to avoid penalty.
- Leads, plans, develops, implements and evaluates performance improvement and regulatory compliance to support program strategic initiatives and operational priorities.
- Collaborates with appropriate team members to ensure the timely completion of required documents to meet CMS guidelines. Identifies areas requiring improvement and facilitates the development of action plans in collaboration with the Rehabilitation leadership team.
- Educates and serves as a resource to staff, physicians and leadership on performance improvement and regulatory standards.
- Monitors publications, CMS website and other sources for updates, changes or new requirements.
- Leads efforts to provide ongoing Quality Indictors training for new personnel within the rehabilitation program.
- Assists Director of Rehab Quality/PPS quality improvement and monitoring activities as requested.
- Facilitates data entry into UDS-PRO software for all admission and discharge all IRF-PAI item.
- Provides ongoing review of documentation of all disciplines and care plans to ensure regulatory compliance.
- Collaborates with appropriate team members with denials management to ensure the timely submission of requested documents and timely appeals to payer source while adhering to submission deadlines.
- Analyzes reasons for denials and provides ongoing education to team members on documentation requirements to reduce/prevent denials
Bachelor's degree from an accredited program in Physical Therapy, Occupational Therapy, Speech Language Pathology, Nursing or Science.
Two years. Three – five years of inpatient Rehab and/or PPS experience.
BLS from AHA
Licensed as a Physical Therapy, Licensed Physical Therapy Assistant, Occupational Therapy, Speech Language Pathology or Registered Nurse in Virginia.