Prospective Payment System (PPS) IP Program Coordinator – (Part-Time) – Valley Health/Mary Free Bed

Mary Free Bed Rehabilitation Hospital•Winchester, VA

16h•Onsite

About The Position

The PPS Program Coordinator is responsible for assigned aspects of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) Program at Mary Free Bed. This role involves training and ongoing collaboration with treatment team members involved in patient assessment and data reporting, ensuring compliance with all quality measures. The coordinator works with physicians and coders to ensure data is encoded and transmitted according to Medicare guidelines and other payor requirements, capturing tier codes effectively for optimal reimbursement. The position also participates in staff education and quality assessment/improvement activities related to the IRF-PAI process. Key responsibilities include overseeing functional measurements (GG) education, providing feedback through audits and ongoing education, and assisting leadership in developing documentation systems that reflect the complex nature of inpatient rehabilitation care and comply with Medicare guidelines.

Requirements

Associate's degree in applicable field of study
A minimum of two years of relevant clinical experience and direct experience with the Inpatient Rehabilitation Prospective Payment System (PPS) process.
Demonstrated effectiveness in the following areas: Able to review medical/functional documentation for accurate impairment group code (IGC) assignment, Able to identify documented and potential co-morbid tier codes, Expert in physician relations, Understands interdisciplinary care delivery process, Able to communicate across disciplines (medical, nursing, therapy, coding, medical records).
Attention to detail – “accuracy is paramount
Demonstrated excellent written and verbal communication skills.
Information management skills to communicate, explain, interpret, and present data.
Demonstrated ability to work both independently and in conjunction with a team of professionals for problem solving.
Sense of urgency, collaborative team style, and ability to quickly adapt to changes in priorities.
Ability to multi-task and delegate tasks for timely project completion.
Demonstrated commitment to the organizational mission with a “whatever it takes” attitude to get the job done.

Nice To Haves

Bachelor’s Degree
Registered Nurse Licensure

Responsibilities

Provide patient care, treatment, and services within the scope of their license, certification or registration and as required by Federal and State laws and regulations.
Completes the IRF-PAI data which determine a patient’s RIC (Rehabilitation Impairment Category), Impairment Group Code (IGC), CMG (Case Mix Group), and payment under the Rehabilitation Perspective Payment system.
Develops and implements a schedule for completion of IRF-PAI according to Medicare requirements.
Assures accuracy and thoroughness of data recorded.
Coordinates the pre-admit assessment and screening process for patients in conjunction with the Admission Coordinators, Physicians and Coders.
Comprehensively assesses the data gathered for the IRF-PAI and may contribute to the development of the plan of care.
Coordinates and completes the PAI on all acute rehabilitation inpatients as part of the hospital outcomes tool.
Works directly with the inpatient coding staff to properly identify and document all applicable codes on a concurrent basis.
Identifies all appropriate tier codes.
Maintains timely transmission of IRF-PAI to CMS.
Reports key metrics to the leadership team from UDS or eRehab.data, including: CMI, 60% rule compliance, Admission Function, Discharge “Graduation” process and discharge function, Functional change, % cases with tier codes.
In collaboration with the clinical leadership team and the MFB Network Manager of Regulatory and PPS Compliance, assists necessary training for clinical employees that are responsibility for functional evaluation (GG Scoring) and documentation.
Through regular audits, evaluates documentation of clinical team members and provides timely feedback when opportunities for improvement are identified.
Maintains communication with leadership team members when repeated documentation concerns are identified.
Serves as a clinical resource for PPS regulations and compliance, coding and billing related to the IRF-PAI, and CMS documentation requirements.
Provides physician and clinical staff education regarding regulatory requirements.
Provides direct and timely feedback to physicians when components of documentation are not present, and provides suggestions for improvement.
May assist team with development of a comprehensive, integrated patient plan of care, as required by CMS.
Stays abreast of regulatory and accreditation changes that impact the rehabilitation industry.
Observes and analyzes systems through regular audits to enhance systems efficiencies and conducts quality assurance activities.
Maintains all components of case reviews / payment audits, and necessary appeals for The Center for Medicare and Medicaid Services (CMS) and other payers.
Monitors, audits, and ensures submission of all QRP Data Collection elements (including CAUTI, C-Diff, caregiver and patient vaccines, etc.).
Maintains effective working relationships with the inpatient rehabilitation medical directors and other physicians that provide care to the patients served.
Provides leadership for the entire PPS program, including ongoing staff development and education, coaching and mentoring of clinical staff and physicians, as required.
Encourages staff development through formal and informal learning opportunities.
Encourages a culture of personal accountability, solution-seeking behavior, and mutual respect, timely communication, openness to change, enthusiasm, and pride.
Promotes collaboration within all disciplines within the inpatient rehabilitation unit, and with other departments and institutions.
Works to effectively integrate all members of the patient care team to provide outstanding rehabilitation services.
Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members.
This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.
Contribute by identifying problems and seeking solutions.
Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.