Prospective Payment System Coordinator - Inpatient Rehab Unit (Physical Medicine)

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full.  Below, you’ll find other important information about this position. 

The PPS coordinator is responsible for planning, developing and overall coordination of activities that support the Prospective Payment System (PPS) process for the inpatient rehabilitation unit. Assures compliance with all State and Federal requirements related to and oversees the accuracy and timely completion/transmission of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI). Coordinates staff education and training related to scoring and documenting observations of Care Set coding (section GG). Coordinates data analysis and quality improvement opportunities with rehab leadership team.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. ADN, Diploma, BSN or higher degree

2. Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

3. Obtain BLS within 30 days of hire

EXPERIENCE:

1. Two (2) years clinical experience, including experience as a IRF PAI Coordinator and previous experience with UDS.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Completes and transmits the IRF-PAI to CMS.

- Oversees and ensures the accuracy and completion of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) prior to electronic transmission within required time frames

- Maintains a current knowledge of IRF-PAI software and provides expertise on this software within the inpatient rehab setting.

- Collaborates with rehab liaison/case manager and admitting physician to determine the anticipated case mix group (CMG) to be assigned to each patient admitted.

- Collects pertinent demographic, clinical and care set data and enters it on the IRF-PAI.

- Ensures Preadmission Screen is completed (PASE) and signed with 48 hours of IRF admit

- Ensures HPI completed as required for IRF documentation and as required under the conditions of participation.

- Ensures Individualized Overall Plan of Care includes CMS required documentation and is completed with 4 days of IRF admit

- Tracks, monitors and reports Intense Level of Rehabilitation Services and individualized care.

- Communicates with coders within 4 days of admission to determine etiologic diagnosis and co-morbid conditions present on admission.

- Communicates estimated length of stay and expected outcomes to the team and to case manager for discharge planning and discussion at case conference.

- Participates in all care conferences and reviews documentation concurrently throughout the stay to ensure accurate documentation of team conference discussion. Reviews codes as provided by health information management for capture of documented conditions.

- Tracks and reports regularly on 60% rule compliance.

- Maintains a current knowledge of CMS and PPS regulations related to participation requirements for inpatient rehabilitation facilities.

- Provides ongoing staff education to ensure compliance with CMS guidelines.
 

2. Collaborates with interdisciplinary members of the team.

- Assists with formulating a plan of care including expected outcomes for each patient based on diagnoses derived from patient assessments.

- Educates and trains staff, including physician, nurses and therapists, on documenting to ensure that the plan of care and supporting documentation reflects the need for intensity of services provided, medical necessity of the services provided and need for 24-hour rehab nursing.

- Educates and trains staff to accurately score IRF PAI and GG section

- Completes competency check off for Care Set coding (GG section) on all new rehab staff.

- Reviews documentation for inconsistencies in Care Set coding

- Ensures completion of Care set coding re-credentialing for facility and all appropriate staff members.

 - May serve as a scribe in care conferences.

- Promotes participation, cooperation, and teamwork. Demonstrates problem solving in resolving issues.

3. Participates in Quality Improvement Activities.

- Prepares data for program development and rehab operations meetings

- Data An