Prospective Payment System (PPS) IP Program - Sinai Chicago

The PPS Program Coordinator is responsible for assigned aspects of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) Program. The PPS Program Coordinator is responsible for training and ongoing collaboration with members of the treatment team that are involved in patient assessment and data reporting, including compliance with all quality measures.  

The PPS Program Coordinator works with physicians and coders to assure data is encoded and transmitted in accordance with Medicare guidelines and those requirements of other payors, and that tier codes are captured effectively to maximize appropriate reimbursement. The PPS Program Coordinator participates in staff education and quality assessment/improvement activities related to the IRF-PAI process.

The PPS Coordinator oversees the rehabilitation hospital’s Functional Independence Measure (FIM) education and certification and provides feedback to the clinical teams through audits and ongoing education.

The PPS Program Coordinator also assists members of the leadership team to develop thorough documentation systems for all disciplines that reflect the complex nature of inpatient rehabilitation care, and that comply with Medicare guidelines.

Essential Job Responsibilities  

• Inpatient Rehabilitation Facility – Patient Assessment Instrument (IRF-PAI)
  • 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 contributes to the development of the plan of care.
  • Coordinates and completes the PAI on all other 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 does
  • Maintains timely transmission of Medicare IRF-PAI to CMS.
  • Reports key metrics to the leadership team from UDS or eRehab.data, including:
• Medicare Documentation Requirements
  • The PPS Program Coordinator serves as a clinical resource for PPS regulations and compliance, coding and billing related to the IRF-PAI, and CMS documentation requirements.
  • The PPS Coordinator provides physician and clinical staff education regarding regulatory requirements.
  • Provides direct and timely feedback to physicians when required components of documentation are not present, and provides suggestions for improvement.
  • Assists 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.
• Physician Relations – Maintains effective working relationships with the inpatient rehabilitation medical directors and other physicians that provide care to the patients served.
• Staff Development and Mentoring – 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.
• Professional Work Environment - Encourages a culture of personal accountability, solution-seeking behavior, and mutual respect, timely communication, openness to change, enthusiasm, and pride.
• Interdepartmental and Interdisciplinary Collaboration - 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.

Essential Job Qualifications                        

• Education: RN preferred, although not required.  Associates degree required. Bachelor’s degree preferred.
• Experience: A minimum of two years of relevant clinical experience and direct experience with the Inpatient Rehabilitation Prospective Payment System (PPS) process.

PI254782651