Job Summary:
The Prospective Payment System (PPS) Coordinator provides oversight and coordination for the timely and accurate completion and submission of all Inpatient Rehabilitation Facility Patient Assessment Instruments (IRF-PAI) for the combined 36 bed Inpatient Rehabilitation Facility between Westchester Medical Center and Mid-Hudson Regional Hospital. In collaboration with the multi-disciplinary team, this individual will collect, review, and monitor the information contained on the IRF-PAI of each patient to ensure accuracy in scoring of functional status and representation of the patient’s care needs as documented in the medical record and the Uniform Data System (UDS). This position also acts as a resource to clinical staff in assessing functional status utilizing Quality Indicator(s) measures (QIs) and serves as educator of QI scoring as outlined by UDS training materials and guidelines.
Responsibilities:
- Oversees, completes and analyzes QI data on IRF-PAIs in accordance with CMS guidelines;
- Provides orientation and ongoing education of staff to optimize QI score accuracy at admission, throughout the patient’s stay and upon discharge, and ensures accurate and timely completion of the IRF‑PAI;
- Monitors for and implements annual changes to IRF-PAI form and educates staff accordingly;
- Maintains up to date knowledge of regulations which affect documentation and IRF-PAI completion;
- Collaborates with the multidisciplinary team to ascertain an accurate assessment of the needs and strengths of the patients, ensures that such information is captured in UDS, and makes appropriate corrections to the IRF-PAI in order to continually reflect care throughout patients’ stay;
- Ensures timely completion of the admission assessment of the IRF-PAI;
- Attends team and patient conferences to obtain patient information and to ensure this information is captured on the IRF-PAI;
- Utilizes IRF-PAI admission assessment to identify the CMS Expected Length of Stay for all new admissions;
- Investigates the Impairment Group Code (IGC) and comorbidities in a collaborative manner with physicians, screener and coders to ensure accurate coding of patients’ stay;
- Identifies target reference dates for the completion of the IRF-PAI for all patients;
- Reviews medical record documentation to ensure accuracy and to substantiate the case mix group assignment;
- Coordinates with the Health Information Management department to ensure appropriate coding prior to submitting completed IRF-PAI to CMS National Database, and ensures timely transmittal of the IRF‑PAI;
- Maintains up to date knowledge of UDS system and provide expertise on use of the software and its reporting capabilities in order to contribute to Quality Assurance/Performance Improvement (QA/PI) process;
- Participates in the QA/PI process for the Rehabilitation Service Line, tracking and trending data which impact upon reimbursement and regulatory concerns;
- Develops and distributes monthly reports to monitor financial and clinical progress of the inpatient rehabilitation unit;
- Provides backup coverage to the rehabilitation liaison as needed, including screening potential patients for admission to the rehabilitation unit, reviewing cases with clinical team and documenting the preadmission screening form.
- Effectively uses automated systems to perform work assignments;
- Performs related duties as assigned.
Qualifications/ Requirements: Required Knowledge, Skills, Abilities and Attributes: Thorough knowledge of CMS requirements concerning IRF-PAI prospective payment system; good working knowledge of acute rehabilitation criteria, level of care requirements, and medical necessity; good working knowledge of CMS and hospital electronic systems; excellent problem solving, critical thinking and organizational skills; ability to collaborate with a variety of disciplines across the organization; ability to audit medical records; ability to create a variety of reports and analyze data; ability to present information clearly and to provide effective staff education; ability to communicate effectively, both orally and in writing. Willing to train the right candidate.
Education:
Successful completion of a master’s degree or higher education from an accredited University in Physical Therapy, Occupational Therapy or Speech Language Pathology in accordance with New York State regulations. Licenses / Certifications. Current New York State License to practice as a Physical Therapist, Occupational Therapist or Speech Language Pathologist
About Us:
WMC Advanced Physician Services PC