Prospective Payment System (PPS) IP Program

Job Title: Prospective Payment System (PPS) IP Program

Mary Free Bed Summary

We have the great privilege of helping patients and families re-build their lives. It's extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients "Ask for Mary," they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership, to clinicians and care providers.

Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed physicians, nurses and therapists help our patients achieve outstanding clinical outcomes. The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.

Mission Statement

Restoring hope and freedom through rehabilitation.

At Mary Free Bed, we take pride in our values-based culture:

• Diversity, Equity, and Inclusion. Our Commitment to providing an inclusive environment for patients, families, staff, and community, through embracing Diversity, Equity, and Inclusion T.O.G.E.T.H.E.R.
• Focus on Patient Care. A selfless drive to serve and heal connects all MFB employees.
• Clinical Variety and Challenge. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.
• Family Culture. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.
• Trust in Each Other. Each employee knows that co-workers can be trusted to make the right decision for our family, patients, staff, and community.
• A Proud Tradition. Years of dedicated, quality service to our patients and community have yielded a reputation that fills our employees with pride.

The PPS Program Coordinator responsible for assigned aspects of the Inpatient Rehabilitation Facility Patient

Assessment Instrument (IRF-PAI) Program at Mary Free Bed. 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 measurements (GG) education 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.

• Clinical Required: 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.
• 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. o Assures accuracy and thoroughness of data recorded. o 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 o 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
    
    
    
    
  
  
  
  
• Functional Measurement (QRP/GG) - Education and Resource o 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. o 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.
  
  
  
  
• Medicare Documentation Requirements o 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.
  • May assist team with development of a comprehensive, integrated patient plan of care, as required by CMS. o Stays abreast of regulatory and accreditation changes that impact the rehabilitation industry. o 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.)
  
  
  
  
• 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.
• Embrace Diversity, Equity and Inclusion, by:

Treating everyone with dignity and respect

Opening more doors to opportunities for underrepresented cultures

Growing talent and people

Evaluating and eliminating disparities

Taking action against injustices, bias and racism

Honoring our differences and how to collaborate

Educating staff, patients and the communities we care for

Restoring Hope and Freedom, together

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.

Responsibilities in Quality Improvement

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

• Education: Associate's degree required in applicable field of study
• Experience:
  
  
  
  • 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
• Skills and Attitude:

• Demonstrated excellent written and verbal communication skills. o Information management skills to communicate, explain, interpret, and present data. o 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. o 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.

• Bachelor's Degree
• Registered Nurse Licensure