Inpatient Rehabilitation PPS Coordinator - Part Time (20 Hours) - Wyandotte Hospital

GENERAL SUMMARY :

Ensure compliance with all CMS regulations affecting inpatient rehabilitation, specifically PPS (Prospective Payment System).

Establish policies, practices and processes to ensure compliance with 60% rule, CMS IRF-PAI quality and technical requirements, as well as all other related documentation requirements.

Coordinates the appeal process whenever a denial from our fiscal intermediary occurs. Is the primary author of the content of the appeal and ensures all steps of the appeal process are executed as dictated by CMS.

PRINCIPAL DUTIES AND RESPONSIBILITIES :

• Research and maintain up-to-date knowledge and expertise on all CMS regulations related to PPS, 60% rule and intensity.
• Ensure compliance with all CMS regulations related to PPS, serving as PRS resource.
• Collect, encode, transmit, and export IRF-PAI data to UDS and CMS on every rehab patient.
• Receives all CMS denials for inpatient rehab; tracks all denials through the various appeal stages. Acts as liaison between HIM and patient billing services regarding all appeals and their status.
• Writes, assembles and submits all appeals for inpatient rehab denials. Collaborates with attending physiatrist, as needed, to construct the clinical rationale.

Ensures all timeframes are met at each of the 4 steps of the appeal, from receipt of ADR to Administrative Law Judge level.

• Educates all key stakeholders (nursing, therapy and physiatry) related to documentation content necessary to demonstrate reasonable and necessary care to mitigate our risk of claim denial.
• Manage the medical necessity denial work queue in EPIC.
• Interface with HIM to ensure proper coding of medical charts in order to maximize reimbursement.
• Provide ongoing communication and education to Rehab physicians, billing department, HIM, and IT services regarding PPS and reimbursement issues.
• Assist in development of tactics and process improvements to achieve financial, satisfaction and quality targets.
• Provide ongoing communication / education to rehab staff concerning changes in reimbursement and patient care issues.
• Maintain UDS software and UDS contracts for outcome management system.
• Completes yearly CMS-mandated fiscal intermediary audit including collection and transmittal of required information in an accurate and timely manner.

Maintains and updates these files throughout the year.

• Conduct concurrent chart reviews, providing staff and physicians with feedback on documentation required for accurate coding to maximize reimbursement.
• Coordinates yearly FIM education for nursing and therapy staff.
• Performs patient care as an Occupational Therapist, minimally at a .1 FTE status. May be required to perform more as census dictates.
• Input 90 day FIM follow-up information into UDS-Pro.
• Communication with rehab admissions nurses for proper impairment group coding upon admission.
• Liaison between rehab services and FI, regulatory and government agencies.
• Exhibit behavior consistent with Service Excellence standards.
• Demonstrate HFHS Standards of Excellence.
• Other duties as assigned.

EDUCATION / EXPERIENCE REQUIRED :

• Bachelor's Degree in a clinical rehabilitation related profession required.
• Three to five years recent clinical and inpatient rehabilitation experience, preferred.
• Interpersonal skills to effectively lead assigned personnel and to communicate with internal and external customers.
• Analytical skills to evaluate procedures, techniques, assess problems / identify solutions.
• High degree of written and verbal communication skills.
• Basic computer skills to use hospital software programs and email.
• Willingness to adapt to job changes and work schedule to meet customers needs.
• Clinical knowledge to evaluate level of patient care services.

Additional Information

Organization : Henry Ford Wyandotte Hospital

Department : Physical Medicine-WH

Shift : Day Job

Union Code : Not Applicable