What is PPS Coordination?

Last week, I read the plea from a nurse at a Midwest rehabilitation hospital requesting assistance in describing the role and qualifications of a PPS coordinator. When searching, the CMS website and referencing the Medicare regulations, mention of PPS Coordinator as a requirement cannot be found. The fact remains there is no standard for this position and each facility is left to fend for itself when defining this job. Sometimes, in the rehabilitation hospital, the position is described as an IRF PAI coordinator. Depending on the size of the hospital or unit, it might be combined with other job responsibilities such as care manager, case manager, program coordinator, discharge coordinator, social worker, liaison, admissions coordinator and sometimes ward clerk or unit secretary. The common theme seen, when describing the expectations of this position, is to make sure all the requirements for submitting the documentation to receive the appropriate Medicare payment is performed according to the CMS requirements.

A quick Google search makes the point:

“… The PPS Nurse role is a finance-related position requiring clinical skills to develop, implement and manage a successful Medicare Part A IRF program from admission through discharge.”

“… The PPS Coordinator coordinates the process of providing accurate and timely data to the appropriate entities involved in the Prospective Payment System for Medicare patients. The PPS Coordinator oversees all aspects of data collection on the IRF PAI, ensures the presence of supporting documentation and provides staff education to ensure compliance with CMS guidelines.

“… The PPS Coordinator coordinates all patient information to be submitted to CMS for Medicare reimbursement.  Responsible for Utilization Review and formatting team conferences to maximize LOS efficiency.  Coordinate and monitor compliance with 75% rule.”

“… Responsible for monitoring patient charts for correct coding, electronically transmitting data in a timely manner and communicating with a multidisciplinary team to create and carry out patient treatment plans. Monitor program compliance with changing for Medicare Services (CMS).
- Responsible for clinical data collection, entry, transmission and analysis to ensure compliance with the requirements of the Medicare Prospective Payment System.
-Perform IRF PAI data collection and review for completeness, accuracy, consistency, reliability
-Provide periodic and ongoing staff training nursing, therapy, physician at least quarterly
- Audit medical records for medical necessity/staff documentation.”

And of course, “May be required to perform other duties as assigned by supervisor,” always rounds out the description.

The majority of job postings for a PPS Coordinator favor a nurse, who knows something about inpatient rehabilitation.

Typical Qualifications:

- Licensure/Certification/Registration: Currently licensed as a Registered Nurse
- Education: Graduate from an accredited School of Nursing, BSN preferred
- Experience: A minimum of two years experience as a case manager in inpatient rehabilitation preferred. Must have a working knowledge of IRF PAI and FIM.

The position has evolved within the healthcare industry in reaction to meeting the CMS conditions of payment for the Medicare prospective payment system for IRFs. Both UDS and eRehab offer educational programs for PPS coordinators. UDS will certify the PPS Coordinator’s competency through examination.

Average PPS coordinator salaries can vary greatly due to company, location, industry, experience and benefits. Currently, the average PPS Coordinator’s salary for job postings in the US, according to http://www.indeed.com, is $80,640. Now to justify this salary FTE, a hospital must have a sufficient Medicare population and discharge at least 600 patients annually.  The average Medicare patient PPS revenue estimated at $18,500 for FY2011. Doing the math, we can estimate the cost of the PPS coordinator is $159 per Medicare discharge.

Given today’s information and management systems available, the coordination cost of managing the PPS requirements could use a closer look.