PPS (Prospective Payment System) Coordinator
PPS (Prospective Payment System) Coordinator is a high level clerical position working under the direct supervision of the Intake Supervisor. This position requires a great deal of skill and ability to understand CMS rules related to the home health prospective payment program as they relate to tracking multiple identifiers-i.e. Face to Face, Q-Codes, therapy reassessments, etc. These job duties may expand with new CMS rulings. The PPS Coordinator may be requested to coordinate activities among Agency Team Leaders and Team Coordinators.
- High school graduate at minimum. Prefer BS in health care administration.
- Highly organized and energetic.
- Excellent skills in detail.
- Excellent communication skills.
- Demonstrated ability to analyze and report information particular to the PPS process.
Essential Responsibilities and Duties:
- Works with Intake Supervisor to identify high risk issues prior to Start of Care. For instance, recent hospitalization, lack of caregivers in the home, more than 5 (five) prescribed medications, etc.
- Assists in getting required medications delivered to home either prior to patient arrival home or within 12 hours of arrival to home.
- Assures Face to Face documentation is completed prior to start of care.
- If a “face to face” contact with the physician has NOT been made, assists the patient/caregiver in arranging for a “face to face” visit with the primary physician.
- Assists the Intake Coordinator with gathering required information from physician office and/or hospital. Information will include, but is not limited to, history and physical, current medication list, documentation of homebound status, current X-ray reports, current reports on cardiac testing (if any), dates for immunizations, etc. The Intake Coordinator will determine documents to be secured and information to be captured depending on patient diagnosis
- Applies appropriate Q-codes to intake information for team leaders. Clinicians must verify correctness of code at admission.
- Works with Intake Supervisor in communicating patient scheduling needs to appropriate Team Leaders to assure “Timeliness of Care” timeframes are met.
- Assists in identifying any potential “LUPA” (low utilization payment adjustment) patients. For instance, those patients who are difficult to locate, patients not at home after the first visit, etc.
- Verify 30 day Therapy Reassessment Progress Visits and review reports weekly from Team Coordinator.
- Identifies patients who have been under Agency care during 12 months prior to admission. Reviews past record to identify immunization record during that period.
- Identifies patients who have been admitted to agency more than once during the prior 6 month period. Provides information (i.e. dates of previous admission, HRRG scores at discharge) to Team Leader on previous admission.
- Perform backup duties for the Intake Coordinator when needed.
- Download CASPER and PEPPER reports at least quarterly-distributes to appropriate staff.
- Other duties as identified by supervisor.