As healthcare delivery is increasingly moving from acute care facilities and into outpatient and post-acute settings, patient data is moving along with it. As a result, demand for health information management (HIM) professionals experienced in this arena is growing too. Inpatient rehabilitation facilities (IRFs) are dynamic settings where the patient population is constantly changing, as it includes patients recovering from surgeries and injuries as well as patients needing longer-term care. HIM professionals working in IRFs often have the job title of prospective payment system coordinator—or PPS coordinator.
For those working in this space, AHIMA has released the Inpatient Rehabilitation Facility Toolkit, which includes information related to the general duties of the HIM professional in the IRF and resources regarding coding and reimbursement differences between the IRF and other settings. It also includes the multiple uses of the IRF Patient Assessment Instrument (IRF-PAI), auditing and compliance in the IRF, and other setting-specific information.
Although specific responsibilities vary based on the needs of the IRF setting, the following criteria are the cornerstone of the PPS coordinator’s role:
- Accurate IRF-PAI coding
- Documentation specificity of all disciplines to support medical necessity
- Staff education
- Ensuring compliance with CMS and other payer guidelines
Functions within the HIM department for an IRF may include:
- Coding of both IRF-PAI and claims
- Documentation improvement
- Data analysis to support decision making
- Coordination of the IRF-PAI completion and submission
- Qualitative and quantitative audits for medical necessity and deficiencies
- Release of information
- Appeals and denials management/coordination