The Multiple Procedure Rule (MPR) is applied when more than one procedure is performed on a patient during a single encounter with a provider. The MPR allows the payer to only reimburse the full fee schedule of the highest-valued procedure, then reduce payment by a specified percentage for the subsequent procedures. Genie saves you time by having an inbuilt function that calculates the MPR and applies the calculation within your billing processes.
Before you begin
When applying the Multiple Procedure Rule to invoices, Genie will base this off the Organisation's MPR rule allocated in their Account Holder record. To specify the MPR for the organisation, navigate to Open > Account Holders, search for your organisation and then double click on their name to open their Account Holder record. In this window select the appropriate rule from the drop down in the bottom right corner.
Billing Items that the Multiple Procedure Rule apply to can be identified in Open > Billing Items. Any item that the MPR applies to will have Multiple Procedure Rule Applies to This Item ticked. These items should already be marked upon importing your MBS schedule.
If you find that an item has not been marked as Multiple Procedure Rule Applies to This Item when it should be, simply put a tick in the box and save.
When invoicing procedures, add all items to your invoice with the full fee for each item. Once you have added your second item, the Apply Multiple Item Rule button will appear.
Once you have added all your items for the invoice, select the Apply Multiple Item Rule button. Genie will then work from the most expensive item down to apply this rule. Please note: This is applied based on the Medicare Schedule fees, not private fees.
On the rare occasion that there are multiple procedure items that have the same Schedule fee, Medicare will apply the MPR to the items in numerical order.
Note: If you are entering multiple procedural items that took place on different days, Genie will calculate each days items separately. This negates the need to create separate invoices for each day.
The process for applying the Multiple Procedure Rule for IMC invoices is almost identical to using it in normal manual invoices. The only difference in applying the MPR between the two invoicing types is that the Apply Multiple Procedure Rule will appear as a checkbox in the IMC Invoice window instead. This will automatically be selected by default and will need to be manually unticked if you do not wish for the MPR to be calculated.