What is the Multiple Procedure Rule?
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.
How does Genie apply the MPR?
Account holders
Genie calculates the Multiple Procedure Rule based off the percentage set in the organisation's account holder record. To specify the MPR, navigate to Open > Account Holders, search for your organisation and double-click on their name.
In this window, select the appropriate rule from the drop-down in the bottom-right and Save.
Item numbers
When downloading the Medicare schedule from Special > Software Updates > Fee Schedules, all relevant procedural items should be marked as MPR-applicable. To check this, or add another item to this ruling, navigate to Open > Billing Items, search for your item and double-click on the record to open.
Place a tick in the Multiple Procedure Rule Applies to This Item checkbox and press Save.
Standard vs ECLIPSE invoices
The MPR can be applied to both standard and inpatient ECLIPSE invoices.
Standard invoices
Add all items to your invoice as normal, then click the button on the right. This will apply the MPR from the most expensive item down based on the Schedule fee*.
* On the rare occasion that multiple procedural items in your invoice have the same Schedule fee, Medicare will apply the MPR in numerical item order.
If you are adding procedures on different service days to your invoice, the MPR will apply correctly for each day, negating the need to create separate invoices for each service day.
ECLIPSE invoices
Add all items to your IMC invoice as normal. The Apply Multiple Procedure Rule checkbox will appear and be ticked automatically during this process.
If you do not wish for the MPR to be calculated you must manually un-tick this before transmitting.