Multiple Procedure Rules (MPR), also referred to as Multiple Operation Rules (MOR) by Medicare, are a set of rules applied to claims by various Australian health organisations including Medicare, Workcover, and Health Funds. These rules specify the total amount that these organisations will pay for procedures where multiple items are charged to reflect the efficiency of undertaking multiple surgical items at the same time.
Gentu is capable of automatically calculating and applying MPRs for all types of Accounts, be they Bulk Billed, DVA, No Gap or Known Gap Health Fund claims. It is also capable of applying specific MPRs to invoices to allow you to correctly invoice organisations where these rules apply, such as Workcover. This means you never have to worry about getting out the rule book and calculator to determine what you can charge.
Self, Bulk Billing and Health Fund MPRs
Gentu automatically selects the correct MPR for Self, Bulk Bill, DVA and Health Fund accounts.
In the case of Bulk Billed, DVA and No Gap Health Fund accounts, Gentu is also able to automatically calculate the MPR. When invoicing these account types, there is no Apply MPR button; the MPR is applied as you add items to the invoiced and requires no action on behalf of the user, so you never have to worry about not applying the MPR when making claims for these kinds of accounts.
If you raise an invoice for Self or Known Gap Health Fund accounts, you will need to apply the MPR. To do this, you should:
1) Add Items
2) Apply Gap (where applicable)
3) Apply MPR by clicking Apply MPR.
You can now create and claim this invoice as you would normally.
Other... Account Types and specifying an MPR
Other... account types operate differently to the other account types in Gentu. Because the other... account allows you to assign invoices to organisations like WorkCover who have specific MPRs and fee schedules, invoices created against other... accounts require you to specify the MPR you need to apply.
For these kinds of accounts, you will need to:
1) Specify the Other... account type and Addressee
2) Add items
3) Adjust fees (if necessary)
4) Apply MPR by clicking Apply MPR and selecting the relevant rule from the drop down list.
In the above screenshot we can see the three MPRs available in Gentu: 100/50/25; 100/75/75; and 100/75/50. The 100/50/25 MPR is most common, but you should discuss with the organisation you are billing which MPR they expect to be applied.
The MPR is applied based on the highest fee entered into the invoice; it will ignore all information in the Billing Items menu.
Once the MPR is applied, the Apply MPR button becomes MPR Applied and is greyed out. The specific rule that you have selected will be noted below.