In this article:
The Multiple Procedure Rule (MPR), also referred to as Multiple Operation Rule or Multiple Item Rule, are a set of rules applied to item fees and/or rebate amounts.
The MPR specifies the total amount that a certain organisation will pay for procedures where multiple items are charged, to reflect the efficiency of performing multiple surgical procedures at the same time.
The standard, or most common, MPR scale is 100/50/25.
- Gentu automatically applies the relevant MPR to items' rebate amounts. This applies to all Account Types except for the Other Account Type.
- As you add items to the invoice, Gentu will automatically re-order the items to align with the MPR, based on the MBS schedule amount for the item (or the health fund schedule amount, for Health Fund account type invoices).
- Gentu also allows you to apply the MPR to the item fees on Self, Health Fund: Known Gap, and Health Fund: Private invoices.
- Gentu automatically applies the standard MPR to the rebate amounts for Bulk Bill and DVA invoices.
- Gentu automatically applies the standard MPR to No Gap invoices' rebate amounts.
- The item fee MPR is not applicable.
- For Known Gap invoices, Gentu will automatically apply the relevant MPR to the rebate amounts of all items added to the invoice.
- You can then apply the MPR to the item fees by clicking Apply MPR.
- Alternatively, you can press Apply This Gap to apply the health fund's known gap amount to the invoice. This will also cause Gentu to automatically apply the relevant MPR to the item fees.
Known Gap AHSA
- For AHSA-fund Known Gap invoices, Gentu automatically applies the relevant MPR to items' rebate amounts.
- You can press Apply MPR to apply the MPR to the item fees.
- Alternatively you can press Apply AHSA Gap to apply the AHSA per-item gap to each item, which will also cause Gentu to apply the fee MPR and the gap fee MPR.
- Please see this article for more information on AHSA gaps.
- For Health Fund: Private invoices, Gentu will automatically apply the standard MPR to the item rebate amounts.
- You can optionally press Apply MPR after adding all items to apply the standard MPR to the item fees as well.
- For Self account type invoices, Gentu will automatically apply the MPR to the item rebate amounts.
- You can optionally apply the MPR to the item fees by pressing Apply MPR.
- If you choose not to apply the item fee MPR, Gentu will leave the item fees unchanged. The patient will likely receive a reduced rebate amount, and therefore may have a higher out of pocket (gap) cost.
- If you choose to apply the fee MPR, you can so by clicking the Apply MPR button. Gentu will scale the item fees in line with the multiple procedure rule, resulting in a lower out of pocket (gap amount) cost to the patient.
- Other... Account Types, used for third party billing, operate differently.
- For Other invoices, you have the option of leaving the item fees unchanged, or you can choose a specific MPR scale to apply.
- The MPR used for third party invoices should be based on the organisation's requirements. If you are unsure which MPR to use, you should contact the third party organisation.
- To apply the MPR to an Other Account Type invoice, click the Apply MPR button to reveal a drop down menu with several MPR scale options:
- From this list, select the relevant MPR to apply it to the invoice fees.
- If desired, you can exclude specific items on an invoice from being MPR applicable.
- Excluded items will not have the rebate MPR or the fee MPR applied to them.
To exclude an item:
- Add the item to the invoice.
- Click the flag icon to the item's left to open the Overrides window.
- Tick the Not Multiple Procedure override, and then enter the explanatory Service Text.
- Click Apply to save.
- Once you have done this, the item will be excluded from both the rebate and fee MPR scaling.
> How do I stop Gentu from re-ordering items on an invoice?
As you add items to an invoice, the items will be automatically re-ordered based on their MBS Schedule fee.
Gentu does this to align with the rules and calculation guidelines outlined by Medicare Australia to ensure that your claims are processed and paid correctly.
It is possible to prevent items from being re-ordered by excluding them from the MPR, as outlined above.
If you believe that an Australian health fund has different MPR requirements to those mentioned here, please forward through any written documentation from the body in question to firstname.lastname@example.org.