Create a Line Item MPR clause or term

Use these instructions to create Line Item MPR Multiple Procedure Payment Reduction. When providers report more than a single (non-evaluation and management) procedure during a single encounter, payers typically will reimburse only the highest-valued procedure at full fee schedule value, and will reduce payment for the second and subsequent procedures. calculations on a clause or term. Line Item MPRs calculate claims that are reimbursed based on multiple rate tiers.

To create a line item MPR clause or term:

1. Navigate to the Clauses or Terms page for the desired provision.
2. Click +Add a New Clause (or +Add a New Term).
3. In the Add a New Clause (or Term) dialog, from the description field, select a description.
4. From the Calc Basis drop-down, select Line Item Code MPR.

5. From the Calc Type drop-down, select either Dollar Rate or % Charges, whichever applies.

   The Calc Measure drop-down is set automatically to Per Line Item, which is required for this calculation basis.

6. For Terminal? select either Yes or No.

7. Do one of the following:

   • To save changes and keep working in the dialog, click Save.

   • To close the dialog after saving, click Save and Close.

   • To cancel your unsaved changes and close the dialog, click Close.

8. Import translation tables and then import rates.