Multiple Reimbursement Calculations

The Multiple Reimbursement Calculations (MRC) feature provides the ability to view multiple calculations for a single patient account number. For example, you can review the calculation details for an inpatient claim and a vaccine claim that share the same account number or for recurring outpatient claims that share the same account number.

In the account worklists, an account number is listed with a parenthetical indicator of the number of accounts that share that account number. For example, account number 012345678 (3) indicates that there are three accounts that share the account number 012345678. Within the Patient Account Audit page, you can easily toggle between reprice details for each account associated with the account number.

Master Accounts

A master account is an aggregate of all the accounts that share the same account number. For example, you can view the individual account details for an inpatient claim and a vaccine claim for the same account number, but you can also view the billed charges, expected reimbursement, discount variance, and so on for these accounts combined into one master account.

When multiple accounts are present, one account is designated as the primary account. The primary account is determined as the account with the highest expected reimbursement. For fields that do not display a combined calculation, such as DRG, Bill Type, and Reprice Type, the value for the primary account displays.

Master Account Worklist

When creating a worklist, you can choose to create a Master Account Worklist that shows totals for the master accounts. The Master Account Worklist page displays a reprice type to help you distinguish between the accounts included in a single master account, and this worklist lets you toggle your view so you can see details at either the account or master account level. This page also contains many hyperlinks, like the Account Worklist, so you can drill down for more details about a specific account or master account.

If you create a master account worklist based on fields such as DRG, Bill Type, Reprice Type, and so on, the worklist returns all master accounts where at least one of the associated accounts contains the selected value. However, the worklist displays the value for the primary account. For example, assume you created a master account worklist for all master accounts with a bill type of 121. Master account 01234567 has two accounts, one with a bill type of 111, and one with a bill type of 121, and the primary account bill type is 111. Account 01234567 displays in the worklist for accounts with a bill type of 121, but displays a bill type of 111 because that is the bill type of the primary account.

Master Account Audit

The Master Account Audit page functions much like the Patient Account Audit page, but provides information at the master account level. This page summarizes master account transactions including charges, payments, adjustments, and expected reimbursements. Following the patient summary and display of the selection criteria is the list of account transactions, from which you can drill down to more detailed information about each account or contract.

Reprice Types

The reprice type associated with each account indicates the reason the claim was repriced separately from other claims for this account. The reprice type helps to distinguish between multiple claims on an account.

The criteria for each reprice type can be defined by your facility, and specific reprice types can also be deactivated by your facility. The available reprice types include the following:

  • MCR Part-B Vaccine – Identified by bill type and revenue code as a Medicare Part-B vaccine claim.
  • 1500 Claim (Hospital-based)– Identified by claim type as a CMS-1500 claim and associated to a UB by account number.
  • MCR Part-B – Identified by product, bill type, occurrence span code, and length of stay as a Medicare Part-B one day stay claim.
  • Recurring Outpatient (OP) – Identified by patient type and account number as a recurring outpatient claim when more than one claim exists.
  • Standard – Any claim that does not fit one of the reprice types described above.

If a claim has not been repriced, “Not Repriced” displays in the Reprice Type field or column.