Proceduralists & Surgical Assistants
ECLIPSE Billing and Patient Invoicing for Proceduralists and Surgical Assistants
Multiple Operation Rules — How They Affect Your Claims
When a surgeon performs multiple procedures in a single episode, Medicare applies the Multiple Operation Rule (MOR) — a tiered fee reduction that determines the schedule fee for each item. The highest item is paid at 100%, the second at 50%, and every subsequent item at 25%. Your claim must reflect these adjusted amounts, not the full schedule fee for each item.
| Item position | MOR rate | What happens |
|---|---|---|
| Item 1 (highest fee) | 100% | Paid at full schedule fee |
| Item 2 | 50% | Paid at half the schedule fee |
| Item 3+ | 25% | Paid at quarter of the schedule fee |
| If miscalculated | — | Claim paid at the wrong amount or rejected outright |
FreshClaim's rules engine derives the correct MOR automatically for every claim. You enter the surgical items; the system calculates the correct fee for each position, applies the right item numbers, and submits a claim that won't be rejected for fee mismatches.
The error nobody sees
MOR errors don't always generate rejections — they often generate payments at the wrong amount. The claim is paid, the fee looks plausible, and the shortfall goes unnoticed. Over a full operating list, the cumulative loss is significant.
High-value claims mean high-value errors
The more items on the list, the more the MOR matters. Complex procedures with multiple items have the highest exposure to miscalculation — and the highest financial impact when items are ordered or rated incorrectly.
No-Gap vs Known-Gap
Your billing decision affects downstream invoicing. No-gap claims are simpler but cap your income. Known-gap allows up to $500 above the fund schedule. FreshClaim handles out-of-pocket patient invoicing at 5% — included in your plan.
FreshClaim vs Conventional Billing
Conventional billing
- MOR calculated manually or not at all — errors go undetected
- Assistant fees require a separate calculation step
- No-gap and known-gap treated identically at submission
- Patient invoicing handled outside the billing system
- Claim status requires manual follow-up with funds
FreshClaim
- MOR derived automatically — correct item ordering and fee calculation every time
- Surgical assistant fees calculated from the surgical items you enter
- Gap structure handled correctly at submission with fund-specific rules
- Patient invoicing and IFC included at 5% — no separate system needed
- Real-time claim tracking and payment visibility from submission to settlement
Billing that actually works for proceduralists
2.85% for ECLIPSE claims. 5% for private patient invoicing. No setup fees, no lock-in contracts, no hidden charges.
