Preparing Quotes

Before creating your quote, you'll need to consider the type of quote you'll be creating. Some things that can impact the different types of quotes you might create are;

• Is the  patient  receiving the quote insured?
• Does the surgeon have an agreement with the insurer to charge a specific out of pocket gap?
• Do you want the patient to pay  an out of pocket expense for this surgery?
• Will your out of pocket expenses exceed the Known Gap for the surgery?

A brief outline of the different types of quotes, and what defines these, can be found below:

Uninsured

Uninsured patients have no private health fund to help cover the cost of their fees. All uninsured patients will need to be provided with informed financial consent as they will be paying out of pocket for the service, if they are seeing a private doctor.

Insured

As the name suggests, insured patients are covered under one of the many Private Health insurers within Australia. There are three common quoting scenarios for insured patients: Known Gap, No Gap and Private Fee quotes.

Private quotes 

This is used when the patient is insured but the doctor has no agreement with the health fund or wishes to charge a gap amount that will exceed the agreement in place with the Health Fund

Known Gap 

Known gap is used when the surgeon holds an agreement with the Health Fund to charge a specified amount above what the health fund will pay for the patient and wishes to apply this gap to the quote. There are three ways to charge a known gap within the quoting window; using the maximum known gap for the fund, applying a custom gap, or using a private fee schedule to calculate the gap.  As this is still a Known Gap quote, it is expected in the Custom gap and Private fee scenarios that the total gap does not exceed the Maximum Known gap for the fund, or the provider has made an agreement with the health fund to exceed the maximum known gap for this specific procedure.

No Gap 

No gap quotes are entirely covered by the health fund. The patient is expected to have no out of pocket expenses, and the surgeon will be reimbursed entirely by the Health Fund and Medicare.

Depending on the type of quote being performed both the Fee and the expected Rebate amount will change. An overview of how this changes based on the Quote type can be found in the below table.

All rebates figures within the quote window are estimates of what the patient or provider should receive back for the procedure. There are a number of factors that can impact whether the estimated rebate amount will be paid, these may include:

• If the provider does not have an agreement with the health fund but still creates a Known Gap Quote
• If the gap  amount being charged exceeds the total known gap previously agreed upon without any further agreement between the provider and the health fund

• If the patients insurance does not cover the services being performed

You can access the Genie Quote window either through an existing Procedure record for which you need to create a quote, or for a new Procedure you're creating. The Adding Procedure Records article explains the process of creating Procedure records in more detail.

To simplify the process of adding items to a quote, you can use the Commonly Used Items popup/drop-down  to the left of the window. To add items to this list, you can click the blue plus icon  to search for an item, and then click the Add to Commonly Used Items Popup button.

Alternately, you can simply open the popup/drop-down menu, and use the Add Item option.

Regardless of the type of quote you're creating, there are some common steps you will need to take:

1. Add all the relevant items to the quote using the blue plus icon or select ‘Load Template’ to use a pre-set Procedure Template.
2. Select the patient’s private fund if not already selected, or set the quote to uninsured if required.
3. Select the Type of procedure: Inpatient, Outpatient, Day surgery.
4. If the Quote requires the MPR (Multiple Procedure Rule) to be applied, ensure this has been ticked and the appropriate breakdown has been selected.
5. If the quote requires the DIMSR (Diagnostic Imaging Multiple Service Rule) to be applied, ensure this has been ticked.

Once you've gone through the above steps, you can now change the settings to reflect the appropriate quote Type.

Uninsured Quote

1. Select the Fee Schedule you wish to charge
2. Click Use Selected Schedule (above)
3. Tick Include Assistant's Fee if appropriate. You will be prompted for the assistant's name, which draws from any address book entry marked as Assists at Operation. Select the appropriate fee to be charged for the assistant.
4. Finally, click on CALCULATE FEES to get the total for your quote.

No Gap Quote

1. Select Use No Gap.
2. Tick Include Assistant's Fee if appropriate. You will be prompted for the assistant's name, which draws from any address book entry marked as Assists at Operation. You are then able to choose what you will be charging for the assist fee, which in this case would be Health Fund Fee.
3. Click CALCULATE FEES to get the total of your quote.

Known Gap Quote – Using the Funds Known Gap

1. Select Use Known Gap 
2. Select Use Fund's Gap. The Maximum Known Gap for the Health Fund should be listed to the left of this check box.
   If this is $0 or the incorrect amount, you can edit this directly from the Quote window, before saving the change you will be presented with the following prompt.
   
   If this is permanent update, click Update Maximum Gap, and proceed with the quote. If you only wish to change the Gap amount for this specific quote, click Cancel and proceed to the Known Gap Quote – Using a custom Gap section of this guide.
3. Tick Include Assistant's Fee, if appropriate. You will be prompted for the assistant's name which draws from any address book entry marked as Assists at Operations. You are then able to choose what you will be charging for the assist fee, which in this case would be Health Fund Fee.
4. Click CALCULATE FEES to get the total of your quote.

Known Gap Quote – Using a custom gap

This option should be used if you have an agreement with the fund to charge the patient an out of pocket gap, however for this specific quote you wish to charge an amount different to the maximum known gap.

1. Select Use Known Gap 
2. Select Use Custom Gap and enter the desired gap for this specific quote.
3. Tick Include Assistant's Fee, if appropriate. You will be prompted for the assistant's name which draws from any address book entry marked as Assists at Operations. You are then able to choose what you will be charging for the assist fee, which in this case would be Health Fund Fee.
4. Click CALCULATE FEES to get the total of your quote.

Known Gap Quote – Using your own fees to determine the known gap

1. Select the appropriate Fee Schedule.
2. Click Use Known Gap.
3. Click Use Selected Schedule Above.
4. Tick Include Assistant's Fee, if appropriate. You will be prompted for the assistant's name which draws from any address book entry marked as Assists at Operations. You are then able to choose what you will be charging for the assist fee.
5. Click CALCULATE FEES to get the total of your quote.

Linking Item 31340

The Link 31340 button is used to link to a certain range of procedural item numbers that involve excision and removal of cancerous tissue. To use this button you will first need to select the item that this is relevant to and then select Link 31340. This will add this item into your quote. You can find further information on when to use the 31340 item under the MBS Online website.

Quoting for Assistant Fees

If you would like to include an assistants fee in your quote you will need to first ensure that you have an item containing “assist” in the description included in your quote. You can then select “Include Assistant’s Fee” from within the quoting window. You will be prompted for the assistant's name which draws from any entry in the Address Book marked as Assists at Operations. You are then able to choose what you will be charging for the assist fee from the options that appear.

To print your quote, select the Quote Actions drop-down option at the bottom of the Quote tab. Then highlight the Print Quote option and select the correct quote template from here. If you have not yet created a quote template, select Add Template... to create a new one.

If you are running Genie v9.3.6 and below, you will need to instead choose the Select Template option to print your quote.

The item information and fees will be transcribed to the quote template, and can then be printed using the Printer button  at the top of this window.

These instructions would be used to create an invoice from the quote if there were no complications during the procedure and the quote is correct.

In the Quotes tab of the procedure record, click on the Quote Actions drop-down and select the option to Transfer Quote to Invoice.

If you are running Genie v9.3.6 and below, your buttons will look slightly different, and you can simply click the Invoice button in the bottom-left.

Assign the Account Holder (Eg. the health fund) and apply the deposits as per usual. If billing to a health fund, there must be a corresponding account holder. For information on how to attach an account holder to an organisation, please see Account Holders for Organisations.

If the quote is vastly different to what needs to be invoiced just invoice through the Billing menu (Billing > Invoice).