If you perform surgery or procedural operations for your patients, you may need to provide a quote for the expected costs prior to a patient's procedure. Quotes can be created directly from a procedure with automatic fee calculation based on the type of quote you are creating (e.g. uninsured, insured - known gap, no gap).
Before you begin
You will need to create a quote template if you wish to print the quote for your patient.
To ensure your fees are accurately calculated for insured patients, your health fund fee schedules must be up to date. If you are quoting an insured patient, their health fund details should also be added to their demographics.
Access the quote window
If you don't already have the quote open, you can access the Quotes window through two different areas in Genie:
- From the appointment book
With a patient's surgical appointment highlighted, click the procedure icon.
Note: This will create a new procedure if there is no existing procedure linked to that appointment.
- From the clinical window
In a patient's clinical file, double-click on an existing procedure or go to Tools > Add Procedure to create a new procedure.
Create the quote
To create a quote, navigate to the Quotes tab of your procedure and complete the details accordingly. An overview of each function and how to use it is below.
|Private Fund||The patient's private fund will pull in from their demographics if already entered, otherwise can be selected here.|
|Type||Choose the type of procedure: Inpatient, Outpatient, or Day Surgery.|
|Fee Schedule||If you are quoting uninsured patients, this drop-down must be set to the fee schedule you wish to charge (e.g. Private, AMA, Custom, etc.)|
|Use Selected Fee Schedule (above)||Choose this radio button for uninsured surgery quotes where the patient will be paying out of pocket for the service and the fees will not be determined by a private fund rebate.|
|Use No Gap||Choose this radio button for quotes that are entirely covered by the patient's health fund. The patient is expected to have no out of pocket expenses and the surgeon will be reimbursed by Medicare and the fund.|
|Use Known Gap||Choose this radio button for quotes where the surgeon holds an agreement with the fund to charge a specified amount above what the health fund will pay. You can choose to Use Fund's Gap (max known gap), Use Custom Gap, or Use Selected Schedule Above (e.g. use private fees to determine the gap).
As this is still a known gap quote, it is expected that if you are charging a custom gap or using private fees, the total gap does not exceed the maximum known gap for the fund unless the provider has a specific agreement with the fund.
|Apply DIMSR||This should be ticked if you want the Diagnostic Imaging Multiple Service Rule to apply to any applicable items in your quote.|
|Apply Multiple Procedure Rule||This should be ticked if you want the Multiple Procedure Rule to apply to any applicable items in your quote. Alter the MPR percentage calculations using the drop-down on the right.|
|Link 31340||This function is used to link a certain range of procedural item numbers that involve excision and removal of cancerous tissue. You will need to highlight the relevant item in your quote and then click this button.
You can find further information on when to use the 31340 item under the MBS Online website.
|Assistant Threshold||The assistant threshold determines which item number is used when billing for assistants, depending on if the procedural item/s fees exceed the threshold set by Medicare.|
|This drop-down houses your commonly used items. To add items to this list, you can click the button when adding a new item, or click this drop-down icon and choose Add Item.|
|Add a billing item to your quote by clicking this button. Enter the item number in the resultant window and press Save.
All items will pull in with $0 fees until you use the Calculate Fees button.
|Highlight an item in the quote and use this icon to open the Editing Item window. You can then edit fees, item description, etc.|
|Highlight an item in the quote and use this icon to delete the item from the quote.|
|Include Assistant's Fee||You can use this function when you have procedural items that attract an assistant fee and you are billing for an assistant.
Choose the desired fee from the options: One Fifth of Surgeon's Fee, Medicare Schedule Fee, DVA, Health Fund Fee, Workcover Fee, or Your Own Private Fee.
|Once you have set the details for your quote as above and added all item numbers (and assistant fee if applicable), click the Calculate Fees button to add the appropriate fees for each item.|