WAGMSS

Billing for services under WAGMSS is slightly different to usual private patient billing. For WAGMSS the invoice is raised to and paid by the hospital where the service was provided. There is no charge to the patient.

The inpatient services are charged on a per-patient/procedure basis, where:

• Consult items have their own WAGMSS specific item numbers and WAGMSS rate.
• Procedure items use the MBS item numbers, charged at a WAGMSS rate.
• MBS derived fees in the WAGMSS are paid at the MBS value and adjusted with MBS updates.

Although WAGMSS is based upon the Medicare Benefits Schedule (MBS), it should be noted that not all item numbers and descriptions are included.  An MBS item number cannot be used unless it is published in the WAGMSS Schedule.

Why are there different percentages?

Generally, the standard WAGMSS fee is paid for metro hospitals while a percentage above this fee is paid for rural hospitals. The fees are rounded up to the nearest 5c, which can cause accounts to be paid a slightly different amount to what is claimed as Genie rounds both up & down (e.g. – for a fee of $10.22 Genie will round it to $10.20 while WAGMSS will round to $10.25).

Because each arrangement is a private contract with the hospital and the doctor, we cannot advise which particular % they should be charging. The below rates are just a guide.

Metro Hospitals (usually 100%, but may be more, or less): 

• St John of God Midland (Public)
• Osborne Park Hospital 
• Peel Health Campus
• Joondalup Health Campus 

Regional Hospitals:

The Rural Practice Incentive (RPI) is a fixed payment incentive over and above fee for service payments which is paid in recognition of the importance of attracting and retaining doctors in regional, rural or remote areas. The payment is available to Visiting Medical Practitioners (VMPs) who sign a contract and are resident in those areas.

Does the Multiple Procedure Rule Apply?

Yes, the MPR still applies but it is slightly different from the standard MBS percentages. The rates are as follows:

100/75/50           Standard Items

100/100/100       Emergency/After Hours

100/50/25           Ophthalmology

80/60/40             Endoscopy at Midland Public 

How are Derived Fees calculated?

For Example:

Step 1. CA020 = 4 RVG units 

= 4 x $35.90 = $143.60

Step 2. $143.60 x 71% = $101.96

Step 3. $101.96 rounded up to nearest 5 cents = $102.00

To configure Genie to use WAGMSS you will need to:

1. Configure your Account Holders
2. Configure your Health Funds and Fees

Configuring your Account Holders

Each hospital that you are billing to needs their own account holder. You will need to confirm the details of the hospital first so that these can be accurately added into Genie.

If using the WAGMSS including GST fee schedule (for account holders with WAGMSS standard fees):

• Batch Process Invoices ticked so Manual Batching can be used
• Charge GST for ALL items ticked (already included in the schedule)
• Ensure that the correct Health Fund is selected. You may have  multiple health funds set up to meet the needs of different hospitals
• Ensure that the correct MPR is selected based on the services the doctor provides

If using the WAGMSS excluding GST fee schedule:

• Batch Process Invoices ticked so Manual Batching can be used
• Charge GST for ALL items ticked
• Ensure that the correct Health Fund is selected. You may have multiple health funds set up to meet the needs of different hospitals
• Ensure that the correct MPR is selected based on the services the doctor provides

Configuring your Health Fund and Fees

Configuring for Metro Fees

1. Navigate to Open > Billing Items and select Health Funds in the top right corner.
2. Select Add and enter WAGMSS as the Fund Name
3. Once saved, navigate to Special > Software Updates > Fee Schedules. Select the option for WAGMSS. Please Note: There are two WAGMSS options in this list. One is WAGMSS the other is WAGMSS ex. GST. If your contract is for the standard WAGMSS fees, you will need to use the WAGMSS rates and WAGMSS. WAGMSS ex GST should only be used if you charge a percentage above or below standard rates

Configuring for Regional Fees

1. Navigate to Open > Billing Items and select Health Funds in the top right corner.
2. Select Add and enter the Fund Name. It is recommended that you make the name WAGMSS + X% to denote the percentage above the fee schedule used. If you are billing to multiple different locations, they may all use a different percentage above the fee schedule. As such, you will need to add in a new health fund for each different percentage that you use. 
3. Navigate to Open > Account Holders and search for the record created in step two, and double click on them.  Ensure that Charge GST for All Items is not ticked.  Save out.
4. From Special > Software Updates, click into the Fee Schedules tab.  Tick the box to the left of WAGMSS ex. GST and click on Install 1 Item and choose to Apply Update Now.  If prompted, select WAGMSS + X% from the fund list, and agree to update/include any extra items.
5. Once complete, navigate to Open > Billing Items and click on Increase Fees.  At the 'Increase Fee' drop down menu, choose WAGMSS + X% and choose "By a Percentage" and type in the percentage above the fee schedule you are charging.  Set the 'round to the nearest' to 5c and click OK, and click OK again at the alert.

Setting up WAGMSS for 80/60/40

1. Navigate to Open> Billing Items and select Health Funds. Configure a new health fund named "WAGMSS 80/60/40" using the Add button.
2. Select the search icon next to Account Holder and search for the appropriate record. This will be the hospital you are billing for. If this does not already exist you will have the option to create it. When creating the Account holder you will need to ensure that "Charge GST for all Items" is ticked and the Multiple Procedure Rule is selected as 100/75/50. If you are using an existing Account Holder, you can make these changes by opening the Account Holder record through Open> Account Holders. 
3. Navigate to Special> Software Updates> Fee Schedules and download WAGMSS Exc GST fee schedule. When prompted to choose the health fund, ensure you select "WAGMSS 80/60/40"
4. Navigate to Open> Billing Items and select Increase Fees. In the Increase the fee for section, select your Account Holder. Choose the option for By a Percentage and enter -20% in the by section. Ensure to also Round to the nearest 1 cent. 
5. You can then submit your invoices as per the instructions in the section below. 

Configuring Genie for Joondalup

If you are billing to any Joondalup hospitals, you will need to configure an additional health fund as these sites still use the 2018 WAGMSS schedule. To do this navigate to Open> Billing Items> Health Funds and select Add. Input all the appropriate details as well as a Health Fund name such as WAGMSS 2018. This new health fund will need to be identical to your other WAGMSS health fund, but with a different name.

Once you have set up your new health fund, navigate to Special> Software Updates and select the Fee Schedules tab. Select to download the appropriate WAGMSS 2018 fee schedule. Note that there will be one that includes GST and one that excludes GST. The option you select will depend on your agreement. Simply select Install 1 Item and you will be prompted to choose which health fund you would like to match this fee schedule to. Ensure that you select your new WAGMSS 2018 fund. Once this download is completed, you should be able to invoice as normal for these sites.

Once created, invoices need to be sent to the hospitals directly. Some hospitals accept the invoices via email instead of needing to be posted. To confirm the best way to send off these invoices, it is best to get in touch with each of hospitals you perform services at.

To create an invoice for the hospital