Module 6 - Quoting

Module 6: Quoting -  Billing, and Financial Workflows

Description

Understand how to configure and manage quoting and billing templates, including surgical and Med Spa quoting. Learn how to handle financial transactions, deposits, recurring payments, and patient financials.

Key Topics

• Creating and modifying quote templates
• Surgical and Med Spa quoting
• OR and anesthesia fee configuration
• Deposits and linking quotes to appointments
• Billing templates and invoicing
• Recurring payments and payment requests
• Patient financials and refunds

4D EMR Onboarding 6.0 - Quote Overview (00:51)

Quote Overview

Overview

This module reviews everything related to quotes so you can configure your database to match your practice’s workflow, including:

• A quick quoting walkthrough
• How to fine‑tune quote settings
• How to configure quotes to match your practice’s pricing structure
• How to ensure all fees, supplies, and options calculate correctly

Prerequisites for Accurate Quoting

To ensure your quotes calculate correctly, confirm the following are complete:

1. Procedure List

• Must be finalized and imported
• Should include surgeon fees, durations, and any linked supplies

2. Surgery Items

• Should be configured to automatically populate into quotes
• Ensures consistent and accurate OR supply charges

3. Facility & Anesthesia Fee Schedules

• Must be configured for each surgery center and anesthesia group
• Required for automatic fee calculations during quoting

If any of these are missing, quoting accuracy will be affected.

4D EMR Onboarding 6.1 - Creating Quotes (03:11)

Creating Quotes

Overview

Creating quotes in 4D is intuitive once you understand the workflow.
This section walks through how to build a quote from start to finish, including procedures, supplies, fees, and optional adjustments.

Nearly every field in the quote can be manually modified, and templates can automate much of the process.
(Templates will be covered later in the module.)

Accessing the Quote Workflow

Navigate to:
Patients → Select Patient → Quotes

A new quote window will appear, allowing you to begin building the quote.

Step 1 — Basic Quote Details

Quote Date

• Confirm the quote date
• Adjust if needed

Expiration Date

• Set when the quote expires
• This can be automated through templates

Provider

• Select the provider associated with the quote

Template

• 4D includes a default quote template
• You will learn how to modify or create templates later in the module

Step 2 — Adding Procedures

In the Procedure Table, you can add procedures in several ways:

• Start typing the procedure name to filter results
• Use the dropdown to scroll through all available procedures

Example:
Quoting a patient for a breast augmentation and abdominoplasty.

Automatic Supply Pull‑In

If your procedures are configured correctly:

• Surgical items
• Supplies
• Garments

…will automatically populate in the Supply section.

For example, a breast augmentation will automatically pull in:

• Two implants
• One surgical bra

Manual Adjustments

You can:

• Update procedure costs
• Apply discounts (percentage or dollar amount)
• Select a discount reason from the dropdown
  • These were configured in the Money & Charges module

Step 3 — Managing Supplies

The Supply Table works similarly to the procedure table.

You can:

• Select + New to add additional supplies
• Type to search for products
• Use the dropdown to browse
• Modify cost and quantity as needed

Step 4 — Configuring Surgical Details

After procedures and supplies are set, fine‑tune the surgical details:

Surgery Center Location

• Select the location from the dropdown
• The system automatically references the facility’s fee schedule

Surgery Duration

• Adjust duration to account for multiple procedures
• Facility and anesthesia fees update automatically

Consultation Credits

• Add consultation credits if your practice uses them
• This can be automated through templates

Anesthesia

• Select the anesthesia type
• Choose the anesthesia group
• The quote will reference the group’s fee schedule

Recovery Options

If your practice offers recovery services:

• Add hospital or nurse visit options
• Configure associated fees

Step 5 — Finalizing the Quote

Custom Message

Add a personalized message for the patient at the bottom of the quote.

Save the Quote

Once all details are configured:

• Select Save
• The quote is now ready for payment collection and additional 4D features

4D EMR Onboarding 6.2 - Quote Action Items (03:31)

Quote Action Items 

Overview

Once a quote has been created and saved to the patient’s account, several action items become available.
These tools allow you to review, edit, version, sign, complete, deactivate, and manage the status of quotes throughout the patient journey.

All action items appear on the left side of the quote page.

Action Items on Saved Quotes

PDF Icon — Review the Quote

• Opens a PDF preview of the quote
• Useful for reviewing details with the patient

Blue Pencil Icon — Edit the Quote

• Allows you to modify the quote after it has been saved
• Ideal for quick adjustments based on patient requests
• When saved, a new version of the quote is automatically created

Example:
In the previous video, we removed the abdominoplasty from a breast augmentation quote.
Saving this change created a new version.

Printer Icon — Print the Quote

• Prints a physical copy of the quote for the patient

Email Icon — Email the Quote

• Sends the quote directly to the patient
• Optionally save a copy of the email to chart notes

Payment History Icon

• Displays a copy of the quote with a payment history section at the bottom
• Useful for reviewing deposits or partial payments

Yellow Stacks Icon — Quote Versions

This is where all versions of the quote are stored.

• Selecting the icon shows every saved edit
• Each version has a unique quote ID (e.g., .1 → .2)
• You can switch between versions by selecting the bubble on the right
• You can create unlimited versions and activate the one the patient chooses

Clipboard  Icon — Complete the Surgery

• Allows you to mark the surgery as completed and enter the completion date
• Only used if the quote was not linked to the scheduled surgery appointment
• You cannot enter a future date

(You’ll learn more about linking quotes to surgery appointments later.)

Signature Icon — Patient Signature

Opens a signable version of the quote.

You can choose how the patient signs:

Send to Patient

• Send via text or email
• Patient signs through their portal at home

Sign in Office

• Select Send to Patient Portal to sign in office
• Open the patient’s portal on a tablet and have them sign

Sign on This Device

• Select Display & Sign on This Device
• A signable quote appears
• Patient taps the signature button at the bottom
• Select Save

Once signed, the signature icon turns green.

Trash Can Icon — Deactivate the Quote

• Moves the quote from Active to Inactive
• Used when a patient declines or no longer plans to move forward

If needed, you can reactivate the quote:

• Navigate to the Inactive tab
• Select the Reactivate icon

Quote Status Tabs

Located near the top middle of the quote page:

Active

• Quotes the patient is considering or planning to move forward with

Inactive

• Quotes that have expired or been deactivated

Completed

• Quotes that have been completed
• If a quote is linked to a scheduled surgery appointment, it will automatically move to Completed

4D EMR Onboarding 6.3 - Taking Surgery Deposits (02:33)

Taking Surgery Deposits 

Overview

Now that you know how to create quotes and use all available action items, the next step is taking a surgery deposit and scheduling the patient for surgery.
In this example, we’ve already created a quote, made modifications, and obtained the patient’s signature. The patient is now ready to pay their deposit.

Step 1 — Take a Deposit on the Quote

Access the Quote in the Money Tab

Navigate to:
Money → Select Patient

You’ll see a pink‑outlined tile representing the active quote.

Enter the Deposit Amount

1. Select the green card icon in the Paying Today field
2. Enter the deposit amount
   • Example: If your practice requires a $1,000 minimum deposit, enter 1000
3. Select OK
4. Select Checkout
5. Collect payment and complete the transaction

Note: Quote templates can include a scheduling fee. This will be covered in the Quote Templates video.

Step 2 — Schedule the Surgery Appointment

Navigate to the Schedule

Return to the Schedule tab.

1. Find the date and time the patient wants for surgery
2. Right‑click the time slot
3. Select Existing Patient
4. Locate and select the patient’s account
5. Choose Surgery as the appointment type

Link the Quote

A Quote field will appear.

• Select the quote you created
• This links the quote to the appointment

Why Linking Matters

Linking the quote:

• Automatically blocks off the correct surgery duration
• Ensures the quote moves from Active to Completed once the surgery is finished
• Helps staff prepare required supplies and pre‑op items

Automatic Duration Update

If the quote includes a 4‑hour procedure, selecting the quote will automatically update the appointment duration to 4 hours.

Step 3 — Review Pre‑Op Items

In the Quote tab of the appointment:

• Items needed may include surgical supplies or pre‑op checklist items
• These ensure the practice has everything required for surgery

Check off items as completed.

Step 4 — Save the Appointment

Once everything looks correct:

• Select Save

The surgery appointment will now appear on the calendar.

The patient can continue paying off their quote between the deposit date and surgery day.

Why Linking the Quote Is Essential

Linking the quote to the surgery appointment:

• Ensures the surgeon’s time is properly blocked
• Keeps the quote status accurate
• Automatically moves the quote to Completed after surgery
• Maintains clean financial and scheduling workflows

4D EMR Onboarding 6.4 - Modifying Quote Templates (07:09)

Modifying Quote Templates 

Overview

Now that you understand how to create quotes, use action items, take deposits, and schedule surgeries, it’s time to fine‑tune your quoting workflow using Quote Templates.

Quote templates allow you to standardize how quotes look, behave, and calculate fees—ensuring consistency across providers and procedures.

Accessing Quote Templates

Navigate to:
Practice → Settings → Quotes → Templates

By default, 4D includes one template available to all providers.
Select the default template to begin modifying it.

Template Basics

Active Toggle

• When enabled, the template is available for use
• When disabled, the template is hidden until reactivated

MedSpa‑Only Toggle

• Allows MedSpa teams to use the quoting workflow for products and services
• If your practice includes a MedSpa, watch the dedicated MedSpa Quoting video

Default Template Toggle

• Determines which template is automatically applied when creating a new quote

Template Name

• Give each template a clear, unique name
• Helps staff select the correct template during quoting

Provider Assignment

• Apply the template to all providers or specific providers
• Create multiple templates if providers have different quoting preferences

Include Commission

• Toggle on if supply item commissions should appear on quotes

Show Recalculate Alert (Recommended)

• Displays an alert icon if someone manually changes facility or anesthesia fees
• Helps prevent accidental fee overrides

Apply Tax to Procedures

• Enable if your practice charges tax on surgical procedures

Default Anesthesia Method

• Choose from four available anesthesia types
• Sets the default selection for all quotes using this template

Pre‑Op Clearance Tasks

Clearance tasks allow you to create a pre‑op checklist that appears on every scheduled surgery.

Adding Tasks

1. Select + New
2. Add required tasks such as:
   • Labs
   • Medical clearance
   • Imaging

These tasks will appear:

• In the Items Needed section when scheduling surgery
• In the Pre‑Ops tab on the schedule page, where staff can check them off as completed

Quote Appearance & Display Options

Header Section

You can customize the top of the quote:

• Add your practice logo (pulled from your initial setup)
• Add a quote title
• Set a default expiration period (e.g., 90 days)

Additional Header Options

• Show Patient ID
• Show Prepared By (staff member who created the quote)
• Do Not Use Nickname (forces display of legal name)

Introductory Text

4D includes default text at the top of the quote.
You can edit or replace this with your own messaging.

Itemized Sections

Procedure Section Title

• Change the label (default: Description)

Pricing Display Options

You can control how much detail patients see:

• Only Show Total Price
  • Hides all itemized pricing
  • Shows one combined total
• Show Procedure Subtotal
  • Displays subtotal before supplies
• Show Supply Subtotal
  • Displays subtotal after supplies

Every practice has different preferences—test your setup before going live.

Summary Section Configuration

Facility & Anesthesia Fees

If these fees are $0, choose how they appear:

• Show as $0.00
• Hide the line
• Display as Included

Consultation Credit

• Set a default consultation credit amount
• Automates adding it to every quote using this template

Additional Fees

If your practice charges extra fees (e.g., medications):

1. Toggle Additional Fee
2. Provide a label
3. Choose whether it is a percentage or fixed amount

Show Summary Line

• Displays a summary of charges next to the total

Show O2 List

• Displays who should be paid for facility or anesthesia fees
• Requires proper setup of facilities and anesthesia groups

Payment to Schedule

If you require a minimum payment to schedule surgery:

• Toggle Show Payment to Schedule
• Enter a percentage or fixed dollar amount
• Optionally include facility and anesthesia fees in the calculation

Optional Discount

• Toggle Show Optional Discount
• Enter discount percentage and description
• Commonly used for cash‑pay incentives
• Note: This does not automatically calculate in the Money tab

Footer Text

4D includes default text at the bottom of the quote.
You can edit or replace this to match your practice’s policies or messaging.

Creating Multiple Templates

Once your default template is configured, you can create additional templates for:

• Different providers
• Different procedures
• MedSpa vs. surgical workflows
• Special pricing structures

If you need multiple templates, watch the Creating Multiple Quote Templates video for additional guidance.

4D EMR Onboarding 6.5 - Multiple Quote Templates (01:34)

Multiple Quote Templates

Overview

Most practices only need one quote template.
However, some practices benefit from creating multiple templates to support different providers, workflows, or procedure types.

Multiple templates are not required to go live, but they can greatly improve accuracy and efficiency when your practice has varied quoting needs.

When Multiple Templates Are Helpful

Below are common scenarios where practices choose to create more than one quote template.

1. MedSpa Quoting

If your practice includes a MedSpa that wants to use the quoting workflow for services:

• Create a MedSpa‑specific template
• Configure it with MedSpa‑appropriate settings, verbiage, and pricing display
• A dedicated video covers MedSpa quote templates in detail

2. Multiple Providers With Different Preferences

If different providers want:

• Unique quote wording
• Different default anesthesia types
• Different pre‑op requirements
• Different pricing display preferences

…then each provider should have their own template.

This ensures each provider’s quotes reflect their preferred structure and workflow.

3. Procedure‑Specific Templates

Some practices create templates based on procedure categories, such as:

• Breast procedures
• Face procedures
• Body procedures

This is useful when certain procedure groups require:

• Additional imaging
• Extra pre‑op clearance tasks
• Different instructions or disclaimers
• Different expiration rules

Creating category‑specific templates ensures each quote includes the correct requirements automatically.

Planning Your Templates During Onboarding

During onboarding, consider:

• How many providers need unique templates
• Whether your MedSpa will use quoting
• Whether certain procedure categories require different pre‑op tasks or verbiage

Create as many templates as needed to support your practice’s workflow.

Using Multiple Templates in Quotes

Once your templates are created:

• They will appear in the Template dropdown when building a quote
• Staff can select the correct template based on provider, procedure type, or workflow

Next Steps

If your practice includes a MedSpa, the next video will walk through MedSpa quoting and how to activate and use MedSpa‑specific templates.

4D EMR Onboarding 6.6 - Medspa Quote Templates (01:35)

MedSpa Quote Templates 

Overview

MedSpa teams can use 4D’s quoting system to create clean, consistent quotes for aesthetic services.
To enable MedSpa quoting, a few configuration steps must be completed first.

This section explains what must be set up, how MedSpa quotes differ from surgical quotes, and how to use MedSpa‑specific templates.

Requirements for MedSpa Quoting

Before MedSpa staff can create quotes, ensure the following items are configured:

1. Users Must Be Set Up Correctly

• All MedSpa users must be created in the system
• The Provider for Quotes box must be enabled for each user who will create quotes

2. Services Must Be Imported

• All MedSpa services must be imported into your database
• Activate each user who is authorized to provide those services

3. A MedSpa Quote Template Must Be Created

• Create a dedicated MedSpa quote template
• Previous videos in this module explain how to build and customize templates

Creating a MedSpa Quote

When creating a new quote:

1. Select a MedSpa provider from the provider dropdown
2. Select your MedSpa quote template

Procedure Section

• Surgical procedures are replaced with MedSpa services
• Add the appropriate service(s)
• Add any required supplies

Ignored Sections

Because MedSpa services are not surgical procedures, you can ignore:

• Facility fees
• Anesthesia fees
• Surgery‑related sections

These fields will not apply to MedSpa quotes.

Saving the Quote

• Save the quote as usual
• In the quote list, it will be labeled as a Spa Quote

Using MedSpa Quotes in the Money Tab

After saving the quote:

• Navigate to the Money tab
• A pink‑outlined tile will appear, indicating an active Spa Quote
• You can collect payment directly from this tile
• You can also add the MedSpa service to the calendar if needed