Resource type: chargeitem

Description

The resource ChargeItem describes the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation.

Elements

PathShortDefinitionComments
Item containing charge code(s) associated with the provision of healthcare provider productsThe resource ChargeItem describes the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation.
identifierBusiness Identifier for itemIdentifiers assigned to this event performer or other systems.
definitionUriDefining information about the code of this charge itemReferences the (external) source of pricing information, rules of application for the code this ChargeItem uses.
definitionCanonicalResource defining the code of this ChargeItemReferences the source of pricing information, rules of application for the code this ChargeItem uses.
statusplanned | billable | not-billable | aborted | billed | entered-in-error | unknownThe current state of the ChargeItem.Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. This element is labeled as a modifier because the status contains the code entered-in-error that marks the charge item as not currently valid.
partOfPart of referenced ChargeItemChargeItems can be grouped to larger ChargeItems covering the whole set.
codeA code that identifies the charge, like a billing codeA code that identifies the charge, like a billing code.
subjectIndividual service was done for/toThe individual or set of individuals the action is being or was performed on.
contextEncounter / Episode associated with eventThe encounter or episode of care that establishes the context for this event.
occurrence[x]When the charged service was appliedDate/time(s) or duration when the charged service was applied.The list of types may be constrained as appropriate for the type of charge item.
performerWho performed charged serviceIndicates who or what performed or participated in the charged service.
performer.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
performer.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
performer.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
performer.functionWhat type of performance was doneDescribes the type of performance or participation(e.g. primary surgeon, anaesthesiologiest, etc.).
performer.actorIndividual who was performingThe device, practitioner, etc. who performed or participated in the service.
performingOrganizationOrganization providing the charged seviceThe organization requesting the service.Practitioners and Devices can be associated with multiple organizations. It has to be made clear, on behalf of which Organization the services have been rendered.
requestingOrganizationOrganization requesting the charged serviceThe organization performing the service.The rendered Service might not be associated with a Request. It has to be made clear, ob which Organization's Request, the services have been rendered. (In many cases, this may just be the Department associated with the Encounter.location).
costCenterOrganization that has ownership of the (potential, future) revenueThe financial cost center permits the tracking of charge attribution.The costCenter could either be given as a reference to an Organization(Role) resource or as the identifier of the cost center determined by Reference.identifier.value and Reference.identifier.system, depending on use case requirements.
quantityQuantity of which the charge item has been servicedQuantity of which the charge item has been serviced.In many cases this may just be a value, if the underlying units are implicit in the definition of the charge item code.
bodysiteAnatomical location, if relevantThe anatomical location where the related service has been applied.Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
factorOverrideFactor overriding the associated rulesFactor overriding the factor determined by the rules associated with the code.There is no reason to carry the factor in the instance of a ChargeItem unless special circumstances require a manual override. The factors are usually defined by a set of rules in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overriden.
priceOverridePrice overriding the associated rulesTotal price of the charge overriding the list price associated with the code.There is no reason to carry the price in the instance of a ChargeItem unless circumstances require a manual override. The list prices or are usually defined in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overriden.
overrideReasonReason for overriding the list price/factorIf the list price or the rule based factor associated with the code is overridden, this attribute can capture a text to indicate the reason for this action.Derived Profiles may chose to add invariants requiring this field to be populated if either priceOverride or factorOverride have been filled.
entererIndividual who was enteringThe device, practitioner, etc. who entered the charge item.The enterer is also te person considered responsible for factor/priceOverrides if applicable.
enteredDateDate the charge item was enteredDate the charge item was entered.The actual date when the service associated with the charge has been rendered is captured in occurrence[x].
reasonWhy was the charged service rendered?Describes why the event occurred in coded or textual form.If the application of the charge item requires a reason to be given, it can be captured here. Textual reasons can be captured using reasonCode.text.
serviceWhich rendered service is being charged?Indicated the rendered service that caused this charge.
product[x]Product chargedIdentifies the device, food, drug or other product being charged either by type code or reference to an instance.
accountAccount to place this chargeAccount into which this ChargeItems belongs.Systems posting the ChargeItems might not always be able to determine, which accounts the Items need to be places into. It is up to the potprocessing Financial System to apply internal rules to decide based on the Encounter/EpisodeOfCare/Patient/Coverage context and the type of ChargeItem, which Account is appropriate.
noteComments made about the ChargeItemComments made about the event by the performer, subject or other participants.
supportingInformationFurther information supporting this chargeFurther information supporting this charge.


Scope and Usage

Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. The resource ChargeItem describes the charge for provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation. They are created as soon as the products are planned or provisioned, references to Encounters and/or Accounts can be maintained in a later process step.

The target of ChargeItem.definition may provide information on the Charge code such as pricing and inclusion/exclusion rules as well as factors that apply under certain conditions. In many cases however this information may been drawn from sources outside of FHIR depending on the distribution format of the code catalogue. The ChargeItem assumes that such information is either implicitly known by the communicating systems or explicitly shared through the ChargeItem.definition. Therefore explicit pricing information is not shared within the ChargeItem resource. Also, the systems posting the ChargeItems are not expected to apply the rules associated with the charge codes as they may not know the whole context of the patient/encounter to evaluate such rules. It lies within the responsibity of a billing engine, to collect the ChargeItems in the context of an Account or Encounter at a certain point in time (e.g. discharge of the patient) and to evaluate the associated rules resulting in some of the ChargeItems to be set to the status "not billable" in case the rules exclude them from being billed, or to create financial transactions according to base price and factors. Additional references to Encounter/EpisodeOfCare, Patient/Group and Services provide further context to help billing systems determine the appropriate account and establish the clinical/financial context to evaluate the rules associated with the charge codes.

Boundaries and Relationships

This resource is not an actual financial transaction (such as an item on an invoice or any concise monetary amount being transferred from one Account to another), but is the base administrative data that may be used by a billing engine to create the financial transactions based on rules, factors and base prices associated with the charge code.

Unlike the Financial Transaction the ChargeItem primarily describes the provision, whereas the Financial Transaction documents cash flow. Therefore, the Financial Transaction results from ChargeItems created via the subsequent billing- or cost allocation process.

The actual financial transaction resulting from the evaluation of these rules against the clinical and financial context may be represented in formats appropriate to the financial realm. These are considered out of scope for the FHIR Standard, as they are not specific to the healthcare domain. The FHIR Claim resource does contain line items, and this ChargeItem resource provides the source material for the billing engine to create the items on the claim (which may be different due to business rules).



Search Parameters

accountAccount to place this chargeChargeItem.account
codeA code that identifies the charge, like a billing codeChargeItem.code
contextEncounter / Episode associated with eventChargeItem.context
entered-dateDate the charge item was enteredChargeItem.enteredDate
entererIndividual who was enteringChargeItem.enterer
factor-overrideFactor overriding the associated rulesChargeItem.factorOverride
identifierBusiness Identifier for itemChargeItem.identifier
occurrenceWhen the charged service was appliedChargeItem.occurrence
patientIndividual service was done for/toChargeItem.subject.where(resolve() is Patient)
performer-actorIndividual who was performingChargeItem.performer.actor
performer-functionWhat type of performance was doneChargeItem.performer.function
performing-organizationOrganization providing the charged seviceChargeItem.performingOrganization
price-overridePrice overriding the associated rulesChargeItem.priceOverride
quantityQuantity of which the charge item has been servicedChargeItem.quantity
requesting-organizationOrganization requesting the charged serviceChargeItem.requestingOrganization
serviceWhich rendered service is being charged?ChargeItem.service
subjectIndividual service was done for/toChargeItem.subject

Extension Definitions

These are extension definitions for this resource defined by the spec