Path | Short | Definition | Comments |
---|---|---|---|
Tracks balance, charges, for patient or cost center | A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc. | ||
identifier | Account number | Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number). | |
status | active | inactive | entered-in-error | on-hold | unknown | Indicates whether the account is presently used/usable or not. | This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid. |
type | E.g. patient, expense, depreciation | Categorizes the account for reporting and searching purposes. | |
name | Human-readable label | Name used for the account when displaying it to humans in reports, etc. | |
subject | The entity that caused the expenses | Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Account. | Accounts can be applied to non patients for tracking other non patient related activities, such as group services (patients not tracked, and costs charged to another body), or might not be allocated. |
servicePeriod | Transaction window | The date range of services associated with this account. | It is possible for transactions to be posted outside the service period, as long as the service was provided within the defined service period. |
coverage | The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account | The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account. | Typically this may be some form of insurance, internal charges, or self-pay. Local or jurisdicational business rules may determine which coverage covers which types of billable items charged to the account, and in which order. Where the order is important, a local/jurisdicational extension may be defined to specify the order for the type of charge. |
coverage.id | Unique id for inter-element referencing | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | |
coverage.extension | Additional content defined by implementations | May 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. |
coverage.modifierExtension | Extensions that cannot be ignored even if unrecognized | May 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. |
coverage.coverage | The party(s), such as insurances, that may contribute to the payment of this account | The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay). A coverage may only be resposible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing. | |
coverage.priority | The priority of the coverage in the context of this account | The priority of the coverage in the context of this account. | It is common in some jurisdictions for there to be multiple coverages allocated to an account, and a sequence is required to order the settling of the account (often with insurance claiming). |
owner | Entity managing the Account | Indicates the service area, hospital, department, etc. with responsibility for managing the Account. | |
description | Explanation of purpose/use | Provides additional information about what the account tracks and how it is used. | |
guarantor | The parties ultimately responsible for balancing the Account | The parties responsible for balancing the account if other payment options fall short. | |
guarantor.id | Unique id for inter-element referencing | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. | |
guarantor.extension | Additional content defined by implementations | May 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. |
guarantor.modifierExtension | Extensions that cannot be ignored even if unrecognized | May 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. |
guarantor.party | Responsible entity | The entity who is responsible. | |
guarantor.onHold | Credit or other hold applied | A guarantor may be placed on credit hold or otherwise have their role temporarily suspended. | |
guarantor.period | Guarantee account during | The timeframe during which the guarantor accepts responsibility for the account. | |
partOf | Reference to a parent Account | Reference to a parent Account. |
The Account resource acts as a central record against which charges, payments, and adjustments are applied. It contains information about which parties are responsible for payment of the account.
While the Account does conceptually have a balance, expressing that balance directly as a resource property is challenging due to the complexity of pricing contracts. An operation to retrieve the current balance of an account is in consideration as future work.
The Account itself does not include information about the charges, payments or adjustments, but rather those resources, such as ChargeItem point to the account to which they apply. Payment and adjustment resources have not yet been developed.
The Account resource can be considered a "bucket" to which ChargeItem resources are linked. These charges are processed by a billing system, which determines the responsible parties for the balance of the account. The billing system then submits claims or sends statements to the appropriate parties. Once payment is received, an adjustment is applied to the Account. The internal calculation of balances and allocation of responsibility is expected to be internal to the billing systems. Only the inputs and outputs of the billing process is communicated in the relevant financial FHIR resources.
identifier | Account number | Account.identifier |
name | Human-readable label | Account.name |
owner | Entity managing the Account | Account.owner.where(resolve() is Organization) |
patient | The entity that caused the expenses | Account.subject.where(resolve() is Patient) |
period | Transaction window | Account.servicePeriod |
status | active | inactive | entered-in-error | on-hold | unknown | Account.status |
subject | The entity that caused the expenses | Account.subject |
type | E.g. patient, expense, depreciation | Account.type |