Invoice

Introduction

Scope and Usage

Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. An invoice is a financial document issued by a healthcare provider to a patient or a payer indicating the goods and services (ChargeItems) performed with their quantities and prices.

Example implementations:

• Any solution that tracks billing information and needs to issue invoices
• Private Insurance Providers who want to deliver structured information to patients to increase cost transparency
• Patient apps that want to include information on the amount and reason of the charged costs for the healthcare services a patient received

Note to Balloters:

This resource is likely to be removed from the specification and moved to being an Additional Resource after this ballot due to concerns around it's readiness, and the thin implementation experience. Ballot comments on this subject are welcome.

Boundaries and Relationships

The existing Claim resource is constricted to use cases where Claims are sent to insurances for reimbursement, in a message-like style. It neither references ChargeItems nor Accounts.

Competing invoicing standards such as EDIFACT or X12 are aiming at inter-organizational exchange and do not offer human readable representations or traceable links to services rendered which is a requirement for invoicing towards patients. This resource is used where existing ChargeItems in an Account are collected to create an Invoice to be sent out to Individuals or Organizations in a structured way. The invoice is the hospital's view, whereas the Claim is the payer's view on the performed services.

Since the individual ChargeItem resources that make up the line items of the Invoice do not carry any pricing information, ChargeItemDefinitions will have to be applied to the ChargeItems in order to calculate the price components for the Invoice depending on the context of the ChargeItem

Background and Context

Provides additional detail on exactly how the resource is to be used

StructureDefinition

Elements (Simplified)

• Invoice [0..*]: - Invoice containing ChargeItems from an Account
• Invoice.identifier [0..*]: Identifier Business Identifier for item
• Invoice.status [1..1]: code required:invoice-status draft | issued | balanced | cancelled | entered-in-error
• Invoice.cancelledReason [0..1]: string Reason for cancellation of this Invoice
• Invoice.type [0..1]: CodeableConcept Type of Invoice
• Invoice.subject [0..1]: [Reference(Patient](/Reference(Patient), Group)) Recipient(s) of goods and services
• Invoice.recipient [0..1]: [Reference(Organization](/Reference(Organization), Patient, RelatedPerson)) Recipient of this invoice
• Invoice.creation [0..1]: dateTime When posted
• Invoice.period[x] [0..1]: date, Period Billing date or period
• Invoice.participant [0..*]: BackboneElement Participant in creation of this Invoice
• Invoice.participant.role [0..1]: CodeableConcept Type of involvement in creation of this Invoice
• Invoice.participant.actor [1..1]: [Reference(Practitioner](/Reference(Practitioner), Organization, Patient, PractitionerRole, Device, RelatedPerson)) Individual who was involved
• Invoice.issuer [0..1]: [Reference(Organization](/Reference(Organization), Practitioner, PractitionerRole)) Issuing entity
• Invoice.account [0..1]: Reference(Account) Account that is being balanced
• Invoice.lineItem [0..*]: BackboneElement Line items of this Invoice
• Invoice.lineItem.sequence [0..1]: positiveInt Sequence number of line item
• Invoice.lineItem.serviced[x] [0..1]: date, Period Service data or period
• Invoice.lineItem.chargeItem[x] [1..1]: Reference, CodeableConcept Reference to ChargeItem containing details of this line item or an inline billing code
• Invoice.lineItem.priceComponent [0..*]: MonetaryComponent Components of total line item price
• Invoice.totalPriceComponent [0..*]: MonetaryComponent Components of Invoice total
• Invoice.totalNet [0..1]: Money Net total of this Invoice
• Invoice.totalGross [0..1]: Money Gross total of this Invoice
• Invoice.paymentTerms [0..1]: markdown Payment details
• Invoice.note [0..*]: Annotation Comments made about the invoice

Mappings

• Invoice Mappings — 42 mapping entries

Resource Packs

list-Invoice-packs.xml

<?xml version="1.0" encoding="UTF-8"?>

<List xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../publish/List.xsd">
  <id value="Invoice-packs"/>
  <status value="current"/>
  <mode value="working"/>
</List>

Search Parameters

• account — reference — Account that is being balanced — Invoice.account
• date — date — Invoice date / posting date — Invoice.creation
• identifier — token — Business Identifier for item — Invoice.identifier
• issuer — reference — Issuing Organization of Invoice — Invoice.issuer
• participant — reference — Individual who was involved — Invoice.participant.actor
• participant-role — token — Type of involvement in creation of this Invoice — Invoice.participant.role
• patient — reference — Recipient(s) of goods and services — Invoice.subject.where(resolve() is Patient)
• recipient — reference — Recipient of this invoice — Invoice.recipient
• status — token — draft | issued | balanced | cancelled | entered-in-error — Invoice.status
• subject — reference — Recipient(s) of goods and services — Invoice.subject
• totalgross — quantity — Gross total of this Invoice — Invoice.totalGross
• totalnet — quantity — Net total of this Invoice — Invoice.totalNet
• type — token — Type of Invoice — Invoice.type

Full Search Parameters

Examples

• example — invoice-example — Example of invoice
• invoice-example — invoice-example
• invoice-examples-header — invoice-examples-header

Full Examples

Mapping Exceptions

invoice-event-mapping-exceptions.xml

Divergent Elements

• Event.code → Invoice.type
  • shortUnmatched | reason=Unknown | pattern=What service was done | resource=Type of Invoice
  • definitionUnmatched | reason=Unknown | pattern=A code that identifies the specific service or action that was or is being performed. | resource=Type of Invoice depending on domain, realm an usage (e.g. internal/external, dental, preliminary).
• Event.subject → Invoice.subject
  • shortUnmatched | reason=Unknown | pattern=Individual service was done for/to | resource=Recipient(s) of goods and services
  • definitionUnmatched | reason=Unknown | pattern=The individual or set of individuals the action is being or was performed on. | resource=The individual or set of individuals receiving the goods and services billed in this invoice.
  • requirementsUnmatched | reason=Unknown | pattern=Links the invoice to the Patient context. May also affect access control. | resource=Links the event to the Patient context.
• Event.note → Invoice.note
  • shortUnmatched | reason=Unknown | pattern=Comments made about the event | resource=Comments made about the invoice
  • definitionUnmatched | reason=Unknown | pattern=Comments made about the invoice by the performer, subject or other participants. | resource=Comments made about the invoice by the issuer, subject, or other participants.

Unmapped Elements

• Event.partOf — Unknown
• Event.reported — Unknown
• Event.reason — Unknown
• Event.relevantHistory — Unknown
• Event.location — Unknown
• Event.status — Unknown
• Event.statusReason — Unknown
• Event.performer.actor — Unknown
• Event.performer.function — Unknown
• Event.category — Unknown
• Event.encounter — Unknown
• Event.recorded — Unknown
• Event.occurrence — Unknown
• Event.product — Unknown
• Event.performer — Unknown
• Event.identifier — Unknown
• Event.basedOn — Unknown
• Event.researchStudy — Unknown

invoice-fivews-mapping-exceptions.xml

Unmapped Elements

• FiveWs.recorded — Unknown
• FiveWs.author — Unknown
• FiveWs.cause — Unknown
• FiveWs.version — Unknown
• FiveWs.witness — Unknown
• FiveWs.class — Unknown
• FiveWs.where — Unknown
• FiveWs.context — Unknown
• FiveWs.init — Unknown
• FiveWs.why — Unknown
• FiveWs.source — Unknown
• FiveWs.who — Unknown
• FiveWs.grade — Unknown
• FiveWs.planned — Unknown
• FiveWs.done — Unknown