type: resource-definitionsresource: Account

Account Definitions

Account

Tracks balance, charges, for patient or cost center

Definition: 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.

Aliases: Cost center, Record

Cardinality: 0..*

Mappings: rim=Account; w5=financial.support

Account.identifier

Account number

Definition: Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Cardinality: 0..*

Type: Identifier

Summary: true

Mappings: w5=FiveWs.identifier; rim=.id

Account.status

active | inactive | entered-in-error | on-hold | unknown

Definition: Indicates whether the account is presently used/usable or not.

Comments: 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.

Cardinality: 1..1

Type: code

Binding: required:account-status

Summary: true

Is Modifier: true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)

Mappings: w5=FiveWs.status; rim=.statusCode

Account.billingStatus

Tracks the lifecycle of the account through the billing process

Definition: The BillingStatus tracks the lifecycle of the account through the billing process. It indicates how transactions are treated when they are allocated to the account.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:account-billing-status

Summary: true

Account.type

E.g. patient, expense, depreciation

Definition: Categorizes the account for reporting and searching purposes.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:account-type

Summary: true

Mappings: w5=FiveWs.class; rim=.code

Account.name

Human-readable label

Definition: Name used for the account when displaying it to humans in reports, etc.

Aliases: Title

Cardinality: 0..1

Type: string

Summary: true

Mappings: w5=FiveWs.what[x]; rim=.title

Account.subject

The entity that caused the expenses

Definition: 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.

Comments: 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. Accounts might reference a different Patient resource instance than is referenced by clinical resources if the demographics for the Account differ from the demographics that are most appropriate for clinical purposes. For example, the demographics on Account might need to exactly match what the insurance company has on file in order for claims to be processed efficiently. But the demographics the insurance company have might not reflect the demographics that are appropriate for coordinating clinical care. When two (or more) Patient resource instances are used, they should be linked using Patient.link with a type of 'seealso'.

Aliases: target

Cardinality: 0..*

Type: Reference(Patient, Device, Practitioner, PractitionerRole, Location, HealthcareService, Organization)

Summary: true

Mappings: w5=FiveWs.subject; rim=.subject

Account.servicePeriod

Transaction window

Definition: The date range of services associated with this account.

Comments: It is possible for transactions to be posted outside the service period, as long as the service was provided within the defined service period.

Cardinality: 0..1

Type: Period

Summary: true

Mappings: w5=FiveWs.done[x]; rim=.coverage.insurancePolicy.effectiveTime

Account.covers

Episodic account covering these encounters/episodes of care

Definition: An account that collects the charges for a specific set of services offered over a limited time period. For example, a hospital account might contain all charges related to a given admission, including any inpatient appointments, and possibly re-admissions, of the billing for those re-admissions should be grouped with the initial admission for the purpose of claim submission.

Comments: Episode Accounts often exist for the duration of a relatively short billing cycle (for example, a month, or possibly a quarter). One a given billing cycle ends, the associated Episodic Account would close, and a new account would open for the next billing cycle. A patient that is admitted for 6 months, where the billing cycle is monthly, would have 6 episodic accounts each covering one month.

Cardinality: 0..*

Type: Reference(Encounter, EpisodeOfCare)

Summary: true

Account.coverage

The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account

Definition: The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account.

Comments: Typically. this may be some form of insurance, internal charges, or self-pay.

Local or jurisdictional 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/jurisdictional extension may be defined to specify the order for the type of charge.

Cardinality: 0..*

Type: BackboneElement

Summary: true

Mappings: rim=.coverage

Account.coverage.coverage

The party(s), such as insurances, that may contribute to the payment of this account

Definition: 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 responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing.

Cardinality: 1..1

Type: Reference(Coverage)

Summary: true

Mappings: rim=.coverage.insurancePolicy.author

Account.coverage.priority

The priority of the coverage in the context of this account

Definition: The priority of the coverage in the context of this account.

Comments: 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).

Aliases: coordination of benefit priority

Cardinality: 0..1

Type: positiveInt

Summary: true

Mappings: rim=.coverage.sequenceNumber

Account.owner

Entity managing the Account

Definition: Indicates the service area, hospital, department, etc. with responsibility for managing the Account.

Cardinality: 0..1

Type: Reference(Organization)

Summary: true

Mappings: rim=.holder

Account.description

Explanation of purpose/use

Definition: Provides additional information about what the account tracks and how it is used.

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=.subjectOf.observationEvent[code="annotation"].value

Account.guarantor

The parties ultimately responsible for balancing the Account

Definition: The parties responsible for balancing the account if other payment options fall short.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.holder.guarantorRole

Account.guarantor.party

Responsible entity

Definition: The entity who is responsible.

Comments: A party and/or an account is expected to be present on the guarantor.

Cardinality: 0..1

Type: Reference(Patient, RelatedPerson, Organization)

Mappings: rim=.holder.guarantorRole[guarantorPerson|guarantorOrganization]

Account.guarantor.onHold

Credit or other hold applied

Definition: A guarantor may be placed on credit hold or otherwise have their role temporarily suspended.

Cardinality: 0..1

Type: boolean

Mappings: rim=.holder.guarantorRole.statusCode

Account.guarantor.period

Guarantee account during

Definition: The timeframe during which the guarantor accepts responsibility for the account.

Cardinality: 0..1

Type: Period

Mappings: rim=.holder.guarantorRole.effectiveTime

Account.guarantor.account

A specific Account for the guarantor

Definition: Reference to a specific Account belonging to the guarantor to use.

Comments: A party and/or an account is expected to be present on the guarantor.

Cardinality: 0..1

Type: Reference(Account)

Account.guarantor.responsibility

Responsible %'age of charges

Definition: The amount (as a percentage) of the charges the guarantor is responsible.

Cardinality: 0..1

Type: Quantity(SimpleQuantity)

Account.guarantor.limit

Responsible financial limit

Definition: The maximum amount the guarantee will pay.

Cardinality: 0..1

Type: Money

Account.guarantor.rank

Rank order of guarator

Definition: The order in which guarantors will be held responsible.

Cardinality: 0..1

Type: positiveInt

Account.diagnosis

The list of diagnoses relevant to this account

Definition: When using an account for billing a specific Encounter the set of diagnoses that are relevant for billing are stored here on the account where they are able to be sequenced appropriately prior to processing to produce claim(s).

Cardinality: 0..*

Type: BackboneElement

Summary: true

Constraints: act-1 | error | The dateOfDiagnosis is not valid when using a reference to a diagnosis | condition.reference.empty().not() implies dateOfDiagnosis.empty()

Account.diagnosis.sequence

Ranking of the diagnosis (for each type)

Definition: Ranking of the diagnosis (for each type).

Cardinality: 0..1

Type: positiveInt

Account.diagnosis.condition

The diagnosis relevant to the account

Aliases: indication

Conditions: act-1

Cardinality: 1..1

Type: CodeableReference

Binding: example:condition-code

Summary: true

Account.diagnosis.dateOfDiagnosis

Date of the diagnosis (when coded diagnosis)

Definition: Ranking of the diagnosis (for each type).

Conditions: act-1

Cardinality: 0..1

Type: dateTime

Account.diagnosis.type

Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)

Definition: Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …).

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:encounter-diagnosis-use

Account.diagnosis.onAdmission

Diagnosis present on Admission

Definition: Was the Diagnosis present on Admission in the related Encounter.

Cardinality: 0..1

Type: boolean

Account.diagnosis.packageCode

Package Code specific for billing

Definition: The package code can be used to group diagnoses that may be priced or delivered as a single product. Such as DRGs.

Cardinality: 0..*

Type: CodeableConcept

Binding: example

Account.procedure

The list of procedures relevant to this account

Definition: When using an account for billing a specific Encounter the set of procedures that are relevant for billing are stored here on the account where they are able to be sequenced appropriately prior to processing to produce claim(s).

Cardinality: 0..*

Type: BackboneElement

Summary: true

Constraints: act-2 | error | The dateOfService is not valid when using a reference to a procedure | code.reference.empty().not() implies dateOfService.empty()

Account.procedure.sequence

Ranking of the procedure (for each type)

Definition: Ranking of the procedure (for each type).

Cardinality: 0..1

Type: positiveInt

Account.procedure.code

The procedure relevant to the account

Aliases: indication

Conditions: act-2

Cardinality: 1..1

Type: CodeableReference

Binding: example:procedure-code

Summary: true

Account.procedure.dateOfService

Date of the procedure (when coded procedure)

Definition: Date of the procedure when using a coded procedure. If using a reference to a procedure, then the date on the procedure should be used.

Conditions: act-2

Cardinality: 0..1

Type: dateTime

Account.procedure.type

How this procedure value should be used in charging the account

Definition: How this procedure value should be used in charging the account.

Cardinality: 0..*

Type: CodeableConcept

Binding: example

Account.procedure.packageCode

Package Code specific for billing

Definition: The package code can be used to group procedures that may be priced or delivered as a single product. Such as DRGs.

Cardinality: 0..*

Type: CodeableConcept

Binding: example

Account.procedure.device

Any devices that were associated with the procedure

Definition: Any devices that were associated with the procedure relevant to the account.

Cardinality: 0..*

Type: Reference(Device)

Summary: true

Account.parent

Reference to an associated parent Account

Definition: Reference to an associated parent Account which has this account as a sub-account.

Cardinality: 0..1

Type: Reference(Account)

Account.currency

The base or default currency

Definition: The default currency for the account.

Cardinality: 0..1

Type: CodeableConcept

Binding: required:currencies

Account.balance

Calculated account balance(s)

Definition: The calculated account balances - these are calculated and processed by the finance system.

The balances with a term that is not current are usually generated/updated by an invoicing or similar process.

Cardinality: 0..*

Type: BackboneElement

Account.balance.aggregate

Who is expected to pay this part of the balance

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:account-aggregate

Account.balance.term

current | 30 | 60 | 90 | 120

Definition: The term of the account balances - The balance value is the amount that was outstanding for this age.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:account-balance-term

Account.balance.estimate

Estimated balance

Definition: The amount is only an estimated value - this is likely common for current term balances, but not with known terms (that were generated by a backend process).

Cardinality: 0..1

Type: boolean

Account.balance.amount

Calculated amount

Definition: The actual balance value calculated for the age defined in the term property.

Cardinality: 1..1

Type: Money

Account.calculatedAt

Time the balance amount was calculated

Comments: The total(s) are not typically updated using the restful API but more often by back-end processes included in a typical finance system.

Cardinality: 0..1

Type: instant