R4 Ballot #1 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

8.12 Resource Account - Content

Patient Administration Work GroupMaturity Level: 2 Trial Use Compartments: Device, Patient, Practitioner

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.

8.12.1 Scope and Usage

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.

8.12.2 Boundaries and Relationships

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.

8.12.3 Background and Context

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.

This resource is referenced by ChargeItem, Encounter, EpisodeOfCare and Invoice

8.12.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Account TUDomainResourceTracks balance, charges, for patient or cost center
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierAccount number
... status ?!Σ1..1codeactive | inactive | entered-in-error | on-hold | unknown
AccountStatus (Required)
... type Σ0..1CodeableConceptE.g. patient, expense, depreciation
Account Types (Example)
... name Σ0..1stringHuman-readable label
... subject Σ0..1Reference(Patient | Device | Practitioner | Location | HealthcareService | Organization)What is account tied to?
... servicePeriod Σ0..1PeriodTransaction window
... coverage Σ0..*BackboneElementThe party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
.... coverage Σ1..1Reference(Coverage)The party(s) that are responsible for covering the payment of this account
.... priority Σ0..1positiveIntThe priority of the coverage in the context of this account
... owner Σ0..1Reference(Organization)Who is responsible?
... description Σ0..1stringExplanation of purpose/use
... guarantor 0..*BackboneElementResponsible for the account
.... party 1..1Reference(Patient | RelatedPerson | Organization)Responsible entity
.... onHold 0..1booleanCredit or other hold applied
.... period 0..1PeriodGuarantee account during
... partOf 0..1Reference(Account)Reference to a parent Account

doco Documentation for this format

UML Diagram (Legend)

Account (DomainResource)Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number)identifier : Identifier [0..*]Indicates whether the account is presently used/usable or not (this element modifies the meaning of other elements)status : code [1..1] « Indicates whether the account is available to be used. (Strength=Required)AccountStatus! »Categorizes the account for reporting and searching purposestype : CodeableConcept [0..1] « The usage type of this account, permits categorization of accounts. (Strength=Example)Account Types?? »Name used for the account when displaying it to humans in reports, etcname : string [0..1]Identifies the patient, device, practitioner, location or other object the account is associated withsubject : Reference [0..1] « Patient|Device|Practitioner|Location| HealthcareService|Organization »The date range of services associated with this accountservicePeriod : Period [0..1]Indicates the organization, department, etc. with responsibility for the accountowner : Reference [0..1] « Organization »Provides additional information about what the account tracks and how it is useddescription : string [0..1]Reference to a parent AccountpartOf : Reference [0..1] « Account »CoverageThe party(s) that are responsible for payment (or part of) of 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 billingcoverage : Reference [1..1] « Coverage »The priority of the coverage in the context of this accountpriority : positiveInt [0..1]GuarantorThe entity who is responsibleparty : Reference [1..1] « Patient|RelatedPerson|Organization »A guarantor may be placed on credit hold or otherwise have their role temporarily suspendedonHold : boolean [0..1]The timeframe during which the guarantor accepts responsibility for the accountperiod : Period [0..1]The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the accountcoverage[0..*]Parties financially responsible for the accountguarantor[0..*]

XML Template

<Account xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Account number --></identifier>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error | on-hold | unknown -->
 <type><!-- 0..1 CodeableConcept E.g. patient, expense, depreciation --></type>
 <name value="[string]"/><!-- 0..1 Human-readable label -->
 <subject><!-- 0..1 Reference(Patient|Device|Practitioner|Location|
   HealthcareService|Organization) What is account tied to? --></subject>
 <servicePeriod><!-- 0..1 Period Transaction window --></servicePeriod>
 <coverage>  <!-- 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account -->
  <coverage><!-- 1..1 Reference(Coverage) The party(s) that are responsible for covering the payment of this account --></coverage>
  <priority value="[positiveInt]"/><!-- 0..1 The priority of the coverage in the context of this account -->
 </coverage>
 <owner><!-- 0..1 Reference(Organization) Who is responsible? --></owner>
 <description value="[string]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* Responsible for the account -->
  <party><!-- 1..1 Reference(Patient|RelatedPerson|Organization) Responsible entity --></party>
  <onHold value="[boolean]"/><!-- 0..1 Credit or other hold applied -->
  <period><!-- 0..1 Period Guarantee account during --></period>
 </guarantor>
 <partOf><!-- 0..1 Reference(Account) Reference to a parent Account --></partOf>
</Account>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Account;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Account.identifier [ Identifier ], ... ; # 0..* Account number
  fhir:Account.status [ code ]; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:Account.type [ CodeableConcept ]; # 0..1 E.g. patient, expense, depreciation
  fhir:Account.name [ string ]; # 0..1 Human-readable label
  fhir:Account.subject [ Reference(Patient|Device|Practitioner|Location|HealthcareService|Organization) ]; # 0..1 What is account tied to?
  fhir:Account.servicePeriod [ Period ]; # 0..1 Transaction window
  fhir:Account.coverage [ # 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    fhir:Account.coverage.coverage [ Reference(Coverage) ]; # 1..1 The party(s) that are responsible for covering the payment of this account
    fhir:Account.coverage.priority [ positiveInt ]; # 0..1 The priority of the coverage in the context of this account
  ], ...;
  fhir:Account.owner [ Reference(Organization) ]; # 0..1 Who is responsible?
  fhir:Account.description [ string ]; # 0..1 Explanation of purpose/use
  fhir:Account.guarantor [ # 0..* Responsible for the account
    fhir:Account.guarantor.party [ Reference(Patient|RelatedPerson|Organization) ]; # 1..1 Responsible entity
    fhir:Account.guarantor.onHold [ boolean ]; # 0..1 Credit or other hold applied
    fhir:Account.guarantor.period [ Period ]; # 0..1 Guarantee account during
  ], ...;
  fhir:Account.partOf [ Reference(Account) ]; # 0..1 Reference to a parent Account
]

Changes since R3

Account
Account.status
  • Min Cardinality changed from 0 to 1
Account.servicePeriod
  • Added Element
Account.partOf
  • Added Element
Account.period
  • deleted
Account.active
  • deleted
Account.balance
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.). Note: these have note yet been updated to be R3 to R4

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Account TUDomainResourceTracks balance, charges, for patient or cost center
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierAccount number
... status ?!Σ1..1codeactive | inactive | entered-in-error | on-hold | unknown
AccountStatus (Required)
... type Σ0..1CodeableConceptE.g. patient, expense, depreciation
Account Types (Example)
... name Σ0..1stringHuman-readable label
... subject Σ0..1Reference(Patient | Device | Practitioner | Location | HealthcareService | Organization)What is account tied to?
... servicePeriod Σ0..1PeriodTransaction window
... coverage Σ0..*BackboneElementThe party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
.... coverage Σ1..1Reference(Coverage)The party(s) that are responsible for covering the payment of this account
.... priority Σ0..1positiveIntThe priority of the coverage in the context of this account
... owner Σ0..1Reference(Organization)Who is responsible?
... description Σ0..1stringExplanation of purpose/use
... guarantor 0..*BackboneElementResponsible for the account
.... party 1..1Reference(Patient | RelatedPerson | Organization)Responsible entity
.... onHold 0..1booleanCredit or other hold applied
.... period 0..1PeriodGuarantee account during
... partOf 0..1Reference(Account)Reference to a parent Account

doco Documentation for this format

UML Diagram (Legend)

Account (DomainResource)Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number)identifier : Identifier [0..*]Indicates whether the account is presently used/usable or not (this element modifies the meaning of other elements)status : code [1..1] « Indicates whether the account is available to be used. (Strength=Required)AccountStatus! »Categorizes the account for reporting and searching purposestype : CodeableConcept [0..1] « The usage type of this account, permits categorization of accounts. (Strength=Example)Account Types?? »Name used for the account when displaying it to humans in reports, etcname : string [0..1]Identifies the patient, device, practitioner, location or other object the account is associated withsubject : Reference [0..1] « Patient|Device|Practitioner|Location| HealthcareService|Organization »The date range of services associated with this accountservicePeriod : Period [0..1]Indicates the organization, department, etc. with responsibility for the accountowner : Reference [0..1] « Organization »Provides additional information about what the account tracks and how it is useddescription : string [0..1]Reference to a parent AccountpartOf : Reference [0..1] « Account »CoverageThe party(s) that are responsible for payment (or part of) of 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 billingcoverage : Reference [1..1] « Coverage »The priority of the coverage in the context of this accountpriority : positiveInt [0..1]GuarantorThe entity who is responsibleparty : Reference [1..1] « Patient|RelatedPerson|Organization »A guarantor may be placed on credit hold or otherwise have their role temporarily suspendedonHold : boolean [0..1]The timeframe during which the guarantor accepts responsibility for the accountperiod : Period [0..1]The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the accountcoverage[0..*]Parties financially responsible for the accountguarantor[0..*]

XML Template

<Account xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Account number --></identifier>
 <status value="[code]"/><!-- 1..1 active | inactive | entered-in-error | on-hold | unknown -->
 <type><!-- 0..1 CodeableConcept E.g. patient, expense, depreciation --></type>
 <name value="[string]"/><!-- 0..1 Human-readable label -->
 <subject><!-- 0..1 Reference(Patient|Device|Practitioner|Location|
   HealthcareService|Organization) What is account tied to? --></subject>
 <servicePeriod><!-- 0..1 Period Transaction window --></servicePeriod>
 <coverage>  <!-- 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account -->
  <coverage><!-- 1..1 Reference(Coverage) The party(s) that are responsible for covering the payment of this account --></coverage>
  <priority value="[positiveInt]"/><!-- 0..1 The priority of the coverage in the context of this account -->
 </coverage>
 <owner><!-- 0..1 Reference(Organization) Who is responsible? --></owner>
 <description value="[string]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* Responsible for the account -->
  <party><!-- 1..1 Reference(Patient|RelatedPerson|Organization) Responsible entity --></party>
  <onHold value="[boolean]"/><!-- 0..1 Credit or other hold applied -->
  <period><!-- 0..1 Period Guarantee account during --></period>
 </guarantor>
 <partOf><!-- 0..1 Reference(Account) Reference to a parent Account --></partOf>
</Account>

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Account;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Account.identifier [ Identifier ], ... ; # 0..* Account number
  fhir:Account.status [ code ]; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:Account.type [ CodeableConcept ]; # 0..1 E.g. patient, expense, depreciation
  fhir:Account.name [ string ]; # 0..1 Human-readable label
  fhir:Account.subject [ Reference(Patient|Device|Practitioner|Location|HealthcareService|Organization) ]; # 0..1 What is account tied to?
  fhir:Account.servicePeriod [ Period ]; # 0..1 Transaction window
  fhir:Account.coverage [ # 0..* The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    fhir:Account.coverage.coverage [ Reference(Coverage) ]; # 1..1 The party(s) that are responsible for covering the payment of this account
    fhir:Account.coverage.priority [ positiveInt ]; # 0..1 The priority of the coverage in the context of this account
  ], ...;
  fhir:Account.owner [ Reference(Organization) ]; # 0..1 Who is responsible?
  fhir:Account.description [ string ]; # 0..1 Explanation of purpose/use
  fhir:Account.guarantor [ # 0..* Responsible for the account
    fhir:Account.guarantor.party [ Reference(Patient|RelatedPerson|Organization) ]; # 1..1 Responsible entity
    fhir:Account.guarantor.onHold [ boolean ]; # 0..1 Credit or other hold applied
    fhir:Account.guarantor.period [ Period ]; # 0..1 Guarantee account during
  ], ...;
  fhir:Account.partOf [ Reference(Account) ]; # 0..1 Reference to a parent Account
]

Changes since DSTU2

Account
Account.status
  • Min Cardinality changed from 0 to 1
Account.servicePeriod
  • Added Element
Account.partOf
  • Added Element
Account.period
  • deleted
Account.active
  • deleted
Account.balance
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.). Note: these have note yet been updated to be R3 to R4

 

Alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

8.12.4.1 Terminology Bindings

PathDefinitionTypeReference
Account.status Indicates whether the account is available to be used.RequiredAccountStatus
Account.type The usage type of this account, permits categorization of accounts.ExampleAccount Types

8.12.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
identifiertokenAccount numberAccount.identifier
namestringHuman-readable labelAccount.name
ownerreferenceWho is responsible?Account.owner
(Organization)
patientreferenceWhat is account tied to?Account.subject
(Patient)
perioddateTransaction windowAccount.servicePeriod
statustokenactive | inactive | entered-in-error | on-hold | unknownAccount.status
subjectreferenceWhat is account tied to?Account.subject
(Practitioner, Organization, Device, Patient, HealthcareService, Location)
typetokenE.g. patient, expense, depreciationAccount.type