Release 4B Snapshot #1

This page is part of the FHIR Specification v4.3.0-snapshot1: R4B Snapshot to support the Jan 2022 Connectathon. About the R4B version of FHIR. The current officially released version is 4.3.0. 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 UseSecurity Category: Patient 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.

8.12.4 References

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

This resource does not implement any patterns.

8.12.5 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)
... subject Σ0..*Reference(Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization)The entity that caused the expenses
... 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), such as insurances, that may contribute to the payment of this account
.... priority Σ0..1positiveIntThe priority of the coverage in the context of this account
... owner Σ0..1Reference(Organization)Entity managing the Account
... description Σ0..1stringExplanation of purpose/use
... guarantor 0..*BackboneElementThe parties ultimately responsible for balancing 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] « null (Strength=Required)AccountStatus! »Categorizes the account for reporting and searching purposestype : CodeableConcept [0..1] « null (Strength=Example)AccountTypes?? »Name used for the account when displaying it to humans in reports, etcname : string [0..1]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 Accountsubject : Reference [0..*] « Patient|Device|Practitioner| PractitionerRole|Location|HealthcareService|Organization »The date range of services associated with this accountservicePeriod : Period [0..1]Indicates the service area, hospital, department, etc. with responsibility for managing 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 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 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..*]The parties responsible for balancing the account if other payment options fall shortguarantor[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..* Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) The entity that caused the expenses --></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), such as insurances, that may contribute to 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) Entity managing the Account --></owner>
 <description value="[string]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <party><!-- 1..1 Reference(Organization|Patient|RelatedPerson) 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(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ], ... ; # 0..* The entity that caused the expenses
  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), such as insurances, that may contribute to 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 Entity managing the Account
  fhir:Account.description [ string ]; # 0..1 Explanation of purpose/use
  fhir:Account.guarantor [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:Account.guarantor.party [ Reference(Organization|Patient|RelatedPerson) ]; # 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
  • Change value set from http://hl7.org/fhir/ValueSet/account-status|4.0.0 to http://hl7.org/fhir/ValueSet/account-status|4.3.0-snapshot1

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and all r3 resources are valid.)

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)
... subject Σ0..*Reference(Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization)The entity that caused the expenses
... 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), such as insurances, that may contribute to the payment of this account
.... priority Σ0..1positiveIntThe priority of the coverage in the context of this account
... owner Σ0..1Reference(Organization)Entity managing the Account
... description Σ0..1stringExplanation of purpose/use
... guarantor 0..*BackboneElementThe parties ultimately responsible for balancing 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] « null (Strength=Required)AccountStatus! »Categorizes the account for reporting and searching purposestype : CodeableConcept [0..1] « null (Strength=Example)AccountTypes?? »Name used for the account when displaying it to humans in reports, etcname : string [0..1]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 Accountsubject : Reference [0..*] « Patient|Device|Practitioner| PractitionerRole|Location|HealthcareService|Organization »The date range of services associated with this accountservicePeriod : Period [0..1]Indicates the service area, hospital, department, etc. with responsibility for managing 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 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 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..*]The parties responsible for balancing the account if other payment options fall shortguarantor[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..* Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) The entity that caused the expenses --></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), such as insurances, that may contribute to 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) Entity managing the Account --></owner>
 <description value="[string]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <party><!-- 1..1 Reference(Organization|Patient|RelatedPerson) 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(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ], ... ; # 0..* The entity that caused the expenses
  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), such as insurances, that may contribute to 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 Entity managing the Account
  fhir:Account.description [ string ]; # 0..1 Explanation of purpose/use
  fhir:Account.guarantor [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:Account.guarantor.party [ Reference(Organization|Patient|RelatedPerson) ]; # 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 Release 3

Account
Account.status
  • Change value set from http://hl7.org/fhir/ValueSet/account-status|4.0.0 to http://hl7.org/fhir/ValueSet/account-status|4.3.0-snapshot1

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and all r3 resources are valid.)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

8.12.5.1 Terminology Bindings

PathDefinitionTypeReference
Account.status RequiredAccountStatus
Account.type ExampleAccountTypes

8.12.6 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
ownerreferenceEntity managing the AccountAccount.owner
(Organization)
patientreferenceThe entity that caused the expensesAccount.subject.where(resolve() is Patient)
(Practitioner, Organization, Device, Patient, HealthcareService, PractitionerRole, Location)
perioddateTransaction windowAccount.servicePeriod
statustokenactive | inactive | entered-in-error | on-hold | unknownAccount.status
subjectreferenceThe entity that caused the expensesAccount.subject
(Practitioner, Organization, Device, Patient, HealthcareService, PractitionerRole, Location)
typetokenE.g. patient, expense, depreciationAccount.type