Release 5 FHIR CI-Build

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See the Directory of published versions icon . Page versions: R5 R4B R4 R3 R2

8.13 8.12 Resource Account - Content

Responsible Owner: Patient Administration icon Work Group Maturity Level : 2   Trial Use Normative Security 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.

8.13.1 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.

8.13.2 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.

8.13.3 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.

8.13.4 8.12.4 References to this Resource

8.13.5 8.12.5 Resource Content

Structure

relatedAccount 0..* BackboneElement Other associated accounts related to this account account 1..1
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . Account TU N DomainResource Tracks balance, charges, for patient or cost center

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Account number

. . . status ?! Σ 1..1 code active | inactive | entered-in-error | on-hold | unknown
Binding: Account Status ( Required )
. . . billingStatus Σ 0..1 CodeableConcept Tracks the lifecycle of the account through the billing process
Binding: Example Account Billing Statuses ( Example )
. . . name Σ 0..1 string Human-readable label
. . . subject Σ 0..* Reference ( Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization ) The entity that caused the expenses

. . . servicePeriod Σ 0..1 Period Transaction window
. . . covers Σ 0..* Reference ( Encounter | EpisodeOfCare ) Episodic account covering these encounters/episodes of care

. . . coverage Σ 0..* BackboneElement The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account

. . . . coverage Σ 1..1 Reference ( Coverage ) The party(s), such as insurances, that may contribute to the payment of this account
. . . . priority Σ 0..1 positiveInt The priority of the coverage in the context of this account
. . . owner Σ 0..1 Reference ( Organization ) Entity managing the Account
. . . description Σ 0..1 markdown Explanation of purpose/use
. . . guarantor 0..* BackboneElement The parties ultimately responsible for balancing the Account

. . . . party 1..1 0..1 Reference ( Patient | RelatedPerson | Organization ) Responsible entity
. . . . onHold 0..1 boolean Credit or other hold applied
. . . . period 0..1 Period Guarantee account during
. . . . account 0..1 Reference ( Account ) A specific Account for the guarantor
.... responsibility 0..1 SimpleQuantity Responsible %'age of charges
.... limit 0..1 Money Responsible financial limit
.... rank 0..1 positiveInt Rank order of guarator
. . . diagnosis Σ C TU 0..* BackboneElement The list of diagnoses relevant to this account
+ Rule: The dateOfDiagnosis is not valid when using a reference to a diagnosis

. . . . sequence 0..1 positiveInt Ranking of the diagnosis (for each type)
. . . . condition Σ C 1..1 CodeableReference ( Condition ) The diagnosis relevant to the account
Binding: Condition/Problem/Diagnosis Codes ( Example )
. . . . dateOfDiagnosis C 0..1 dateTime Date of the diagnosis (when coded diagnosis)
. . . . type 0..* CodeableConcept Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
Binding: Encounter Diagnosis Use ( Preferred )

. . . . onAdmission 0..1 boolean Diagnosis present on Admission
. . . . packageCode 0..* CodeableConcept Package Code specific for billing
Binding: diagnosis-package-code ( Example )

. . . procedure Σ C TU 0..* BackboneElement The list of procedures relevant to this account
+ Rule: The dateOfService is not valid when using a reference to a procedure

. . . . sequence 0..1 positiveInt Ranking of the procedure (for each type)
. . . . code Σ C 1..1 CodeableReference ( Procedure ) The procedure relevant to the account
Binding: Procedure Codes (SNOMED CT) ( Example )
. . . . dateOfService C 0..1 dateTime Date of the procedure (when coded procedure)
. . . . type 0..* CodeableConcept How this procedure value should be used in charging the account
Binding: procedure-type ( Example )

. . . . packageCode 0..* CodeableConcept Package Code specific for billing
Binding: procedure-package-code ( Example )

. . . . device Σ 0..* Reference ( Device ) Any devices that were associated with the procedure

. . relationship 0..1 CodeableConcept . parent Relationship of the associated Account Binding: Account Relationship ( Example ) 0..1 Reference ( Account ) Reference to an associated parent Account
. . . currency 0..1 CodeableConcept The base or default currency
Binding: Currencies ( Required )
. . . balance 0..* BackboneElement Calculated account balance(s)

. . . . aggregate 0..1 CodeableConcept Who is expected to pay this part of the balance
Binding: Account Aggregate ( Extensible )
. . . . term 0..1 CodeableConcept current | 30 | 60 | 90 | 120
Binding: Account Balance Term ( Extensible )
. . . . estimate 0..1 boolean Estimated balance
. . . . amount 1..1 Money Calculated amount
. . . calculatedAt 0..1 instant Time the balance amount was calculated

doco Documentation for this format icon

See the Extensions for this resource

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 ! » 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 billingStatus : CodeableConcept [0..1] « null (Strength=Example) AccountBillingStatus ?? » Categorizes the account for reporting and searching purposes type : CodeableConcept [0..1] « null (Strength=Example) AccountTypes ?? » Name used for the account when displaying it to humans in reports, etc name : 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 Account subject : Reference [0..*] « Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization » The date range of services associated with this account servicePeriod : Period [0..1] 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 covers : Reference [0..*] « Encounter | EpisodeOfCare » Indicates the service area, hospital, department, etc. with responsibility for managing the Account owner : Reference [0..1] « Organization » Provides additional information about what the account tracks and how it is used description : markdown [0..1] Reference to an associated parent Account which has this account as a sub-account parent : Reference [0..1] « Account » The default currency for the account currency : CodeableConcept [0..1] « null (Strength=Required) Currencies ! » Time the balance amount was calculated calculatedAt : instant [0..1] Coverage 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 coverage : Reference [1..1] « Coverage » The priority of the coverage in the context of this account priority : positiveInt [0..1] Guarantor The entity who is responsible party : Reference [1..1] [0..1] « Patient | RelatedPerson | Organization » A guarantor may be placed on credit hold or otherwise have their role temporarily suspended onHold : boolean [0..1] The timeframe during which the guarantor accepts responsibility for the account period : Period [0..1] Reference to a specific Account belonging to the guarantor to use account : Reference [0..1] « Account » The amount (as a percentage) of the charges the guarantor is responsible responsibility : Quantity ( SimpleQuantity ) [0..1] The maximum amount the guarantee will pay limit : Money [0..1] The order in which guarantors will be held responsible rank : positiveInt [0..1] Diagnosis Ranking of the diagnosis (for each type) sequence : positiveInt [0..1] The diagnosis relevant to the account condition : CodeableReference [1..1] « Condition ; null (Strength=Example) ConditionProblemDiagnosisCodes ?? » « This element has or is affected by some invariants C » Ranking of the diagnosis (for each type) dateOfDiagnosis : dateTime [0..1] « This element has or is affected by some invariants C » Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …) type : CodeableConcept [0..*] « null (Strength=Preferred) EncounterDiagnosisUse ? » Was the Diagnosis present on Admission in the related Encounter onAdmission : boolean [0..1] The package code can be used to group diagnoses that may be priced or delivered as a single product. Such as DRGs packageCode : CodeableConcept [0..*] « null (Strength=Example) diagnosis-package-code?? » Procedure Ranking of the procedure (for each type) sequence : positiveInt [0..1] The procedure relevant to the account code : CodeableReference [1..1] « Procedure ; null (Strength=Example) ProcedureCodesSNOMEDCT ?? » « This element has or is affected by some invariants C » 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 dateOfService : dateTime [0..1] « This element has or is affected by some invariants C » How this procedure value should be used in charging the account type : CodeableConcept [0..*] « null (Strength=Example) procedure-type?? » The package code can be used to group procedures that may be priced or delivered as a single product. Such as DRGs packageCode : CodeableConcept [0..*] « null (Strength=Example) procedure-package-code?? » Any devices that were associated with the procedure relevant to the account device : Reference [0..*] « Device » RelatedAccount Relationship of the associated Account relationship : CodeableConcept [0..1] « null (Strength=Example) AccountRelationship ?? » Reference to an associated Account account : Reference [1..1] « Account » Balance Who is expected to pay this part of the balance aggregate : CodeableConcept [0..1] « null (Strength=Extensible) AccountAggregate + » The term of the account balances - The balance value is the amount that was outstanding for this age term : CodeableConcept [0..1] « null (Strength=Extensible) AccountBalanceTerm + » 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) estimate : boolean [0..1] The actual balance value calculated for the age defined in the term property amount : Money [1..1] The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account coverage [0..*] The parties responsible for balancing the account if other payment options fall short guarantor [0..*] 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) diagnosis [0..*] 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) procedure [0..*] Other associated accounts related to this account relatedAccount [0..*] 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 balance [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 -->
 <billingStatus><!-- 0..1 CodeableConcept Tracks the lifecycle of the account through the billing process --></billingStatus>
 <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>
 <covers><!-- 0..* Reference(Encounter|EpisodeOfCare) Episodic account covering these encounters/episodes of care --></covers>

 <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 -->
  <<a href="account-definitions.html#Account.coverage.coverage" title="The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).


  <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="[markdown]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <</party>

  <party><!-- 0..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>
  <account><!-- 0..1 Reference(Account) A specific Account for the guarantor --></account>
  <responsibility><!-- 0..1 Quantity(SimpleQuantity) Responsible %'age of charges --></responsibility>
  <limit><!-- 0..1 Money Responsible financial limit --></limit>
  <rank value="[positiveInt]"/><!-- 0..1 Rank order of guarator -->

 </guarantor>
 <diagnosis>  <!-- 0..* The list of diagnoses relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each type) -->
  <condition><!-- I 1..1 CodeableReference(Condition) The diagnosis relevant to the account --></condition>
  <dateOfDiagnosis value="[dateTime]"/><!-- I 0..1 Date of the diagnosis (when coded diagnosis) -->
  <type><!-- 0..* CodeableConcept Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …) --></type>
  <onAdmission value="[boolean]"/><!-- 0..1 Diagnosis present on Admission -->
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* The list of procedures relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the procedure (for each type) -->
  <code><!-- I 1..1 CodeableReference(Procedure) The procedure relevant to the account --></code>
  <dateOfService value="[dateTime]"/><!-- I 0..1 Date of the procedure (when coded procedure) -->
  <type><!-- 0..* CodeableConcept How this procedure value should be used in charging the account --></type>
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
  <device><!-- 0..* Reference(Device) Any devices that were associated with the procedure --></device>
 </procedure>
 <
  <</relationship>
  <</account>
 </relatedAccount>

 <parent><!-- 0..1 Reference(Account) Reference to an associated parent Account --></parent>

 <currency><!-- 0..1 CodeableConcept The base or default currency --></currency>
 <<a href="account-definitions.html#Account.balance" title="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." class="dict">

 <balance>  <!-- 0..* Calculated account balance(s) -->

  <aggregate><!-- 0..1 CodeableConcept Who is expected to pay this part of the balance --></aggregate>
  <term><!-- 0..1 CodeableConcept current | 30 | 60 | 90 | 120 --></term>
  <estimate value="[boolean]"/><!-- 0..1 Estimated balance -->
  <amount><!-- 1..1 Money Calculated amount --></amount>
 </balance>
 <calculatedAt value="[instant]"/><!-- 0..1 Time the balance amount was calculated -->
</Account>

JSON Template 

{doco
  "resourceType" : "Account",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Account number
  "status" : "<code>", // R!  active | inactive | entered-in-error | on-hold | unknown
  "billingStatus" : { CodeableConcept }, // Tracks the lifecycle of the account through the billing process
  "type" : { CodeableConcept }, // E.g. patient, expense, depreciation
  "name" : "<string>", // Human-readable label
  "subject" : [{ Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) }], // The entity that caused the expenses
  "servicePeriod" : { Period }, // Transaction window
  "covers" : [{ Reference(Encounter|EpisodeOfCare) }], // Episodic account covering these encounters/episodes of care

  "coverage" : [{ // The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    "<a href="account-definitions.html#Account.coverage.coverage" title="The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).


    "coverage" : { Reference(Coverage) }, // R!  The party(s), such as insurances, that may contribute to the payment of this account
    "priority" : "<positiveInt>" // The priority of the coverage in the context of this account
  }],
  "owner" : { Reference(Organization) }, // Entity managing the Account
  "description" : "<markdown>", // Explanation of purpose/use
  "guarantor" : [{ // The parties ultimately responsible for balancing the Account
    "

    "party" : { Reference(Organization|Patient|RelatedPerson) }, // Responsible entity

    "onHold" : <boolean>, // Credit or other hold applied
    "

    "period" : { Period }, // Guarantee account during
    "account" : { Reference(Account) }, // A specific Account for the guarantor
    "responsibility" : { Quantity(SimpleQuantity) }, // Responsible %'age of charges
    "limit" : { Money }, // Responsible financial limit
    "rank" : "<positiveInt>" // Rank order of guarator

  }],
  "diagnosis" : [{ // The list of diagnoses relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the diagnosis (for each type)
    "condition" : { CodeableReference(Condition) }, // I R!  The diagnosis relevant to the account
    "dateOfDiagnosis" : "<dateTime>", // I Date of the diagnosis (when coded diagnosis)
    "type" : [{ CodeableConcept }], // Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    "onAdmission" : <boolean>, // Diagnosis present on Admission
    "packageCode" : [{ CodeableConcept }] // Package Code specific for billing
  }],
  "procedure" : [{ // The list of procedures relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the procedure (for each type)
    "code" : { CodeableReference(Procedure) }, // I R!  The procedure relevant to the account
    "dateOfService" : "<dateTime>", // I Date of the procedure (when coded procedure)
    "type" : [{ CodeableConcept }], // How this procedure value should be used in charging the account
    "packageCode" : [{ CodeableConcept }], // Package Code specific for billing
    "device" : [{ Reference(Device) }] // Any devices that were associated with the procedure
  }],
  "
    "
    "
  }],

  "parent" : { Reference(Account) }, // Reference to an associated parent Account

  "currency" : { CodeableConcept }, // The base or default currency
  "<a href="account-definitions.html#Account.balance" title="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." class="dict">balance

  "balance" : [{ // Calculated account balance(s)

    "aggregate" : { CodeableConcept }, // Who is expected to pay this part of the balance
    "term" : { CodeableConcept }, // current | 30 | 60 | 90 | 120
    "estimate" : <boolean>, // Estimated balance
    "amount" : { Money } // R!  Calculated amount
  }],
  "calculatedAt" : "<instant>" // Time the balance amount was calculated
}

Turtle Template 

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


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

  # from 
  # from 

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Account number
  fhir:status [ code ] ; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:billingStatus [ CodeableConcept ] ; # 0..1 Tracks the lifecycle of the account through the billing process
  fhir:type [ CodeableConcept ] ; # 0..1 E.g. patient, expense, depreciation
  fhir:name [ string ] ; # 0..1 Human-readable label
  fhir:subject  ( [ Reference(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ] ... ) ; # 0..* The entity that caused the expenses
  fhir:servicePeriod [ Period ] ; # 0..1 Transaction window
  fhir:covers  ( [ Reference(Encounter|EpisodeOfCare) ] ... ) ; # 0..* Episodic account covering these encounters/episodes of care

  fhir: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:<a href="account-definitions.html#Account.coverage.coverage" title="The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).


    fhir:coverage [ Reference(Coverage) ] ; # 1..1 The party(s), such as insurances, that may contribute to the payment of this account
    fhir:priority [ positiveInt ] ; # 0..1 The priority of the coverage in the context of this account
  ] ... ) ;
  fhir:owner [ Reference(Organization) ] ; # 0..1 Entity managing the Account
  fhir:description [ markdown ] ; # 0..1 Explanation of purpose/use
  fhir:guarantor ( [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:

    fhir:party [ Reference(Organization|Patient|RelatedPerson) ] ; # 0..1 Responsible entity

    fhir:onHold [ boolean ] ; # 0..1 Credit or other hold applied
    fhir:period [ Period ] ; # 0..1 Guarantee account during
    fhir:account [ Reference(Account) ] ; # 0..1 A specific Account for the guarantor
    fhir:responsibility [ Quantity(SimpleQuantity) ] ; # 0..1 Responsible %'age of charges
    fhir:limit [ Money ] ; # 0..1 Responsible financial limit
    fhir:rank [ positiveInt ] ; # 0..1 Rank order of guarator

  ] ... ) ;
  fhir:diagnosis ( [ # 0..* The list of diagnoses relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the diagnosis (for each type)
    fhir:condition [ CodeableReference(Condition) ] ; # 1..1 I The diagnosis relevant to the account
    fhir:dateOfDiagnosis [ dateTime ] ; # 0..1 I Date of the diagnosis (when coded diagnosis)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    fhir:onAdmission [ boolean ] ; # 0..1 Diagnosis present on Admission
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
  ] ... ) ;
  fhir:procedure ( [ # 0..* The list of procedures relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the procedure (for each type)
    fhir:code [ CodeableReference(Procedure) ] ; # 1..1 I The procedure relevant to the account
    fhir:dateOfService [ dateTime ] ; # 0..1 I Date of the procedure (when coded procedure)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* How this procedure value should be used in charging the account
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
    fhir:device  ( [ Reference(Device) ] ... ) ; # 0..* Any devices that were associated with the procedure
  ] ... ) ;
  fhir:
    fhir:
    fhir:
  ] ... ) ;

  fhir:parent [ Reference(Account) ] ; # 0..1 Reference to an associated parent Account

  fhir:currency [ CodeableConcept ] ; # 0..1 The base or default currency
  fhir:<a href="account-definitions.html#Account.balance" title="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." class="dict">balance

  fhir:balance ( [ # 0..* Calculated account balance(s)

    fhir:aggregate [ CodeableConcept ] ; # 0..1 Who is expected to pay this part of the balance
    fhir:term [ CodeableConcept ] ; # 0..1 current | 30 | 60 | 90 | 120
    fhir:estimate [ boolean ] ; # 0..1 Estimated balance
    fhir:amount [ Money ] ; # 1..1 Calculated amount
  ] ... ) ;
  fhir:calculatedAt [ instant ] ; # 0..1 Time the balance amount was calculated
]

Changes from both R4 and R4B

Account
Account.billingStatus
  • Added Element
Account.covers
  • Added Element
Account.description
  • Type changed from string to markdown
Account.guarantor.party
  • Min Cardinality changed from 1 to 0
Account.diagnosis Account.guarantor.account
  • Added Element
Account.diagnosis.sequence Account.guarantor.responsibility
  • Added Element
Account.diagnosis.condition Account.guarantor.limit
  • Added Mandatory Element
Account.diagnosis.dateOfDiagnosis Account.guarantor.rank
  • Added Element
Account.diagnosis.type Account.diagnosis
  • Added Element
Account.diagnosis.onAdmission Account.diagnosis.sequence
  • Added Element
Account.diagnosis.packageCode Account.diagnosis.condition
  • Added Mandatory Element
Account.procedure Account.diagnosis.dateOfDiagnosis
  • Added Element
Account.procedure.sequence Account.diagnosis.type
  • Added Element
Account.procedure.code Account.diagnosis.onAdmission
  • Added Mandatory Element
Account.procedure.dateOfService Account.diagnosis.packageCode
  • Added Element
Account.procedure.type Account.procedure
  • Added Element
Account.procedure.packageCode Account.procedure.sequence
  • Added Element
Account.procedure.device Account.procedure.code
  • Added Mandatory Element
Account.relatedAccount Account.procedure.dateOfService
  • Added Element
Account.relatedAccount.relationship Account.procedure.type
  • Added Element
Account.relatedAccount.account Account.procedure.packageCode
  • Added Element
Account.procedure.device
  • Moved from Account.partOf to account Added Element
Account.parent
  • Min Cardinality changed Renamed from 0 partOf to 1 parent
Account.currency
  • Added Element
Account.balance
  • Added Element
Account.balance.aggregate
  • Added Element
Account.balance.term
  • Added Element
Account.balance.estimate
  • Added Element
Account.balance.amount
  • Added Mandatory Element
Account.calculatedAt
  • Added Element

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

See R4 <--> R5 Conversion Maps (status = See Conversions Summary .)

Structure

relatedAccount 0..* BackboneElement Other associated accounts related to this account account 1..1
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . Account TU N DomainResource Tracks balance, charges, for patient or cost center

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier Account number

. . . status ?! Σ 1..1 code active | inactive | entered-in-error | on-hold | unknown
Binding: Account Status ( Required )
. . . billingStatus Σ 0..1 CodeableConcept Tracks the lifecycle of the account through the billing process
Binding: Example Account Billing Statuses ( Example )
. . . name Σ 0..1 string Human-readable label
. . . subject Σ 0..* Reference ( Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization ) The entity that caused the expenses

. . . servicePeriod Σ 0..1 Period Transaction window
. . . covers Σ 0..* Reference ( Encounter | EpisodeOfCare ) Episodic account covering these encounters/episodes of care

. . . coverage Σ 0..* BackboneElement The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account

. . . . coverage Σ 1..1 Reference ( Coverage ) The party(s), such as insurances, that may contribute to the payment of this account
. . . . priority Σ 0..1 positiveInt The priority of the coverage in the context of this account
. . . owner Σ 0..1 Reference ( Organization ) Entity managing the Account
. . . description Σ 0..1 markdown Explanation of purpose/use
. . . guarantor 0..* BackboneElement The parties ultimately responsible for balancing the Account

. . . . party 1..1 0..1 Reference ( Patient | RelatedPerson | Organization ) Responsible entity
. . . . onHold 0..1 boolean Credit or other hold applied
. . . . period 0..1 Period Guarantee account during
. . . . account 0..1 Reference ( Account ) A specific Account for the guarantor
.... responsibility 0..1 SimpleQuantity Responsible %'age of charges
.... limit 0..1 Money Responsible financial limit
.... rank 0..1 positiveInt Rank order of guarator
. . . diagnosis Σ C TU 0..* BackboneElement The list of diagnoses relevant to this account
+ Rule: The dateOfDiagnosis is not valid when using a reference to a diagnosis

. . . . sequence 0..1 positiveInt Ranking of the diagnosis (for each type)
. . . . condition Σ C 1..1 CodeableReference ( Condition ) The diagnosis relevant to the account
Binding: Condition/Problem/Diagnosis Codes ( Example )
. . . . dateOfDiagnosis C 0..1 dateTime Date of the diagnosis (when coded diagnosis)
. . . . type 0..* CodeableConcept Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
Binding: Encounter Diagnosis Use ( Preferred )

. . . . onAdmission 0..1 boolean Diagnosis present on Admission
. . . . packageCode 0..* CodeableConcept Package Code specific for billing
Binding: diagnosis-package-code ( Example )

. . . procedure Σ C TU 0..* BackboneElement The list of procedures relevant to this account
+ Rule: The dateOfService is not valid when using a reference to a procedure

. . . . sequence 0..1 positiveInt Ranking of the procedure (for each type)
. . . . code Σ C 1..1 CodeableReference ( Procedure ) The procedure relevant to the account
Binding: Procedure Codes (SNOMED CT) ( Example )
. . . . dateOfService C 0..1 dateTime Date of the procedure (when coded procedure)
. . . . type 0..* CodeableConcept How this procedure value should be used in charging the account
Binding: procedure-type ( Example )

. . . . packageCode 0..* CodeableConcept Package Code specific for billing
Binding: procedure-package-code ( Example )

. . . . device Σ 0..* Reference ( Device ) Any devices that were associated with the procedure

. . relationship 0..1 CodeableConcept . parent Relationship of the associated Account Binding: Account Relationship ( Example ) 0..1 Reference ( Account ) Reference to an associated parent Account
. . . currency 0..1 CodeableConcept The base or default currency
Binding: Currencies ( Required )
. . . balance 0..* BackboneElement Calculated account balance(s)

. . . . aggregate 0..1 CodeableConcept Who is expected to pay this part of the balance
Binding: Account Aggregate ( Extensible )
. . . . term 0..1 CodeableConcept current | 30 | 60 | 90 | 120
Binding: Account Balance Term ( Extensible )
. . . . estimate 0..1 boolean Estimated balance
. . . . amount 1..1 Money Calculated amount
. . . calculatedAt 0..1 instant Time the balance amount was calculated

doco Documentation for this format icon

See the Extensions for this resource

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 ! » 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 billingStatus : CodeableConcept [0..1] « null (Strength=Example) AccountBillingStatus ?? » Categorizes the account for reporting and searching purposes type : CodeableConcept [0..1] « null (Strength=Example) AccountTypes ?? » Name used for the account when displaying it to humans in reports, etc name : 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 Account subject : Reference [0..*] « Patient | Device | Practitioner | PractitionerRole | Location | HealthcareService | Organization » The date range of services associated with this account servicePeriod : Period [0..1] 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 covers : Reference [0..*] « Encounter | EpisodeOfCare » Indicates the service area, hospital, department, etc. with responsibility for managing the Account owner : Reference [0..1] « Organization » Provides additional information about what the account tracks and how it is used description : markdown [0..1] Reference to an associated parent Account which has this account as a sub-account parent : Reference [0..1] « Account » The default currency for the account currency : CodeableConcept [0..1] « null (Strength=Required) Currencies ! » Time the balance amount was calculated calculatedAt : instant [0..1] Coverage 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 coverage : Reference [1..1] « Coverage » The priority of the coverage in the context of this account priority : positiveInt [0..1] Guarantor The entity who is responsible party : Reference [1..1] [0..1] « Patient | RelatedPerson | Organization » A guarantor may be placed on credit hold or otherwise have their role temporarily suspended onHold : boolean [0..1] The timeframe during which the guarantor accepts responsibility for the account period : Period [0..1] Reference to a specific Account belonging to the guarantor to use account : Reference [0..1] « Account » The amount (as a percentage) of the charges the guarantor is responsible responsibility : Quantity ( SimpleQuantity ) [0..1] The maximum amount the guarantee will pay limit : Money [0..1] The order in which guarantors will be held responsible rank : positiveInt [0..1] Diagnosis Ranking of the diagnosis (for each type) sequence : positiveInt [0..1] The diagnosis relevant to the account condition : CodeableReference [1..1] « Condition ; null (Strength=Example) ConditionProblemDiagnosisCodes ?? » « This element has or is affected by some invariants C » Ranking of the diagnosis (for each type) dateOfDiagnosis : dateTime [0..1] « This element has or is affected by some invariants C » Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …) type : CodeableConcept [0..*] « null (Strength=Preferred) EncounterDiagnosisUse ? » Was the Diagnosis present on Admission in the related Encounter onAdmission : boolean [0..1] The package code can be used to group diagnoses that may be priced or delivered as a single product. Such as DRGs packageCode : CodeableConcept [0..*] « null (Strength=Example) diagnosis-package-code?? » Procedure Ranking of the procedure (for each type) sequence : positiveInt [0..1] The procedure relevant to the account code : CodeableReference [1..1] « Procedure ; null (Strength=Example) ProcedureCodesSNOMEDCT ?? » « This element has or is affected by some invariants C » 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 dateOfService : dateTime [0..1] « This element has or is affected by some invariants C » How this procedure value should be used in charging the account type : CodeableConcept [0..*] « null (Strength=Example) procedure-type?? » The package code can be used to group procedures that may be priced or delivered as a single product. Such as DRGs packageCode : CodeableConcept [0..*] « null (Strength=Example) procedure-package-code?? » Any devices that were associated with the procedure relevant to the account device : Reference [0..*] « Device » RelatedAccount Relationship of the associated Account relationship : CodeableConcept [0..1] « null (Strength=Example) AccountRelationship ?? » Reference to an associated Account account : Reference [1..1] « Account » Balance Who is expected to pay this part of the balance aggregate : CodeableConcept [0..1] « null (Strength=Extensible) AccountAggregate + » The term of the account balances - The balance value is the amount that was outstanding for this age term : CodeableConcept [0..1] « null (Strength=Extensible) AccountBalanceTerm + » 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) estimate : boolean [0..1] The actual balance value calculated for the age defined in the term property amount : Money [1..1] The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account coverage [0..*] The parties responsible for balancing the account if other payment options fall short guarantor [0..*] 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) diagnosis [0..*] 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) procedure [0..*] Other associated accounts related to this account relatedAccount [0..*] 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 balance [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 -->
 <billingStatus><!-- 0..1 CodeableConcept Tracks the lifecycle of the account through the billing process --></billingStatus>
 <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>
 <covers><!-- 0..* Reference(Encounter|EpisodeOfCare) Episodic account covering these encounters/episodes of care --></covers>

 <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 -->
  <<a href="account-definitions.html#Account.coverage.coverage" title="The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).


  <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="[markdown]"/><!-- 0..1 Explanation of purpose/use -->
 <guarantor>  <!-- 0..* The parties ultimately responsible for balancing the Account -->
  <</party>

  <party><!-- 0..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>
  <account><!-- 0..1 Reference(Account) A specific Account for the guarantor --></account>
  <responsibility><!-- 0..1 Quantity(SimpleQuantity) Responsible %'age of charges --></responsibility>
  <limit><!-- 0..1 Money Responsible financial limit --></limit>
  <rank value="[positiveInt]"/><!-- 0..1 Rank order of guarator -->

 </guarantor>
 <diagnosis>  <!-- 0..* The list of diagnoses relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each type) -->
  <condition><!-- I 1..1 CodeableReference(Condition) The diagnosis relevant to the account --></condition>
  <dateOfDiagnosis value="[dateTime]"/><!-- I 0..1 Date of the diagnosis (when coded diagnosis) -->
  <type><!-- 0..* CodeableConcept Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …) --></type>
  <onAdmission value="[boolean]"/><!-- 0..1 Diagnosis present on Admission -->
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
 </diagnosis>
 <procedure>  <!-- 0..* The list of procedures relevant to this account -->
  <sequence value="[positiveInt]"/><!-- 0..1 Ranking of the procedure (for each type) -->
  <code><!-- I 1..1 CodeableReference(Procedure) The procedure relevant to the account --></code>
  <dateOfService value="[dateTime]"/><!-- I 0..1 Date of the procedure (when coded procedure) -->
  <type><!-- 0..* CodeableConcept How this procedure value should be used in charging the account --></type>
  <packageCode><!-- 0..* CodeableConcept Package Code specific for billing --></packageCode>
  <device><!-- 0..* Reference(Device) Any devices that were associated with the procedure --></device>
 </procedure>
 <
  <</relationship>
  <</account>
 </relatedAccount>

 <parent><!-- 0..1 Reference(Account) Reference to an associated parent Account --></parent>

 <currency><!-- 0..1 CodeableConcept The base or default currency --></currency>
 <<a href="account-definitions.html#Account.balance" title="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." class="dict">

 <balance>  <!-- 0..* Calculated account balance(s) -->

  <aggregate><!-- 0..1 CodeableConcept Who is expected to pay this part of the balance --></aggregate>
  <term><!-- 0..1 CodeableConcept current | 30 | 60 | 90 | 120 --></term>
  <estimate value="[boolean]"/><!-- 0..1 Estimated balance -->
  <amount><!-- 1..1 Money Calculated amount --></amount>
 </balance>
 <calculatedAt value="[instant]"/><!-- 0..1 Time the balance amount was calculated -->
</Account>

JSON Template 

{doco
  "resourceType" : "Account",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Account number
  "status" : "<code>", // R!  active | inactive | entered-in-error | on-hold | unknown
  "billingStatus" : { CodeableConcept }, // Tracks the lifecycle of the account through the billing process
  "type" : { CodeableConcept }, // E.g. patient, expense, depreciation
  "name" : "<string>", // Human-readable label
  "subject" : [{ Reference(Device|HealthcareService|Location|Organization|
   Patient|Practitioner|PractitionerRole) }], // The entity that caused the expenses
  "servicePeriod" : { Period }, // Transaction window
  "covers" : [{ Reference(Encounter|EpisodeOfCare) }], // Episodic account covering these encounters/episodes of care

  "coverage" : [{ // The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account
    "<a href="account-definitions.html#Account.coverage.coverage" title="The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).


    "coverage" : { Reference(Coverage) }, // R!  The party(s), such as insurances, that may contribute to the payment of this account
    "priority" : "<positiveInt>" // The priority of the coverage in the context of this account
  }],
  "owner" : { Reference(Organization) }, // Entity managing the Account
  "description" : "<markdown>", // Explanation of purpose/use
  "guarantor" : [{ // The parties ultimately responsible for balancing the Account
    "

    "party" : { Reference(Organization|Patient|RelatedPerson) }, // Responsible entity

    "onHold" : <boolean>, // Credit or other hold applied
    "

    "period" : { Period }, // Guarantee account during
    "account" : { Reference(Account) }, // A specific Account for the guarantor
    "responsibility" : { Quantity(SimpleQuantity) }, // Responsible %'age of charges
    "limit" : { Money }, // Responsible financial limit
    "rank" : "<positiveInt>" // Rank order of guarator

  }],
  "diagnosis" : [{ // The list of diagnoses relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the diagnosis (for each type)
    "condition" : { CodeableReference(Condition) }, // I R!  The diagnosis relevant to the account
    "dateOfDiagnosis" : "<dateTime>", // I Date of the diagnosis (when coded diagnosis)
    "type" : [{ CodeableConcept }], // Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    "onAdmission" : <boolean>, // Diagnosis present on Admission
    "packageCode" : [{ CodeableConcept }] // Package Code specific for billing
  }],
  "procedure" : [{ // The list of procedures relevant to this account
    "sequence" : "<positiveInt>", // Ranking of the procedure (for each type)
    "code" : { CodeableReference(Procedure) }, // I R!  The procedure relevant to the account
    "dateOfService" : "<dateTime>", // I Date of the procedure (when coded procedure)
    "type" : [{ CodeableConcept }], // How this procedure value should be used in charging the account
    "packageCode" : [{ CodeableConcept }], // Package Code specific for billing
    "device" : [{ Reference(Device) }] // Any devices that were associated with the procedure
  }],
  "
    "
    "
  }],

  "parent" : { Reference(Account) }, // Reference to an associated parent Account

  "currency" : { CodeableConcept }, // The base or default currency
  "<a href="account-definitions.html#Account.balance" title="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." class="dict">balance

  "balance" : [{ // Calculated account balance(s)

    "aggregate" : { CodeableConcept }, // Who is expected to pay this part of the balance
    "term" : { CodeableConcept }, // current | 30 | 60 | 90 | 120
    "estimate" : <boolean>, // Estimated balance
    "amount" : { Money } // R!  Calculated amount
  }],
  "calculatedAt" : "<instant>" // Time the balance amount was calculated
}

Turtle Template 

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


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

  # from 
  # from 

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Account number
  fhir:status [ code ] ; # 1..1 active | inactive | entered-in-error | on-hold | unknown
  fhir:billingStatus [ CodeableConcept ] ; # 0..1 Tracks the lifecycle of the account through the billing process
  fhir:type [ CodeableConcept ] ; # 0..1 E.g. patient, expense, depreciation
  fhir:name [ string ] ; # 0..1 Human-readable label
  fhir:subject  ( [ Reference(Device|HealthcareService|Location|Organization|Patient|Practitioner|
  PractitionerRole) ] ... ) ; # 0..* The entity that caused the expenses
  fhir:servicePeriod [ Period ] ; # 0..1 Transaction window
  fhir:covers  ( [ Reference(Encounter|EpisodeOfCare) ] ... ) ; # 0..* Episodic account covering these encounters/episodes of care

  fhir: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:<a href="account-definitions.html#Account.coverage.coverage" title="The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).


    fhir:coverage [ Reference(Coverage) ] ; # 1..1 The party(s), such as insurances, that may contribute to the payment of this account
    fhir:priority [ positiveInt ] ; # 0..1 The priority of the coverage in the context of this account
  ] ... ) ;
  fhir:owner [ Reference(Organization) ] ; # 0..1 Entity managing the Account
  fhir:description [ markdown ] ; # 0..1 Explanation of purpose/use
  fhir:guarantor ( [ # 0..* The parties ultimately responsible for balancing the Account
    fhir:

    fhir:party [ Reference(Organization|Patient|RelatedPerson) ] ; # 0..1 Responsible entity

    fhir:onHold [ boolean ] ; # 0..1 Credit or other hold applied
    fhir:period [ Period ] ; # 0..1 Guarantee account during
    fhir:account [ Reference(Account) ] ; # 0..1 A specific Account for the guarantor
    fhir:responsibility [ Quantity(SimpleQuantity) ] ; # 0..1 Responsible %'age of charges
    fhir:limit [ Money ] ; # 0..1 Responsible financial limit
    fhir:rank [ positiveInt ] ; # 0..1 Rank order of guarator

  ] ... ) ;
  fhir:diagnosis ( [ # 0..* The list of diagnoses relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the diagnosis (for each type)
    fhir:condition [ CodeableReference(Condition) ] ; # 1..1 I The diagnosis relevant to the account
    fhir:dateOfDiagnosis [ dateTime ] ; # 0..1 I Date of the diagnosis (when coded diagnosis)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type that this diagnosis has relevant to the account (e.g. admission, billing, discharge …)
    fhir:onAdmission [ boolean ] ; # 0..1 Diagnosis present on Admission
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
  ] ... ) ;
  fhir:procedure ( [ # 0..* The list of procedures relevant to this account
    fhir:sequence [ positiveInt ] ; # 0..1 Ranking of the procedure (for each type)
    fhir:code [ CodeableReference(Procedure) ] ; # 1..1 I The procedure relevant to the account
    fhir:dateOfService [ dateTime ] ; # 0..1 I Date of the procedure (when coded procedure)
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* How this procedure value should be used in charging the account
    fhir:packageCode  ( [ CodeableConcept ] ... ) ; # 0..* Package Code specific for billing
    fhir:device  ( [ Reference(Device) ] ... ) ; # 0..* Any devices that were associated with the procedure
  ] ... ) ;
  fhir:
    fhir:
    fhir:
  ] ... ) ;

  fhir:parent [ Reference(Account) ] ; # 0..1 Reference to an associated parent Account

  fhir:currency [ CodeableConcept ] ; # 0..1 The base or default currency
  fhir:<a href="account-definitions.html#Account.balance" title="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." class="dict">balance

  fhir:balance ( [ # 0..* Calculated account balance(s)

    fhir:aggregate [ CodeableConcept ] ; # 0..1 Who is expected to pay this part of the balance
    fhir:term [ CodeableConcept ] ; # 0..1 current | 30 | 60 | 90 | 120
    fhir:estimate [ boolean ] ; # 0..1 Estimated balance
    fhir:amount [ Money ] ; # 1..1 Calculated amount
  ] ... ) ;
  fhir:calculatedAt [ instant ] ; # 0..1 Time the balance amount was calculated
]

Changes from both R4 and R4B

Account
Account.billingStatus
  • Added Element
Account.covers
  • Added Element
Account.description
  • Type changed from string to markdown
Account.guarantor.party
  • Min Cardinality changed from 1 to 0
Account.diagnosis Account.guarantor.account
  • Added Element
Account.diagnosis.sequence Account.guarantor.responsibility
  • Added Element
Account.diagnosis.condition Account.guarantor.limit
  • Added Mandatory Element
Account.diagnosis.dateOfDiagnosis Account.guarantor.rank
  • Added Element
Account.diagnosis.type Account.diagnosis
  • Added Element
Account.diagnosis.onAdmission Account.diagnosis.sequence
  • Added Element
Account.diagnosis.packageCode Account.diagnosis.condition
  • Added Mandatory Element
Account.procedure Account.diagnosis.dateOfDiagnosis
  • Added Element
Account.procedure.sequence Account.diagnosis.type
  • Added Element
Account.procedure.code Account.diagnosis.onAdmission
  • Added Mandatory Element
Account.procedure.dateOfService Account.diagnosis.packageCode
  • Added Element
Account.procedure.type Account.procedure
  • Added Element
Account.procedure.packageCode Account.procedure.sequence
  • Added Element
Account.procedure.device Account.procedure.code
  • Added Mandatory Element
Account.relatedAccount Account.procedure.dateOfService
  • Added Element
Account.relatedAccount.relationship Account.procedure.type
  • Added Element
Account.relatedAccount.account Account.procedure.packageCode
  • Added Element
Account.procedure.device
  • Moved from Account.partOf to account Added Element
Account.parent
  • Min Cardinality changed Renamed from 0 partOf to 1 parent
Account.currency
  • Added Element
Account.balance
  • Added Element
Account.balance.aggregate
  • Added Element
Account.balance.term
  • Added Element
Account.balance.estimate
  • Added Element
Account.balance.amount
  • Added Mandatory Element
Account.calculatedAt
  • Added Element

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON .

See R4 <--> R5 Conversion Maps (status = See Conversions Summary .)

 

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

8.13.5.1 8.12.5.1 Terminology Bindings

?? Example Account.relatedAccount.relationship
Path ValueSet Type Documentation
Account.status AccountStatus Required

Indicates whether the account is available to be used.

Account.billingStatus AccountBillingStatus (a valid code from Example Account Billing Statuses ) Example

Indicates whether the account is available to be used for billing purposes.

Account.type AccountTypes Example

This examples value set defines the set of codes that can be used to represent the type of an account.

Account.diagnosis.condition ConditionProblemDiagnosisCodes Example

Example value set for Condition/Problem/Diagnosis codes.

Account.diagnosis.type EncounterDiagnosisUse Preferred

What a specific Encounter/EpisodeOfCare diagnosis.condition is to be used for.

Account.diagnosis.packageCode ?? Example
Account.procedure.code ProcedureCodesSNOMEDCT Example

Procedure Code: All SNOMED CT procedure codes.

Account.procedure.type ?? Example
Account.procedure.packageCode AccountRelationship Example Relationship between accounts
Account.currency Currencies (a valid code from urn:iso:std:iso:4217 ) Required

Currency codes from ISO 4217 (see https://www.iso.org/iso-4217-currency-codes.html)

Account.balance.aggregate AccountAggregate Extensible

Indicates who is expected to pay a part of the account balance.

Account.balance.term AccountBalanceTerm Extensible

Indicates the account balance's age.

8.13.5.2 8.12.5.2 Constraints

UniqueKey Level Location Description Expression
img  act-1 Rule Account.diagnosis The dateOfDiagnosis is not valid when using a reference to a diagnosis condition.reference.empty().not() implies dateOfDiagnosis.empty()
img  act-2 Rule Account.procedure The dateOfService is not valid when using a reference to a procedure code.reference.empty().not() implies dateOfService.empty()

8.12.6 Notes

8.12.6.1 Perpetual and Episodic Accounts

There may be two types of accounts that are used to track billing activities with medical systems:

  • Episodic Account: 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.
    Episodic 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.
    Episodic Accounts are intended to be communicated using the Account.covers property.
  • Perpetual Account A long running account that accumulates charges and payments associated with a specific beneficiary. This account is often open for as long as the beneficiary has a relationship with the healthcare organization. It may be linked to an EpisodeOfCare. A beneficiary may have different perpetual accounts. For example, one for charges related to car crash (i.e., third party liability). One associated with charges related to a research study the patient is participating in. And one for their general personal/family care, which would be covered by their normal insurance.
    Perpetual Accounts are intended to be communicated using the Encounter.account or EpisodeOfCare.account properties.

8.12.6.2 References to Patient

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 .

8.13.6 8.12.7 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

relatedaccount reference Parent and other related accounts Account.relatedAccount.account ( Account )
Name Type Description Expression In Common
guarantor reference The parties ultimately responsible for balancing the Account Account.guarantor.party
( Organization , Patient , RelatedPerson )
guarantor-account reference Account to use for the guarantor Account.guarantor.account
( Account )
identifier token Account number Account.identifier 65 58 Resources
name string Human-readable label Account.name
owner reference Entity managing the Account Account.owner
( Organization )
patient reference The entity that caused the expenses Account.subject.where(resolve() is Patient)
( Patient ) 		66 60 Resources
period date Transaction window Account.servicePeriod
status token active | inactive | entered-in-error | on-hold | unknown Account.status
subject reference The entity that caused the expenses Account.subject
( Practitioner , Organization , Device , Patient , HealthcareService , PractitionerRole , Location )
type token E.g. patient, expense, depreciation Account.type 11 10 Resources