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.

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

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

This element is labeled as a modifier because the status contains the codes inactive and entered-in-error that mark the Account as not currently valid.

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.

Categorizes the account for reporting and searching purposes.

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

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.

Accounts can be applied to non-patients for tracking other non-patient related activities, such as group services (patients not tracked, and costs charged to another body), or might not be allocated.

The date range of services associated with this account.

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

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.

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

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

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

Local or jurisdictional business rules may determine which coverage covers which types of billable items charged to the account, and in which order. Where the order is important, a local/jurisdictional extension may be defined to specify the order for the type of charge.

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.

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

It is common in some jurisdictions for there to be multiple coverages allocated to an account, and a sequence is required to order the settling of the account (often with insurance claiming).

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

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

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

The entity who is responsible.

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

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

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).

Ranking of the diagnosis (for each type).

The diagnosis relevant to the account.

Ranking of the diagnosis (for each type).

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

Was the Diagnosis present on Admission in the related Encounter.

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

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).

Ranking of the procedure (for each type).

The procedure relevant to the account.

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.

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

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

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

Other associated accounts related to this account.

Relationship of the associated Account.

Reference to an associated Account.

The default currency for the account.

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.

Who is expected to pay this part of the balance.

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

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).

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

Time the balance amount was calculated.

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