Difference between revisions of "Invoice FHIR Resource Proposal"

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==Resource appropriateness==
 
==Resource appropriateness==
  
<!-- Does the resource meet the following characteristics?
+
Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. This resource provides the details of the invoice, and which items are allocated to it.
 
 
Must
 
* Represents a well understood, "important" concept in the business of healthcare
 
* Represents a concept expected to be tracked with distinct, reliable, unique ids
 
* Reasonable for the resource to be independently created, queried and maintained
 
 
 
Should
 
* Declared interest in need for standardization of data exchange</span>
 
* Resource is expected to contain an appropriate number of "core" (non-extension) data elements (in most cases, somewhere in the range of 20-50)
 
* Have the characteristics of high cohesion & low coupling – need to explore whether coupling is good some places, not elsewhere – layers from Bo’s document
 
-->
 
 
 
Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. This resource provides the individual items to track.
 
  
 
Competing invoicing standards such as EDIFACT or X12 are aiming at inter-organisational exchange and do not offer human readable representations or traceable links to services rendered which is a requirement for invoicing towards patients.
 
Competing invoicing standards such as EDIFACT or X12 are aiming at inter-organisational exchange and do not offer human readable representations or traceable links to services rendered which is a requirement for invoicing towards patients.

Revision as of 17:43, 17 January 2019



Invoice

Owning committee name

Financial Management

Committee Approval Date:

PA Approval (4 April 2018 Brian Postlethwaite/Simone Heckmann 3-0-0)

Contributing or Reviewing Work Groups

Patient Administration


FHIR Resource Development Project Insight ID

pending

Scope of coverage

In cases where the provider bills another party directly for products and/or services, an Invoice is used. An invoice is a financial instrument issued by a Healthcare provider to a patient or other party indicating the goods and services performed with their quantities and prices.

The Claim resource is constricted to use cases where a request for reimbursement is sent on behalf of the insured to an insurance for reimbursement under a specified policy.

An Invoice can use ChargeItems in an Account to provide the details to support the creation of an Invoice.

RIM scope

ActInvoiceEvent

Resource appropriateness

Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. This resource provides the details of the invoice, and which items are allocated to it.

Competing invoicing standards such as EDIFACT or X12 are aiming at inter-organisational exchange and do not offer human readable representations or traceable links to services rendered which is a requirement for invoicing towards patients.

Expected implementations

  • Any solution that tracks billing information and needs to issue invoices
  • Private Insurance Providers who want to deliver structured information to patients to increase cost transparency
  • Patient apps that want to include information on the amount and reason of the charged costs for the healthcare services a patient received
  • Interested parties: SAP, IBM, Association of Private Insurers in Germany
  • more interested parties: https://chat.fhir.org/#narrow/stream/4-implementers/topic/Invoices

Content sources

Existing normative V3 and V2 specifications

Example Scenarios

  • Invoicing between systems that primarily interact using FHIR API
  • Patient Apps

Patient apps may chose to not only give patients access to their health data but also to the charges assoicated with them (e.g. provide insight into the cost for medications, treatments and immunizations). Such apps will require structured invoices to allow association between the charges and the services rendered.

Apps can provide abilities to trace and compare costs or deliver additional information as to the meaning of specific billing codes.

It is convenient for both patientes and implementers to be able to exchange billing information through the same app based on the same standard as other information a patiant may want to take home from a doctor's visit or an inpatient tratment such as medication plans or lab results.

These internally created and processed FHIR based invoices may be mapped to other standards such as X12 for posting in external systems.

Resource Relationships

  • Reference to Account (account)
  • Reference to ChargeItems (items)
  • Reference to Encounter/EpisodeOfCare (via Account) (context)
  • Reference to Patient|Group (subject)
  • Reference to any type of Request/Referal (basedOn) (via Account)
  • Reference to any type of Event (service)
  • Payor (Organization|Patient|RelatedPerson)

Referenced by:

  • Claim


Timelines

The aim is to have a draft (Maturity 0) ready for 4.0 timeline.

gForge Users

brianpos simoneheckmann

When Resource Proposal Is Complete

When you have completed your proposal, please send an email to FMGcontact@HL7.org