Balance (patient and guarantor)

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Shilpa sunil kumar

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May 12, 2020, 6:22:12 AM5/12/20
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Hi,

I have few questions on Balance .

1.I see guarantor balance returned on using patient, identifier, type='statement' combination. Is there a way to get the Balance without knowing the statementid?
2.How to get the patient level balance? I see we have an option to get balance by directly providing the AccountID. But, when i try with some AccountId's the extension only doesn't exist
eg:"resourceType": "Account",
        "id": "F703726",

whereas when i try with this,
eg:"resourceType": "Account",
        "id": "S2580833"
i do get back the extension with account-balance

3.What is the accountid that is returned in extension:account-related-parts for ? does it refer to gurantor Accountid?
4.Does every patient have an AccountId, if so, will passing AccountId to the FHIR  yield the patient-level balance ?(Retrieve by Id)
5. Similarly I see a patient has 3 guarantors in the guarantor, so is the account-balance sum of all 3 guarantor balances?

Thank you,
Shilpa

Alex Beckner (Cerner)

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May 12, 2020, 2:50:16 PM5/12/20
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Hi Shilpa,

Please see below for responses to your questions.

1. Account balance is available when performing a search by _id for statement and guarantor-balance types or using the patient, identifier, type='statement' combination.
2. As per our Account Search Implementation Notes, the Account balance extension is only returned on statement and guarantor-balance types. F703726 is a financial-account (patient account) type.
3. The accounts returned in the account-related-parts extension are guarantor-balance (self-pay balances).
4. Every patient does have a financial-account type. Performing a retrieve by Id on the statement and guarantor-balance account types will yield the balance.
5. Yes. The account-balance would be the total self-pay balance.

Regards,
Alex (Cerner)

Shilpa sunil kumar

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May 13, 2020, 8:21:30 AM5/13/20
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Hi Alex,

Thank you for your quick response.I have some further doubts on the below mentioned areas.

1.Account balance is available when performing a search by _id for statement and guarantor-balance types -
 I tried the same data : _id=F703726&type=guarantor-balance.I get an error saying "type: must be one of financial-account or statement".
I tried the same data: _id=F703726&type=statement i get an error : "type: unsupported when _id is provided"
Can you please give me a sample data for which i can try the guarantor-balance type. and what data/combination i should use for guarantor-balance type?

2.As per our Account Search Implementation Notes, the Account balance extension is only returned on statement and guarantor-balance types. F703726 is a financial-account (patient account) type.
How do i differentiate between financial-account type and others? And also is it like a call using _id would yield a 'financal-account' id and search via patient, identifier, type='statement' combination yields other account types.
Which account type will yield me an account-balance extension when I use Retrieve By Id and how can i get that Account Id?


4.Every patient does have a financial-account type. Performing a retrieve by Id on the statement and guarantor-balance account types will yield the balance.
I am not able to get response when i try the combination mentioned in Point 1. 
Can you please give me a working combination so I can try it out with AccountId and guarantor-balance type


6.Is it possible to get the AccountId associated with the patient with just the patientid and without having to provide the statementid(identifier), which can be obtained from the patient only. If so, can you please let me know the FHIR call to be used to get the AccountId and  the combination of data to be passed with a sample one so i can try it out.

Thank you,
Shilpa

Alex Beckner (Cerner)

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May 13, 2020, 10:54:59 AM5/13/20
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Hi Shilpa,

Please see the R4 Account documentation for the supported search capabilities and example requests and responses. Most of your questions are answered in the documentation.

1. A search by _id should not include the 'type' as a parameter. The first example provided in the Account documentation shows how to search by _id.
2. There is a 'type' field in the Account response that differentiates the different account types. A call by _id is supported for all account types. As previously stated, "the Account balance extension is only returned on statement and guarantor-balance types". Unless you have a way to receive the Account Ids directly from the client, a search by patient, identifier, type='statement' combination is the only way to get to the accounts that will return a balance.
4. Same as answer 1.
6. As per our R4 Account documentation, it is not currently supported to search for Accounts with just the patient Id. 

Regards,
Alex (Cerner)

Shilpa sunil kumar

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May 14, 2020, 2:01:53 AM5/14/20
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Hi Alex,

Thank for your response.

I think i should have phrased the question little differently.

So, you say a GET using  " patient, identifier, and type", will yield the GuarantorAccountId  in "account-related-parts" extension (i.e, an accountId that starts with a "G") and also the guarantor-balance of the patient in "account-balance" extension.
And further retrieve using the GuarantorAccountId obtained in the previous call will fetch the patient-balance.

Please correct me if i am wrong. Thank you so much for your patience.

Regards,
Shilpa



Alex Beckner (Cerner)

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May 14, 2020, 9:26:50 AM5/14/20
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Hi Shilpa,

A search using patient, identifier, type='statement' will return a statement account type with the originally billed statement amount in the "account-balance" extension and references to guarantor-balance account Ids in "account-related-parts" extension. The guarantor-balance account Ids can then be searched/retrieved to get the most up to date balances for the self-pay balances that were billed on that statement.

I hope this information helps.

Kind regards,
Alex (Cerner)

Shilpa sunil kumar

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May 15, 2020, 10:18:55 AM5/15/20
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Hi Alex,

Thank you! The information you provided is really helpful.

I am kind of stuck with fetching patient-balance. Say, the guarantor balance which I get using Retrieve By Id on the guarantor account id will fetch me the respective latest guarantor balance and since the guarantor might be supporting more than one patient, this may or may not be same as the patient-balance right.

I tried sending the financial account Id to Retrieve By Id call, but i don't get the account-balance extension as expected and mentioned in the R4 Account Documentation.
I also tried Retrieve By Id  with "S2580833", not sure what Account it is (neither financial nor guarantor i guess) ,and i do not get the account-balance extension.

"Every patient does have a financial-account type. Performing a retrieve by Id on the statement and guarantor-balance account types will yield the balance." I am not able to exactly follow the process of getting the patient-account balance specifically.
How will I be able to get the balance that is specific to a particular patient or patient account and not the guarantor-account.

Regards,
Shilpa

Alex Beckner (Cerner)

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May 15, 2020, 11:55:43 AM5/15/20
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Hi Shilpa,

The guarantor-balance account type represents a single self-pay balance for a given encounter and not the Millennium guarantor account concept. The current balance retrieval capabilities of the Account resource are limited to retrieving balances for a given statement. There is not currently a way to obtain a holistic patient or guarantor account balance, unless you know the statement identifiers. 

I am assuming you attempted a Retrieve by Id on financial-account F703726 as that is the account you previously mentioned. As I previously mentioned and per our Account Search Implementation Notes, the Account balance extension is only returned on statement and guarantor-balance types. F703726 is a financial-account type, so it will never return an account-balance extension.

I receive a account-balance extension value of 2000.00 when I attempt a Retrieve by Id  for account S2580833. I have highlighted the account-balance extension in the response provided below.

{
    "resourceType": "Account",
    "id": "S2580833",
    "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Account</b></p><p><b>Account Type</b>: statement</p><p><b>Service Period Start Date</b>: Aug 13, 2019  3:01 P.M. UTC</p><p><b>Patient</b>: Patient/6330017</p><p><b>Status</b>: active</p><p><b>Statement Number</b>: 68002</p><p><b>Guarantor</b>: 6330015-6330017</p></div>"
    },
    "extension": [
        {
            "valueMoney": {
                "value": "2000.00",
                "currency": "USD"
            }
        },
        {
            "valueCodeableConcept": {
                "coding": [
                    {
                        "code": "20752989",
                        "display": "Pending",
                        "userSelected": true
                    }
                ],
                "text": "Pending"
            }
        },
        {
            "valueReference": {
                "reference": "Account/G2572738"
            }
        }
    ],
    "identifier": [
        {
            "use": "usual",
            "value": "68002"
        }
    ],
    "status": "active",
    "type": {
        "text": "statement"
    },
    "subject": [
        {
            "reference": "Patient/6330017"
        }
    ],
    "servicePeriod": {
        "start": "2019-08-13T15:01:17Z"
    },
    "owner": {
        "reference": "Organization/1259855"
    },
    "guarantor": [
        {
            "party": {
                "reference": "RelatedPerson/6330015-6330017"
            }
        }
    ]
}
 
Kind regards,
Alex (Cerner)

Shilpa sunil kumar

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May 18, 2020, 4:42:31 AM5/18/20
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Hi Alex,

Thank you for the detailed explanation!

Regards,
Shilpa.S
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