Stream: Orders and Observation WG
Topic: Multiple coverage resources
Yassiel Oliva (Feb 28 2019 at 17:18):
Hi, I have a use case like this: "a ServiceRequest created with a coverage defined" now I want to be able to tag that the servicerequest as "free-of-charge" from the point of view of the requester (Practitioner) because someone else is taking care of that. I'm wondering if would be ok to include a new coverage in the ServiceRequest. I would need to do that and mark the old coverage as cancelled and the new one active
Thanks
Lloyd McKenzie (Feb 28 2019 at 17:23):
Coverage is specific to the patient, not the action. ChargeItem is what allows you to capture both the charge associated with the service as well as what account it's going to be charged against. The Account might be one that's managed internally for "free" services, could be associated to Coverage that's intended to cover all or part of the charges, list the guarantors who are responsible for paying for the account, or provide financial information such as a credit card number to bill to.
Yassiel Oliva (Feb 28 2019 at 21:34):
the problem with ChargeItem is we don't have a way to link the charge items directly to the task or the ServiceRequest. we will need to create an encounter to establish the relationship. the other possibility is to use DiagnosticReport for the link but I feel that's not the right place :thinking:
Lloyd McKenzie (Feb 28 2019 at 23:20):
Ah, I see the issue. ChargeItem allows capture of the actual charge once the thing is done, not the potential charge for what's intended to be done. And it needs to be in the context of a specific patient and specific time, so it can't just generically point to ChargeDefinition. @Simone Heckmann @Brian Postlethwaite
Simone Heckmann (Mar 01 2019 at 17:34):
Hmmm... I believe we never considered the requester logging chargeitems. Wouldn’t it be normally the providers call to decide if and how services rendered are being charged? The semantics of what you describe are that the requester asks for a service to be provided free of charge, correct? The actual task of zeroing the cost for a chargeitem or placing it into a specific account would be done by the provider...?
Simone Heckmann (Mar 01 2019 at 17:35):
...or potentially refusing to do it for free ;-)
Simone Heckmann (Mar 01 2019 at 17:36):
Maybe it would make sense, if a ServiceRequest could somehow indicate into which Account the charges for the service should go?
Lloyd McKenzie (Mar 01 2019 at 17:36):
In some cases, there can be a charge for actually creating the order. (I've been charged by the vet for them writing a prescription.) There can also be information on "expected" cost and "expected" payment arrangements - what account, insurance, pre-authorization, etc. applies to the events tied to the order. I think we need to support both.
Simone Heckmann (Mar 01 2019 at 17:38):
Would it help if ChargeItem.service included ServiceRequest as a potential target?
Yassiel Oliva (Mar 01 2019 at 19:42):
yes, @Simone Heckmann that will work for us
Simone Heckmann (Mar 01 2019 at 19:43):
Can you log a change request, please?
Yassiel Oliva (Mar 01 2019 at 19:46):
sure thing. I just don't know where I should do that ;)
Lloyd McKenzie (Mar 01 2019 at 20:06):
Keep in mind that ChargeItem.service pointing to the order would generally be the charge for creating the order, not for providing the service being ordered. There's a need for both and it should be clear which is which.
Yassiel Oliva (Mar 01 2019 at 21:25):
So if I want to perform the tests and later make that free of charge to the patient, I would need to do that using ChargeItem with a reference to the DiagnosticReport. that's correct?
Lloyd McKenzie (Mar 01 2019 at 21:26):
Yes. In fact, it'd be a ChargeItem whether you choose to make it free of charge or not :)
Yassiel Oliva (Mar 01 2019 at 21:27):
thanks!
Brian Postlethwaite (Mar 02 2019 at 20:19):
As @Simone pointed out, please remember that a free service isn't free, it's just charged somewhere else, so the cost is being allocated to a different account.
Finance will be tracking how much of that they do... And why.
Last updated: Apr 12 2022 at 19:14 UTC
