Charge Item Definition

A Charge Item Definition specifies what items/services can be billed and how pricing or conditions are applied. Think of it as the price catalog plus rule engine for your billing system. Each definition includes a billing code, base price or rate, plus optional surcharges, discounts, or taxes. It can also contain rules about when to apply these pricing components—for example, a certain code might only apply to patients of a specific age group, or only for inpatient encounters.

This resource allows your HMIS to automatically derive the appropriate cost of a service or product by referencing the relevant Charge Item Definition. If you later update your official price list, that change is made once in the definition, and all future charges referencing it will use the updated pricing logic. Complex logic (like time-of-day surcharges, tax rules, or special discounts) can also be embedded here.

Schema Definition

{
  "id": "<str>",                  // Internal Identifier
  "version": "<string>",          // Version 
  "title": "<string>",            // Name for this charge item definition
  "slug": "<string>",             // URL-friendly identifier
  "derivedFromUri": "<uri>",      // Was this from a URL
  "status": "<string>",           // draft | active | retired | unknown
  "facility": "<id|fk>",          // Facility where this Charge Item Definition is created
  "description": "<markdown>",    // Natural language description of the charge item definition
  "purpose": "<markdown>",        // Why this charge item definition is defined
  "code": "<code>",               // Billing code or product type this definition applies to
  "instance": [
    { "ActivityDefinition|Medication" }  // Resources this definition can apply to
  ],
  "propertyGroup": [{             // Group of properties which are applicable under the same conditions
    "applicability": [{           // Whether or not the billing code is applicable
      "condition": { "Expression" }  // Boolean-valued expression
    }],
    "priceComponent": [{ "MonetaryComponent" }]  // Components of total line item price
  }]
}

Monetary Component Definition

{
  "type": "<string>",           // base | surcharge | discount | tax | informational
  "code": "<code>",             // Codes to differentiate taxes, surcharges, discounts etc.
  "factor": "<decimal>",        // Factor used for calculating this component
  "amount": {
    "value": "<decimal>",       // Numerical value (with implicit precision)
    "currency": "<string>"      // ISO 4217 Currency Code
  }
}

Core Data Structure

Essential Fields

Field	Description	Technical Notes
id	Internal system identifier	Primary key, auto-generated
version	Version number of the definition	Supports tracking changes over time
title	Human-readable name of the charge item	Used in selection interfaces and reports
slug	URL-friendly identifier	Used for API endpoints and references
status	Current state of the definition	Controls whether it can be used for billing
facility	Healthcare facility reference	Used for facility-specific pricing
description	Detailed description of the charge item	Provides context for billing staff
code	Billing code or identifier	Links to standard coding systems when possible
instance	Reference to clinical resources	Shows which clinical activities can trigger this charge
propertyGroup	Container for pricing rules	Groups related pricing components

Status Values

Status Value	Description	System Behavior
draft	Definition is being created or updated	Not yet available for charging
active	Definition is currently in use	Can be selected for charging
retired	Definition is no longer used	Not available for new charges but preserved for historical records
unknown	Status cannot be determined	Used for imported data with unclear status

Price Component Types

Component Type	Description	Usage
base	Core price of the service or item	Starting point for all calculations
surcharge	Additional charge on top of base price	Used for extras or special conditions (e.g., after-hours service)
discount	Reduction from base price	Used for special programs or agreements
tax	Statutory charges required by law	Applied based on tax regulations
informational	Non-charging line items	Used to show calculations or for documentation

Business Logic

1. Single Source of Truth: All billable items must have a corresponding Charge Item Definition. Users can only bill codes that exist here, ensuring consistent naming/pricing.
2. Lifecycle:
   • draft definitions should not appear in standard picklists for charge entry.
   • active definitions appear in the billing UI.
   • retired definitions are hidden from new usage but remain valid for historical bills.
3. Price Calculation: At the moment a user (or system) creates a Charge Item referencing this definition:
   • Evaluate each propertyGroup in order. For those whose conditions pass, accumulate the price components (base, surcharge, discount, tax, etc.).
   • Derive the final unit price or total by combining those components.
   • If multiple property groups apply, they can be additive. For example, base price = 100, night surcharge = 20, tax = 5% → final = 126.

Step-by-Step User Workflows

Though staff typically do not interact with Charge Item Definitions daily (they are more of an admin function), here is how the workflow might look for a billing administrator:

1. Navigate to “Charge Item Definitions” Admin Screen

   • Only users with proper roles (billing manager) can edit these definitions.

2. Create or Edit a Definition

   • Enter basic info: code, title, description.
   • Set status to active once ready.
   • Define or update propertyGroup details—like base price, potential surcharges, discount conditions.

3. Save & Activate

   • The definition now appears in the system’s reference data.
   • If staff add charges referencing this code, the system automatically uses these pricing rules.

4. Retire a Definition

   • If no longer used, set status to retired. The system hides it from new charge entry. Existing references remain valid historically.

5. Verify Pricing

   • Admin or finance staff can test conditions to confirm the definition yields correct amounts. E.g., “Patient over 60 -> 10% discount is working as intended.”

Deactivating (Retiring) a Charge Item Definition:

• If a service is no longer offered or a code is deprecated, an admin can mark it as Inactive. This usually involves editing the definition and unchecking an “Active” box or setting a termination date.
• Save the change. Inactive definitions are typically hidden from the charge entry UI so that staff won’t accidentally use them. If they try to use an inactive code (say by typing it manually), the system should reject it.
• The definition remains in the database for reference (especially for old records that used it), but it’s not available for new charges. If there’s a replacement code, the admin might add a note like “Replaced by CODE123 as of 2025”.

Viewing the Catalog:

• The Charge Item Definition list can usually be viewed in a table format by authorized users. It might show columns: Code, Description, Price, Unit, Active/Inactive, etc.
• Users (like billing staff) with view-only access can search this list to find how something is billed. For example, “How much is the charge for an MRI spine?” They can find the definition entry for MRI spine which says, e.g., $400.
• This ensures transparency: staff can answer patient queries about costs using the official catalog.