Understanding the Redox Financial Data Model

When do I need to use the Financial Data Model?

The Financial Data Model is used for the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the Financial data model is to enable the billing process and internal cost allocation.

Simply put, this Data Model conveys to (0r from) the EHR when the patient owes something for a medication, lab, test, or other care (bed charges).

When and where can the Financial Data Model be found?

Almost all EHRs have support for the Financial Data Model in order to facilitate financial transactions between the main EHR, third party systems producing charges, and any external billing systems. Typically this is facilitated through an DFT HL7v2 interface or vendor specific API.

Does this mean Redox can integrate with Practice Management Systems as well as EHRs?

We can support integrations with practice management systems as well as other revenue cycle specific products. If we have not already integrated with a specific system that you’re interested in, we’re happy to speak with the vendor and identify their integration capabilities and how we could support a connection with them via Redox.

Can I use the Financial Data Model to post a charge without an encounter?

Most (if not all) EHRs and Practice Management systems will require that you have a specific encounter or visit that you’re posting the charge to. However, some EHRs do support a concept of “billing only encounters”. One common use case for billing only encounters is when a provider performs rounds at a nursing home that doesn’t have an EHR or PM system, so providers are instead forced to bill out of their primary EHR at their typical practice location. In these scenarios, the charges associated with the physician’s rounding are often entered into an EHR at a later date and applied a billing only encounter.

Can I post patient payments with the Financial Data Model?

Yes, you can post patient payments with our Financial Data Model! However, it’s important to consider how the payment will be received and applied to past balances when scoping out a potential workflow.

EHRs will typically have minimal (if any) support for applying a payment to a specific portion of an outstanding balance. Instead, a healthcare organization will typically decide during their initial setup process how they’d like patient payments to apply to past balances. This could mean that all new payments are automatically applied to the oldest balance first (FIFO) regardless of whether or not that balance had any association with your application or they could use a more custom method where a percentage is applied to professional fees before any payments are applied to hospital fees.

There are quite a few different methods that an organization could use when applying payments, so it’s important to discuss this with your partners if you’re looking to include patient payments in your workflow.

What information do we need to post a charge?

We list several items in our data model documentation as required, but it’s important to recognize that EHRs and Practice Management systems will often utilize their own unique terminology and could require additional data to successfully post charges and payments (we do update our documentation whenever we identify new requirements from EHRs).

At a bare minimum, any workflows that will leverage our Financial Data Model to post charges should be prepared to identify a patient ID and charge code. It’s important to note that EHRs or healthcare organizations may use the different charge codes. As a result, you may need to import and maintain a list of charge codes on your end.

In some scenarios, you may also be required to include a visit ID and provider ID associated with the charge. In cases where charges are not generated by a provider during an encounter (ex. home care, or patient tracking scenarios), EHRs may support using a generic provider and a billing only encounter to allow you to post charges without a provider and visit ID.

How does the Financial Data Model differ from the Claim Data Model?

Both the Claim and Financial Data Models deal with fiscal aspects of a patient’s care, but differ in several ways:

  1. Claim messages are generally roughly the summary of all the patient’s Financial charges in an account, with Claim being the amount that the hospital wants to actually bill that is sent to an insurer after care is complete.
  2. Financial occurs on the fly during a patient’s care, whereas Claim is typically sent or received once after an admission or encounter is concluded.