After reviewing your (@ericaVoss and @jweave17) comments, I believe we can capture all of your costs, charged, and paid amounts in one line using a cost_type_concept_id of "claims database" of some sort since all of that information comes from a claims database. We would have to add that cost_type_concept_id.
Strictly speaking, the "cost" variable does not come from raw claims data (as from the ANSI 837/835 file), but it is housed in, what researchers would categorize as, a "claims database". So the cost_type_concept_id could refer to the provenance of the database as a whole. So you can have all of your cost variables under one cost record.
As to indicating the direction of the costs (or perspective), the total_paid and the payer_plan_period_id should define it. If you see an amount in the total_paid field, and there is data in the payer_plan_period_id, then that should tell the analyst that the payer represented in the payer_plan_period_id is the entity that actually PAID the provider the amount in the total_paid field. Then the total_charged field is what was charged to the payer. The paid_patient_copay, paid_patient_deductible, and paid_patient_coinsurance is the amount the payer stated what the patient is responsible for - but NOT what was actually paid. If you have data that shows what the patient actually paid to the provider, then that should be a separate cost record, the total_paid field should be populated with what the patient paid, and the payer_plan_period_id should either reference the patient (if applicable) or set to "0" as per the documentation. Please note that these fields come from claim standards (ANSI 837/835 specifications) because those are the only standards that exist at the moment. Even though this is very claims-centric, EHR cost data is also structured this way (most likely to gather information about patients from claims payments). The only issue I see is if accounting data is trying to be recorded in the CDM (aka a hospital's Quicken entries). I'll wait for the use case on this since I have a hard time seeing how accounting data relates to the patient, which is the whole point of the CDM.
The last outstanding issue I see is what to do with the existing cost_type_concept_ids since they do not seem to represent the provenance of cost data. Maybe retire them?