JP2009032129A - Payment request office work proxy system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a payment request office work proxy system for surely preventing intentional fraudulent request from a bonesetter's office, a massage office or the like. <P>SOLUTION: The payment request office work proxy system is provided with a center system interposed between a medical institution system managed by a medical institution and an examination system managed by a medical bill examination/payment institution and managed by a request office work proxy subject, and an operator's portable terminal 20 carried by an operator. An installation 50 on which a specific code allowed to be read out by the operator's portable terminal 20 is installed in a user's house in advance. In visiting for home medical care, the specific code of the installation 50 read out by using a reader part 21 and the longitude/latitude information of a present position acquired by a GPS part 22 are transmitted. The center system analyzes the specific code information of the installation 50 and the longitude/latitude information acquired by the GPS part 22, confirms the visit to the user house and the execution of massage operation, and after confirming no fraudulent request, automatically prepares a medical bill. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

The present invention relates to a payment request office work system such as medical expenses. More specifically, the present invention provides a billing agency service that enables objective receipt creation processing and medical treatment billing agency processing that cannot be illegally billed for home visit-type massage and massage shiatsu treatment. About the system.
Here, the receipt refers to the receipt examination payment organization (National Health Insurance Association (National Health Insurance Federation), Social Insurance Medical Fee Payment Fund (Payment Fund)) to request payment of medical fees, nursing care fees and medical expenses. This is a payment request application submitted.
The practitioner refers to the user at home, such as a home visit type, such as a Satsuma, massager, acupressure, judo reduction teacher, caregiver, care service provider who performs massage, shiatsu, etc. A person who provides services.

Under the health insurance system and the national health insurance system, medical fees are determined for each medical practice such as medical surgery, medication, and testing for the user. In accordance with the rules, use the created receipt to ask the insurer to which the user belongs to pay medical expenses.
For those who continue to be treated for a long time, such as the Osteopathic Hospital, Acupuncture Clinic, Satsuma Massage Hospital, etc., the medical expenses are determined for each medical treatment, and the medical treatment period for which these medical treatments are performed is created in accordance with the rules for claims for medical expenses. Using the received receipt, ask the insurer to whom the user belongs to pay the medical expenses.

FIG. 9 is a diagram showing an outline of payment request, examination, and payment of medical fees for conventional general judo reduction and massage.
User A presents an insurance card to the practitioner, and after the practitioner has written an interview sheet and the like, a treatment plan is made. For osteoclast treatment and sprain treatment that require long-term medical treatment, an application for payment of medical expenses is required when requesting medical expenses. This medical treatment payment application form requires a user's signature, but the timing of receipt preparation processing and receipt sending processing for payment request does not match the timing of the user's visit, so it is used at the time of receipt creation / delivery It is practically difficult to get a person's autograph, and the current situation is that the user is autographed at the first visit and a blank page is attached.
The practitioner prepares a receipt for the practicing action and notifies the insurer (municipal municipal public health association, mutual aid association, health insurance association) D directly. The insurer D examines the legitimacy of the receipt, and if it is legitimate, pays a medical fee to the medical institution B.

  Here, as shown in FIG. 9, since the practitioner and the like have been making billing work for the receipt of the receipt, there has been a problem of improper medical expenses. Inappropriate medical expenses may be billed for errors due to negligence or intentional fraud. It is easy to prevent mistaken claims due to negligence by devising check methods such as checking the suitability of medical treatment contents and insurance scores, and recalculating insurance score calculations. However, it is said that it is difficult to check for intentional fraud.

  The first problem is that the third party cannot check whether or not the medical treatment contents and treatment contents for the user are the actual contents, and it is difficult to calculate the medical expenses by believing in the self-report of the practitioner as it is. It is a hotbed for fraudulent charges.

The second problem is that, when treating at home, such as osteoclast treatment and sprain treatment, over a long period of time, the medical treatment payment application form is signed at the first visit and the content is delegated to the operator. Believing in the writing of the fictitious medical care as it is, you have to calculate the cost of medical treatment, which is a hotbed for fraudulent claims.
Receipt payment examination bodies conduct a large amount of receipt examinations, and it is difficult to sufficiently check for illegal charges as described above.

  As a conventional technique for preventing an inappropriate payment request, there is a “medical paper processing system and its program recording medium” described in Japanese Patent Application Laid-Open No. 2000-20608, for example. This is because, in medical institutions, the receipt system that manages various medical affairs and the register system that manages the transfer of charges (payment of temporary contributions) at each reception desk were not linked to each other. And counter accounting. This can be said to be a technique for preventing erroneous billing of medical fees mainly due to negligence.

  The technique disclosed in Japanese Patent Application Laid-Open No. 2002-288336 is a technique developed mainly for the purpose of eliminating the troublesomeness of the medical fee reimbursement paperwork, and the main function is the surrogate processing of the medical fee reimbursement paperwork. Although it is a system, it includes a part of the function to prevent unauthorized charges for medical fees. When the system receives a user ID card number sent from a system installed at an osteopathic clinic, etc. via the Internet, and medical information on which the user has received medical care, the user is subscribed. After calculating the insurance, a bill is created, information including the bill is returned to the osteopathic system, and the medical fee billing agency service system uses the received information and the information of the bill as As action information, it is stored together with the basic user information, and it is confirmed whether or not the corresponding user has received a medical examination by referring to the above user medical treatment information at the time of receipt request confirmation processing. Thus, it is characterized in that it is determined whether or not billing is possible based on the result of the confirmation.

  The technology (such as Fig. 2) that prevents unauthorized charges disclosed in the system is equipped with the user basic information DB 71, and the osteotomy and Satsuma massage clinics issue their own examination cards. Without the system operator issuing a user ID card common to each osteopathic clinic, the user ID card is presented at the time of consultation to receive medical treatment, and the user ID when creating a receipt Create a receipt that includes the card number. This is a technology in which the created receipt data is checked by matching with the data in the user basic information DB 71, and when it is matched, it is sent to the receipt examination and payment institution.

JP 2000-20608 A JP 2002-288336 A

The above prior art has a problem that it is still difficult to reliably check or prevent intentional fraud.
As a means for preventing an intentional illegal charge by a practitioner, first, it is effective that a third party does not create a receipt by each practitioner himself. Furthermore, it is effective for a third-party organization not only to make a report from each practitioner but also to make a report or confirmation by another person who is not each practitioner.

  However, in the technique disclosed in Japanese Patent Application Laid-Open No. 2000-20608, the receipt itself is still created by each practitioner himself, and there is no disclosure regarding the third party creation of the receipt. It is not enough as a means to prevent deliberate fraudulent charges for medical fees.

  On the other hand, in the technology disclosed in Japanese Patent Application Laid-Open No. 2002-288336, a mechanism is disclosed in which a receipt is created by a third party (medical fee claiming agency / information service device). However, in the technique disclosed in Japanese Patent Application Laid-Open No. 2002-288336, it is included in the user ID card number of the user ID card that the user presents at the counter of the osteotomy or Satsuma massage clinic and the medical treatment declaration. Matching the user ID card number is the only check item, and as long as the user ID card number matches, the third party will create a receipt based only on the declaration contents from each osteotomy or Satsuma massage clinic Will be.

  There are many factors that cause unauthorized charges for medical fees. In Japanese Patent Laid-Open No. 2002-288336, the user ID card number is used as a check key. For example, after a user actually visits and presents a valid user ID card and receives a reception, It is possible to add more water. Since only the user ID card number is a check key, after the user ID card number is input by the reception, the medical treatment report is authenticated as valid as long as the user ID card number is included, If the medical treatment contents including the medical treatment contents that are not actually performed are reported, the medical fee can be illegally charged. The burden of users who pay for themselves, such as 10% or 30%, increases due to fraudulent charges. However, unless the same routine of routine medical treatment continues, users will not be able to pay only for the amount charged at the counter. Most people are not aware of fraudulent charges from the side of the osteotomy or Satsuma Massage.

  In view of the above problems, the present invention is based on the fact that the receipt is created by a third-party organization, and does not rely solely on self-reporting by the Osteopathic or Satsuma Massage Clinic, but accepts the receipt while objectively confirming the content of treatment. The purpose of the present invention is to provide a billing agency system that can be created and surely prevented from intentional fraud by the Osteopathic and Satsuma Massage Centers.

In order to achieve the above object, the first billing agency service system of the present invention is:
A billing agency service system managed by a billing agency agent acting on behalf of medical treatment fees for home medical treatment,
In the user's house in advance, a fixture printed with a special code readable by the practitioner mobile terminal is installed,
Carrying a practitioner's mobile terminal with GPS function, reader function, and communication function to the practitioner, reading and transmitting the special code of the installation using the practitioner's mobile terminal at the time of home medical treatment, and the current location Send the latitude and longitude information of
In the center system, analyze the transmitted special code information of the installation and the latitude / longitude information acquired by the GPS function, confirm the visit to the user's home and the execution of the massage treatment, Act on behalf of no billing for medical fees.

Next, in order to achieve the above object, the second billing agency service system of the present invention is:
A billing agency service system managed by a billing agency agent acting on behalf of medical treatment fees for home medical treatment,
Prior to the practitioner's visit to the user's home, a FAX transmission slip printed with a special code that is dynamically assigned on that day will be sent by FAX.
Carrying a practitioner's mobile terminal equipped with GPS function, reader function, and communication function to the practitioner, reading and transmitting the special code of the FAX transmission slip using the practitioner's mobile terminal at the time of home medical treatment, Send the latitude and longitude information of the point,
In the center system, analyze the special code information of the transmitted FAX transmission slip and the latitude / longitude information acquired by the GPS function, confirm the visit to the user's home and the execution of the massage treatment, Acting as an agent for billing for medical fees without any medical fees.

In the above configuration, it is preferable that the special code includes a dummy random number portion that is changed every day, and the dummy random number portion is changed every day and transmitted to the FAX at the user's home.
With the above configuration, a special code including a dummy random number that is changed every day is directly faxed to the user's home, and the home visit of the practitioner to the user's home can be further reliably proved.

  In the above configuration, for example, the special code may be a QR code obtained by coding user information including the address information of the user.

Further, in the above configuration, in the center system, the address information of the user's house obtained by decoding the special code transmitted from the practitioner portable terminal, and the latitude and longitude transmitted from the practitioner portable terminal When the error is within a predetermined range by comparing with the information, it can be confirmed as a confirmation proof of the visit to the user's home by the practitioner.
According to the above configuration, according to the first billing agency service system of the present invention and the second billing agency service system of the present invention, it can be confirmed that the practitioner has made a home visit and has performed a massage procedure. It is possible to request medical fees without fraud.

Further, in order to reliably prove that the user visited the user's home while at home, in the above configuration, the practitioner portable terminal includes biometrics information acquisition means for acquiring biometrics information, and the home medical treatment It is preferable that the biometrics information of the user is acquired by the biometrics information acquisition means at the time of the visit and used as the user's identity.
According to the said structure, it can be set as a reliable identification by biometrics information matching.

  Next, in the above configuration, it is preferable to return the treatment contents of the day from the center system to the practitioner portable terminal by reading the special code with the practitioner portable terminal and transmitting it to the center system. . According to the said structure, the treatment content in many home visits can be grasped | ascertained reliably.

In the treatment of home visits, it may be necessary to perform a treatment other than the treatment plan depending on the condition and symptoms of the user on the day. In the above configuration, the treatment is performed by the operator's mobile terminal inputting the treatment contents. It is preferable that an input means is provided, and the contents of the treatment on the day are input by the treatment input means and transmitted to the center system.
With the above configuration, the contents of the treatment performed dynamically can be reliably reflected in the reception.

  According to the first billing agency service system of the present invention and the second billing agency service system of the present invention, it is possible to confirm that the practitioner has made a home visit and has performed a massage treatment, and there is no fraud. Medical fees can be charged.

  Hereinafter, the best mode for carrying out the present invention will be described specifically by way of examples. The present invention is not limited to these examples.

A configuration example of a home-visit payment request agency service system in which a practitioner visits a user's home will be described with reference to the drawings.
In the following description, the medical institution is not particularly limited, and any institution such as an osteopathic institution where the social insurance system can be used and a medical fee reimbursement work is generated is a target institution for introducing the system of the present invention.
The practitioner refers to the user at home, such as a home visit type, such as a Satsuma, massager, acupressure, judo reduction teacher, caregiver, care service provider who performs massage, shiatsu, etc. A person who provides services.
Users are insured persons such as national health insurance and health insurance associations.

  Example 1 shows an example of the configuration of the first billing agency service system of the present invention. In the first billing service agent system of the present invention, a special code is printed in advance on an installation 50 installed in a user's house, and is read by a practitioner portable terminal.

  FIG. 1 is a block diagram of a first billing agency service system according to the first embodiment of the present invention. In FIG. 1, 10 is a center system set up by a payment requesting agency, 20 is a portable terminal for a practitioner who carries a practitioner such as the Osteopathic Clinic or Satsuma Massage Clinic, and 30 is a receipt examination payment by a payment fund / National Health Insurance Federation or the like. Review system established and managed by the institution, 40 is an insurer system installed and managed by insurers of local governments (National Health Insurance, etc.) and companies (Health Insurance Associations, etc.), 50 is a special code An installation 60, which is installed in the user's house in advance, is a third-party management organization for medical fees including a billing agency.

  Here, the center system 10 is interposed between the osteopathy clinic, the Satsuma massage clinic, and the like and the examination organization, and performs the execution of the receipt data creation process between them and the agency of the medical fee claim office process. . The entity that installs and manages the center system 10 is a billing agency, and is preferably an independent entity rather than a single organization such as an osteotomy clinic or a Satsuma massage clinic.

Each component of the center system 10 will be described.
The configuration example of the center system 10 in FIG. 1 includes a user information registration unit 11, a user information database 12, an input unit 13, an analysis unit 14, a receipt data creation unit 15, an insurance information database 16, and a communication unit 17. .

The user information registration unit 11 is a part that accepts input / registration of user information such as a user's name, address, and insurance number from a user who desires medical treatment such as a massage massage at home.
In order to start medical treatment such as Satsuma massage in the home visit type, it is necessary to register user information through the user information registration unit 11 in advance. Here, in order to start medical treatment such as Satsuma massage at home visit type, an application is made in advance to the payment request agency service system operator, and necessary user information such as user name, address and insurance number is registered. It shall be.

  The patient information database 12 is a database storing various information for each user, and stores user ID information in addition to various information indicating user attributes such as a user's name, address, age, and insurance number. When the user ID information is biometric information, biometric information scheduled to be collated, for example, finger vein pattern information, fingerprint information, palm vein pattern information, iris pattern information, and the like are stored.

  The input unit 13 is a part that receives data input.

  The analysis unit 14 includes the special code data read by the reader unit 21 of the practitioner portable terminal 20, the latitude / longitude data acquired by the GPS unit 22 of the practitioner portable terminal 20, and the practitioner portable terminal via the communication unit 17. The data input through the input unit 23 of 20 is received, the special code data is decoded to obtain the user information including the latitude and longitude information of the address, and is analyzed together with the latitude and longitude information from the GPS. It is a part to confirm the visit to the user's home and the execution of massage treatment. This confirmation will be described later.

  The receipt data creation unit 15 receives the medical data input from the input unit 23 of the practitioner portable terminal 20, and transmits the created receipt data to the reception screening system 30 with a function for creating the receipt data based on the medical data. It has a function to do. In home-visit treatment, the user who visits is treated appropriately, but each treatment is given an insurance score, and it is necessary to claim insurance. Since the medical fee billing agent is required to accurately calculate the insurance points, it is necessary to collect the medical treatment performed by the practitioner in the center system 10 and create a receipt. The center system 10 receives the input of the treated medical treatment, creates medical data describing the content of the medical treatment performed on the user, and transmits it to the receipt screening system 30 described later.

The insurance information database 16 includes basic information on local governments and other companies (information on insured persons), basic information on medical institutions and dispensing pharmacies such as hospitals (information on approval applications, etc.), and the Ministry of Health and Welfare at the time of law revision Information necessary for calculating the medical fee issued by the medical data is received, and the receipt data creation unit 15 accesses the insurance information database 16 to convert the medical care contents into insurance points when converting the medical care contents into insurance points. Necessary information such as a calculation formula can be acquired.
The medical fee is ultimately charged to the insurer, but before that, the receipt is submitted for review at the receipt reviewing institution.

  The communication unit 17 has a data communication function. A configuration having a voice communication function in addition to the data communication function is also possible. Here, special code information read by the reader unit 21 of the practitioner portable terminal 20 described later, latitude / longitude information acquired by the GPS unit 22, input data input by the input unit 23, and the like are received.

Next, the practitioner portable terminal 20 will be described. The practitioner portable terminal 20 is carried by the practitioner, and is used by bringing the practitioner portable terminal 20 to the user's home when performing home-visit treatment. Here, the practitioner refers to the user at home, such as a home visit type, such as a Satsuma, massager, shiatsuman, judo remediator, caregiver, care service provider who performs massage, shiatsu, etc. It is a person who provides services to them.
The practitioner portable terminal 20 includes a reader unit 21, a GPS unit 22, an input unit 23, a display unit 24, and a communication unit 25. The operator mobile terminal 20 can be configured using “PlayStation Portable” (hereinafter abbreviated as PSP) of Sony Computer Entertainment Inc. (SCEI) as having these elements.

  As will be described later, the reader unit 21 is a part that reads a special code printed on an installation 50 installed in advance at home. For example, the special code may be a QR code obtained by coding user information including user address information.

  The GPS unit 22 obtains latitude / longitude information of the current location through data transmission / reception with a GPS satellite. It is said that the accuracy of latitude and longitude information obtained by the current GPS is several tens of meters to several hundreds of meters.

  The input unit 23 is an input interface that enables data input by the operating operator. The input method is not particularly limited, and is not particularly limited, for example, an input button, a cross key, a touch panel, or the like. Voice recognition input can also be employed. For example, the contents operated on the day are input from the input unit 23

The display unit 24 is an output interface that enables data output to a practitioner who operates the display unit 24. The display method is not particularly limited, and is, for example, a liquid crystal display panel. When the practitioner is a low vision person, it is preferable to have an audio output function.
For example, after transmitting a special code to the center system 10, it is possible to receive the treatment content data from the center system and display it on the display unit 24 in order to confirm the treatment content of the day.

  The communication unit 25 has a data communication function. A configuration having a voice communication function in addition to the data communication function is also possible.

  Next, the receipt screening system 30 will be described. The receipt examination system 30 is a system established and managed by a receipt examination / payment institution such as a payment fund / National Health Insurance Federation, which receives information such as receipt data necessary for the receipt examination, and receives the receipt examination result information (return notification). Information). In the present invention, since the center system 10 is interposed between the medical institution system 20 and the examination system 30, information such as receipt data is received, and the result information of the receipt examination is returned to the center system 10.

  Insurer system 40 is a system installed and managed by insurers of local governments (National Health Insurance, etc.) and companies (Health Insurance Associations, etc.), which has information on the insured and is approved by the Receipt Review Organization According to the received data, insurance payment processing is performed according to the medical fee request.

  The third-party management company 60 is interposed between an insurer system such as LEIS Co., Ltd., WAD Co., Ltd. and other practitioners such as Satsuma Massage Clinic and Osteopathic Clinic. It is the subject that performs.

Here, the principle of the visit confirmation process to a user's house and the execution confirmation process of a massage treatment which are executed in the payment request office work system will be described.
The visit confirmation process to the user's home is performed by matching the address information data obtained by reading the special code printed on the installation installed in the user's home and the latitude / longitude information obtained by the GPS function.

  What is important here is that both the latitude / longitude information by the GPS function and the reading of the special code of the installation in the user's house are simultaneously performed. If you use a terminal with a GPS function, you can trace the latitude and longitude information acquired by GPS to see the general movement status of the practitioner, but the current GPS has errors and the accuracy is several tens to several hundreds of meters. It has been broken. On the other hand, there are many situations where the number of housing complexes and high-rise condominiums is increasing, and there are many cases where the user's home that the practitioner visits is close. Therefore, the visit to the user's home cannot be surely proved only by the latitude / longitude information by GPS. On the other hand, even if the special code printed on the installation at the user's home is read, if the installation is stored from the user's home visited by the practitioner, it is not necessary to visit the user's home. For example, a fictitious visiting treatment can be performed by reading a special code of an installation stored at a user's house in his own osteotomy or Satsuma massage clinic. Neither of them provides a reliable proof of visit. This is not a reliable proof of visit simply by separately reading the latitude / longitude information by GPS and the special code printed on the installation at the user's home.

  However, the present invention realizes reliable proof of the visit by combining the latitude / longitude information by GPS and the reading of the special code printed on the installation in the user's house at the same time. In the center system, the address information of the user's house obtained by decoding the special code transmitted from the practitioner portable terminal 20 is compared with the GPS latitude / longitude information obtained from the GPS unit 22 of the practitioner portable terminal 20, If the error is within a predetermined range, it will be a confirmation proof of the visit to the user's home by the practitioner. When the practitioner intends to make an unauthorized charge, he or she visits the user's home by car, etc., and keeps the installation that has been mailed to the user's home, and reads the installation by the reader unit 21 at an appropriate time interval. You must follow the procedure of sending. There is almost no merit of making unauthorized charges until following these procedures, and it can be said that a visit to a user's house is unavoidable, and a visit to an individual user's house can be proved.

  When a plurality of massage treatment details are scheduled, the massage treatment execution confirmation process can be performed by inputting the end of the massage treatment content via the input unit 23 when each massage treatment content is completed. The execution of the massage treatment can be confirmed by checking whether the time interval necessary for the treatment content is available.

  Next, the flow of the medical treatment action by the home visit using the center system 10 and the practitioner portable terminal 20, the flow of the receipt creation process and the medical fee claim office work process will be described. In the following flow, the flow at the time of user information registration is summarized in the flowchart of FIG. 2, and the flow at the time of medical treatment by home visit is summarized in the flowchart of FIG. 3, and will be described with reference to other drawings as appropriate at each stage. To do.

(A) Flow at the time of user information registration The user performs a user information registration procedure prior to the first treatment at home visit. The user presents the insurance card in addition to the delivery of various information such as name and address to the payment requesting agent through the practitioner (step S1 in FIG. 2). Although depending on the operation of the system, in order to prevent the practitioner from making a fictitious request, it is also preferable that the user information registration is directly performed by the payment requesting agency.

  The payment requesting agent performs confirmation of the name, address, insurance number, etc., and performs registration processing of user information in the user information database 12 via the user information registration unit 11 of the center system 10 (FIG. 2). Step S2). Here, it is assumed that an accurate address name is registered, accurate latitude / longitude information is obtained from the address information, and accurate latitude / longitude information of the place to be visited is registered. The exact latitude / longitude information of the visited site is important information used for confirming the home visit of the practitioner described later.

  Next, the user makes a medical treatment plan with the practitioner, for example, by entering symptoms in the questionnaire (step S3 in FIG. 2).

  Next, since it is assumed that the disease requires a long-term visit at an osteopathic clinic, etc., create a medical treatment payment application form and give it to the user to have the medical treatment payment application signed (Fig. 2 step S4). In addition, in the case of operation using a medical examination ticket together in a medical institution, it is assumed that a medical examination ticket is also created here.

  Next, the payment requesting agent will deliver the installation 50 printed with a special code that can be read by the practitioner's mobile terminal 20 to a place such as the user's home where he / she receives medical treatment, and have it installed at that place. (FIG. 2, step S5).

FIG. 4 is an example of an installation 50 on which a special code is printed. In this example, the special code is printed in the form of a QR code indicating the user's address or accurate latitude / longitude information, and the entire installation is manufactured as a calendar. Such a calendar is convenient for delivery to the user's home by mailing once a month, for example, and for the user to install in the living room at home.
The above is the flow when registering user information.

Next, the flow of processing at the time of medical treatment by a home visit by the practitioner will be described with reference to the flowchart of FIG.
First, under the treatment plan, the practitioner visits a place for performing a medical treatment by visiting the user, such as the user's home. The practitioner visits with the practitioner mobile terminal 20 carried. Under the consent of the user, the practitioner reads the special code printed on the fixture 50 installed in advance in the user's house or the like using the reader unit 21 (step S1 in FIG. 3). In this example, the QR code printed on the calendar of FIG. 4 is read.

  The GPS unit 22 acquires latitude / longitude data of the current location (step S2 in FIG. 3).

  The practitioner portable terminal 20 transmits the special code data read by the reader unit 21 via the communication unit 25 and also transmits the latitude / longitude data of the current location acquired by the GPS unit 22 (step S3 in FIG. 3).

  The analysis unit 14 decodes the received special code data, and obtains user information transmitted from the user's home 51 via the practitioner portable terminal 20 (step S4 in FIG. 3).

  The latitude / longitude information included in the user information is compared with the latitude / longitude information of the current location acquired by GPS (step S5 in FIG. 3).

  If the difference between the latitude and longitude information included in the user information and the latitude and longitude information of the current location acquired by GPS is within a predetermined value (step S5: Yes in FIG. 3), it is assumed that a visit to the user's home has been confirmed ( FIG. 3 step S6). If it exceeds the predetermined value (step S5 in FIG. 3: No), it is assumed that a visit to the user's home cannot be confirmed (step S7 in FIG. 3).

  Although not described in detail here, when the visit to the user's home cannot be confirmed (step S5: No in FIG. 3), the processing is performed according to the determined operation. For example, whether the remedial action was performed at another place such as a care home instead of the user's home, or whether the mailing of the installation 50 was sent to another address by some mistake It is determined that there is a risk of fraudulent charges through confirmation processing.

Next, the practitioner performs a medical treatment by visiting the user at home based on the medical treatment plan, and performs the medical treatment if a medical treatment other than the medical treatment plan is necessary according to the user's symptoms (Fig. 3 step S8).
In addition, in order to confirm the treatment content of the day, after sending a special code through the reader part 21, the reply of the treatment content of the day is received from a center system, and the display part 24 can display it.

  Next, the practitioner inputs data related to the medical treatment that ended on the day via the input unit 23 and transmits the data to the center system 10 (step S9 in FIG. 3).

  The receipt data creation unit 15 of the center system 10 receives the medical treatment data ended on the day transmitted from the practitioner, creates the receipt data while checking the insurance score by accessing the insurance information database 16, and receives the receipt data creation unit 15 transmits the receipt data to the receipt examination system 30 (step S10 in FIG. 3). Needless to say, it is possible to change whether the transmission is made by day closing, weekly closing, or month closing by operation.

After that, the screening of the receipt is performed in the screening system 30, and if the screening is passed, the receipt data is sent to each insurer and a medical fee is charged.
A medical fee is paid to the practitioner via the third party management organization 60 after reviewing the receipt data. Note that the third party management organization 60 can make advance payment to the practitioner prior to receiving the medical fee from the insurer system 40.

The above is the outline of the flow of processing at the time of medical treatment by the home visit by the practitioner.
The billing agency service system according to the first embodiment of the present invention analyzes the special code information of the installation and the latitude / longitude information acquired by the GPS unit transmitted from the practitioner's mobile terminal, and visits and massages to the user's home You can confirm the execution of the treatment and act as a billing office for medical fees without fraudulent charges.

  In the billing agency service system according to the second embodiment of the present invention, the special code sent to the user is not printed on the installation, but is dynamically transmitted to the FAX at the user's home on the day. A configuration example in the case of a special code printed on a FAX transmission slip will be described with reference to the drawings.

  FIG. 5 is a block diagram of a second billing service agent system according to the second embodiment of the present invention. In FIG. 5, the center system 10, the practitioner mobile terminal 20, the examination system 30, and the insurer system 40 have almost the same configuration, but the one that holds the special code at the user's house is an installation 50 such as a calendar. Instead, it is a FAX 51 that can be received dynamically.

Each component of the center system 10 will be described.
The configuration example of the center system 10 in FIG. 1 includes a user information registration unit 11, a user information database 12, an input unit 13, an analysis unit 14, a receipt data creation unit 15, an insurance information database 16, and a communication unit 17. The configuration is the same as that of the first embodiment. In the second embodiment, when the special code is delivered to the user's home, the FAX transmission slip on which the special code that is dynamically assigned on the day is printed is sent by fax before the visit of the practitioner to the user's home. ing. The special code printed on the FAX transmission slip may be a QR code.

  In order to enable the dynamic assignment of special codes, for example, in addition to various user information such as the user's name, address, and insurance number, it is possible to include dummy random number information. If the dummy part is changed every day, the special code is changed every day, and it is extremely difficult for the practitioner to make an unauthorized or fictitious claim, thereby improving the security.

  Similarly to the first embodiment, the configuration example of the practitioner portable terminal 20 includes a reader unit 21, a GPS unit 22, an input unit 23, a display unit 24, and a communication unit 25, and has these elements. As an example, the practitioner portable terminal 20 can be configured using “PlayStation Portable” (hereinafter abbreviated as PSP) of Sony Computer Entertainment Inc. (SCEI). In the second embodiment, since the special code is dynamically transmitted by FAX at the user's house, the reader unit 21 reads the special code printed on the FAX transmission slip. For example, a special code printed with a QR code as shown in FIG. 4 is read.

  Since the special code of the second embodiment is dynamically changed and transmitted to the FAX at the user's home on that day, the practitioner cannot obtain it unless he / she visits the user's home on that day. Therefore, the security for preventing unauthorized charges and fictitious charges is further improved. For example, the special code of the first embodiment is static for a certain period unless the installation is updated. For example, if the update is performed once a month, the same special code is used for one month. If it is assumed that the practitioner takes out the installation or copies and holds it, the special code printed on the installation by the reader unit 21 without visiting the user's house. Can be read. However, in the case of the second embodiment, the contents of the special code are dynamically changed and transmitted by FAX on the same day, so the user has to go to the user's house.

  As in the first embodiment, the GPS unit 22 acquires the latitude / longitude information of the current location by exchanging with GPS satellites. Also in the second embodiment, as in the first embodiment, the analysis unit 14 of the center system compares the special code information of the transmitted FAX transmission slip with the latitude / longitude information acquired by the GPS unit 22, and the difference between the two is a predetermined value. If it is within the range, it is determined that the visit to the user's home has been confirmed, and if it exceeds the predetermined value, it is determined that the visit to the user's home cannot be confirmed. In particular, since the FAX transmission slip is directly faxed directly to the user's home on the day, the practitioner cannot leave it in advance from the user's home and must visit the user's home. You can be sure of proof of visit.

FIG. 6 is a flowchart of a process flow during a medical treatment action by a practitioner visiting at home by the payment request office work system according to the second embodiment.
Compared with the flowchart of FIG. 3, step S1 is different. In the flowchart of FIG. 6, with the consent of the user, the practitioner reads the special code printed on the FAX transmission form 51 transmitted in advance to the user's house using the reader unit 21 (step in FIG. 6). S1).

  As described above, according to the payment request office work system according to the second embodiment, the special code printed on the FAX transmission slip that is dynamically transmitted to the FAX at the user's house on the day is more reliably read, thereby ensuring more certainty. A proof of visit to the user's home can be ensured.

In the third embodiment, in addition to the visit confirmation process to the user's home using the special code data and the GPS data described in the first and second embodiments, the function of confirming the identity of the user himself / herself is the insured person. To reinforce, it combines identity verification with biometrics information.
For example, vein authentication that reads palm and finger vein patterns as biometrics information, fingerprint authentication that reads finger fingerprints as biometrics information, iris authentication that reads iris patterns as biometrics information, etc. are difficult to do so-called `` spoofing '' It can be said that this is a user authentication method that is effective for improving the security for preventing fraud in the medical fee claim office work of the present invention.

  FIG. 7 is a block diagram of a medical fee reimbursement office proxy system according to Embodiment 3 of the present invention. The examination system 30 and the insurer system 40 may be the same as those described in the first embodiment.

  In FIG. 7, the configuration of the center system 10 includes a biometrics information database 18 that stores biometrics information registered in advance by the user in addition to that of the first embodiment.

The configuration of the practitioner portable terminal 20 includes a biometrics information acquisition unit 26 that acquires biometrics information from the user in addition to the configuration of the first embodiment.
The biometrics information acquisition unit 26 is a part that accepts input of user biometrics information from a user at home at a visited site, and may be able to input biometrics information. For example, finger vein pattern information, fingerprint information, palm vein pattern information, iris pattern information, and the like are stored. Here, for example, finger vein pattern authentication is executed as user biometrics information.

  The practitioner acquires the biometric information of the user by the biometric information acquisition unit 26 at the time of home medical treatment visit and transmits it to the center system 10. The analysis unit 14 of the center system 10 matches the user's biometric information stored in the biometric information database 18 to confirm the identity of the user.

  The analysis unit 14 includes the user's biometric information acquired by the practitioner via the biometrics information acquisition unit 26 incorporated in the practitioner portable terminal 20 and biometrics information registered in the biometrics information database 18. And has a user identification function.

  The receipt data creation / transmission unit 15 creates receipt data based on the medical data only when the identity of the user is confirmed in the confirmation of acceptance by the analysis unit 14, and transmits the receipt data to the examination system 30. To do.

  The functions of the examination system 30 and the insurer system 40 may be the same as those in the first embodiment.

  FIG. 8 is a flowchart of a process flow at the time of a medical treatment by a practitioner visiting a home by the payment request office work system according to the third embodiment.

  The flow from step S1 to step S4 may be the same as the flowchart of FIG.

First, under the treatment plan, the practitioner visits a place for performing a medical treatment by visiting the user, such as the user's home. The practitioner visits with the practitioner mobile terminal 20 carried. The practitioner uses the reader unit 21 to read the special code printed on the installation 50 installed in advance in the user's house or the like with the consent of the user (step S1 in FIG. 8). In this example, the QR code printed on the calendar of FIG. 4 is read.

  The GPS unit 22 acquires latitude / longitude data of the current location (step S2 in FIG. 8).

  The practitioner portable terminal 20 transmits the special code data read by the reader unit 21 via the communication unit 25 and also transmits the latitude / longitude data of the current location acquired by the GPS unit 22 (step S3 in FIG. 8).

  In the third embodiment, the practitioner prompts the user to input biometric information via the biometric information input unit 26. For example, a finger vein pattern is input. The user attaches a finger to the biometrics information input unit 26 and inputs a vein pattern (step S3-2 in FIG. 8).

  Here, the biometrics information database 18 already stores the user's biometrics information, and the user is identified and identified by the finger vein pattern matching processing performed by the analysis unit 14. User identification / identification using this biometrics information is executed (step S3-3 in FIG. 8), authenticating the user who receives the treatment at home, and making a fictitious request using “spoofing” by another person Is impossible.

  The analysis unit 14 receives special code data, GPS data, and biometric data, and decodes the special code data to obtain latitude / longitude information of the user address (step S4 in FIG. 8).

  The latitude / longitude information obtained by decoding is compared with the latitude / longitude information of the current location acquired by GPS (step S5 in FIG. 8). Further, the received biometric information is compared with the registered biometric information (step S5-2 in FIG. 8).

  If the biometric information matches and the difference between the latitude / longitude information included in the user information and the latitude / longitude information of the current location acquired by the GPS is within a predetermined value (step S5 in FIG. 8: Yes), the user's home is reached. Is visited (step S6 in FIG. 8). If the biometrics information matches, it is assumed that personal authentication is confirmed (step S5-2: Yes). If the difference between the latitude and longitude exceeds a predetermined value (step S5 in FIG. 8: No), it is assumed that a visit to the user's home cannot be confirmed (step S7 in FIG. 8). Further, if the biometrics information does not match (step S6-2 in FIG. 8: No), it is assumed that the user himself cannot be confirmed (step S7 in FIG. 8).

  Next, the practitioner performs a medical treatment by visiting the user at home based on the medical treatment plan, and performs the medical treatment if a medical treatment other than the medical treatment plan is necessary according to the user's symptoms (Fig. 3 step S8).

Next, the practitioner inputs data related to the medical treatment that ended on the day via the input unit 23 and transmits the data to the center system 10 (step S9 in FIG. 8).
The receipt data creation unit 15 of the center system 10 receives the medical treatment data ended on the day transmitted from the practitioner, creates the receipt data while checking the insurance score by accessing the insurance information database 16, and receives the receipt data creation unit 15 transmits the receipt data to the receipt examination system 30 (step S10 in FIG. 8). Needless to say, it is possible to change whether the transmission is made by day closing, weekly closing, or month closing by operation.

  According to the billing agency service system according to the third embodiment of the present invention, the user authentication can be performed using the biometric information.

  If the processing steps of the payment request office work system according to the present invention are described as a computer program, the payment request office work system processing program can be provided. In other words, the payment request office agency system processing program according to the present invention is described as a computer program in which the processing steps of the payment request office agency system according to the present invention described in any of the first to third embodiments are described. It can be provided in the form of being carried on a computer-readable storage medium or downloaded via a computer network.

  As mentioned above, although preferred embodiment in the example of composition of the medical treatment fee billing agency system of the present invention was illustrated and explained, it is understood that various changes are possible without departing from the technical scope of the present invention. Will.

  The payment request office agency system of the present invention can be applied to an office processing system in the medical field. Further, the present invention can be applied to an office processing system used by a medical fee requesting office agency.

FIG. 1 is a block diagram of a first payment request office work system according to a first embodiment of the present invention. The flowchart which shows the flow at the time of user information registration by the payment request office work agency system concerning Example 1 Flowchart of a processing flow at the time of medical treatment by a practitioner visiting at home by the payment request office work system according to the first embodiment The figure which shows the example of the installation 50 which printed the special code Block diagram of a second billing service agent system according to the second embodiment of the present invention Flowchart of a processing flow at the time of medical treatment by the practitioner visiting at home by the payment request office work system according to the second embodiment Block diagram of a medical fee reimbursement office service system according to Embodiment 3 of the present invention Flowchart of processing flow at the time of medical treatment by a practitioner visiting at home by the payment request office work system according to the third embodiment The figure which shows the outline of the claim, examination and payment of the medical expenses in the conventional general osteopathic clinic and Jiju-in.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Center system 11 User information registration part 12 User information database 13 Input part 14 Analysis part 15 Receipt data creation part 16 Insurance information database 17 Communication part 18 Biometrics information database 20 Practitioner portable terminal 21 Leader part 22 GPS part 23 Input Unit 24 Display unit 25 Communication unit 26 Biometrics information input unit 30 Examination system 40 Insurer system 50 Installation 51 FAX

Claims (8)

A billing agency service system managed by a billing agency agent acting on behalf of medical treatment fees for home medical treatment,
Install a fixture printed with a special code that can be read by the practitioner's mobile device in the user's home beforehand.
Carrying a practitioner's mobile terminal with GPS function, reader function, and communication function to the practitioner, reading and transmitting the special code of the installation using the practitioner's mobile terminal at the time of home medical treatment, and the current location Send the latitude and longitude information of
In the center system, analyze the transmitted special code information of the installation and the latitude / longitude information acquired by the GPS function, confirm the visit to the user's home and the execution of the massage treatment, A billing agency service system that acts as a proxy for no medical fees. A billing agency service system managed by a billing agency agent acting on behalf of medical treatment fees for home medical treatment,
Prior to the practitioner's visit to the user's home, a FAX transmission slip printed with a special code that is dynamically assigned on that day will be sent by FAX.
Carrying a practitioner's mobile terminal equipped with GPS function, reader function, and communication function to the practitioner, reading and transmitting the special code of the FAX transmission slip using the practitioner's mobile terminal at the time of home medical treatment, Send the latitude and longitude information of the point,
In the center system, analyze the special code information of the transmitted FAX transmission slip and the latitude / longitude information acquired by the GPS function, confirm the visit to the user's home and the execution of the massage treatment, A billing agency service system acting on behalf of the medical bills without medical fees.   3. The billing agency service system according to claim 2, wherein the special code includes a dummy random number portion that is changed daily, and the dummy random number portion is changed daily and transmitted to the FAX at the user's house.   4. The payment request office work system according to claim 1, wherein the special code is a QR code obtained by coding user information including address information of the user. 5.   In the center system, the address information of the user's house obtained by decoding the special code transmitted from the practitioner mobile terminal is compared with the latitude / longitude information transmitted from the practitioner mobile terminal, 5. The billing agency service system according to claim 4, wherein when the error is within a predetermined range, the practitioner confirms the visit to the user's home by the practitioner.   The practitioner mobile terminal comprises biometrics information acquisition means for acquiring biometrics information, the user's biometrics information is acquired by the biometrics information acquisition means during the home medical treatment visit, and the user's identity The payment request office work system according to any one of claims 1 to 5.   The treatment content of the day is returned from the center system to the practitioner portable terminal by reading the special code with the practitioner portable terminal and transmitting it to the center system. Payment billing agency system described in.   The payment according to any one of claims 1 to 7, wherein the practitioner mobile terminal includes a treatment input means for inputting treatment contents, and inputs the treatment contents on the day by the treatment input means and transmits to the center system. Billing agency service system.

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