JP2014021680A - Receipt analysis device and receipt analysis program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a receipt analysis device and a receipt analysis program capable of performing analysis related to the defectiveness of a receipt causing refund or assessment.SOLUTION: A receipt analysis device 40 includes: an input section 43 for accepting the input of temporary receipt check result information constituted by associating medical fee amount information for specifying medical fee amounts with defectiveness possibility information for specifying a check result of whether or not there is possibility of the existence of defectiveness in each receipt as well as the type of the defectiveness; a specification section 42a for specifying doubtful amounts as medical fee amounts which is likely to be unpaid to a medical institution when the receipt is refunded or assessed due to the existence of defectiveness in the receipt; and an output control section 42b for outputting information including the doubtful amounts via an output section 44.

Description

  The present invention relates to a receptor analyzer and a receptor analysis program for analyzing a receptor.

  Various medical institutions such as hospitals and clinics and dispensing pharmacies have received medical treatment details and receipts in order to charge the insurer for insurance contributions in the medical fee (medical fee statement and dispensing fee statement) Must be prepared and submitted to the examination and payment institution. The examination / payment institution examines the contents of the receipt and, if there are no deficiencies in the contents of the receipt, charges an insurance fee to the insurer. Based on this request, a medical fee is paid from the insurer to the medical institution or dispensing pharmacy. On the other hand, if the examination / payment institution finds incompleteness in the contents of the receipt, it performs either “return” or “assessment (reduced assessment)” depending on the content of the incompleteness, The increase / decrease return notification will notify the medical institution or dispensing pharmacy about the amount of money minus the amount of medical fees that were refunded or assessed, or the reason for deficiencies.

  “Return” is a process performed when there is a defect in the insurance card symbol or number, or a defect such as a mismatch between the medical treatment contents and the disease name. Is a process of sending back to the medical institution. When this “return” is made, if the medical institution submits a receipt with correction of deficiencies etc. to the examination / payment institution and makes a request for reexamination, the examination / payment institution will reexamine the contents of the receipt and make the contents of the receipt If there are no deficiencies, a medical fee will be paid. For this reason, if a “return” is made, the medical institution may eventually be able to receive payment of medical fees, but it will be used for rework and reexamination for resubmission of the receipt. Since it takes time, it takes time to receive payment of medical fees, which is a disadvantage for the management of a medical institution.

  An “assessment” is a process that is performed when a defect is described in the receipt, such as an act that is not covered by insurance, an act of overdose of a drug, or an act of simultaneous administration of similar drugs. This is a process in which the payment institution reduces or deletes the medical fee corresponding to the act. For this reason, when an “assessment” was made, the medical institution was able to receive a full medical treatment fee, although it performed a medical practice. Alternatively, if there is an objection to the content of the assessment, it must be explained medically. To that end, the difference between the reason for the inadequacy and the content of the actual medical treatment, A lot of reworking occurs, such as a meeting for doctors and medical clerks to gather and resubmit in the end. As a result, it is a major disadvantage for the management of medical institutions.

  As described above, “return” and “assessment” are directly linked to the management disadvantage of the medical institution. Therefore, reducing these “return” and “assessment” is a major issue in the management of the medical institution. From this point of view, there has conventionally been proposed a receipt inspection system in which the medical institution itself can check for a defect in the reception before the medical institution submits the receipt to the examination and payment institution. For example, Patent Literature 1 discloses that a medical practice or medicine and a disease name are associated with each other and accumulated in a database, a disease name corresponding to the medical practice or medicine stored in the receipt data is acquired from the database, and the acquired disease name A reception check system is disclosed that checks whether or not a medical practice or medicine described in a receipt is appropriate by identifying whether or not is included in the receipt data.

JP 2005-108138 A

  However, although the above-mentioned conventional system is useful for discovering a defect in a receipt that causes “return” or “assessment”, it has not been able to perform various analyzes on such defects. It could not be used as a tool to essentially improve the flaws of the reception.

  For example, by using the above-mentioned conventional system, it is possible to grasp that there are deficiencies that cause "return" and "assessment" in the receipt, but the frequency of this deficiency and the occurrence of this deficiency can occur. The amount of “return” and “assessment” could not be determined. For this reason, when there are multiple types of deficiencies in the receipt, it is not possible to compare each deficiency relatively based on these frequencies and amounts, and which deficiencies should be resolved preferentially, etc. I couldn't judge.

  The present invention has been made in view of the above, and provides a receipt analysis apparatus and a receipt analysis program that enable an analysis regarding a defect in a receptor that causes “return” or “assessment”. With the goal.

  In order to solve the above-described problems and achieve the object, the receipt analysis apparatus according to claim 1 is a provisional receipt check result information on a plurality of receipts for claiming a medical fee for a medical practice performed by a medical institution. The medical fee amount information for specifying the medical fee amount for the medical practice and the check result as to whether or not there is a possibility that each reception for claiming the medical fee for the medical practice may have deficiencies The flaw possibility information that identifies the deficiency type together with the flaw possibility information, input accepting means for accepting input of temporary receipt check result information, and the provisional receipt check result accepted by the input accepting means Based on the information, the medical report associated with the deficiency information that identifies the possibility that a predetermined type of deficiency may exist By extracting the amount information and referring to the medical fee amount specified by the extracted medical fee amount information, since the defect is returned or assessed because the defect is incomplete, A specifying means for specifying a suspicious amount that is a medical fee amount that may not be paid, and information including the suspicious amount specified by the specifying means in a format specified by a predetermined method Output control means for outputting via the

  Moreover, the receipt analysis apparatus according to claim 2 is the receipt analysis apparatus according to claim 1, wherein the temporary receipt inspection result information includes patient attribute information that specifies an attribute of a patient for whom the medical practice has been performed, or the Including medical practice attribute information for identifying a medical practice attribute, wherein the specifying means is based on the patient attribute information or the medical practice attribute information included in the temporary receipt inspection result information received by the input receiving means. Determining whether there is a possibility that a predetermined type of deficiency exists, whether or not the medical fee information associated with the deficiency information is duplicated for the same medical practice for the same patient When it determines and it determines with duplication, the said medical fee amount information which overlaps is excluded, and the said doubt amount is specified.

  Further, the receipt analyzer according to claim 3 is the receipt analyzer according to claim 1 or 2, wherein the specifying means is based on the temporary receipt inspection result information received by the input receiving means. A billable amount that is a medical fee amount that is expected to be billable even if the receipt is returned or assessed, and the medical institution when the receipt is returned or assessed A charge difficulty suspicion amount, which is a medical fee amount that is predicted to be difficult to pay, is specified.

  Moreover, the receipt analysis apparatus according to claim 4 is the receipt analysis apparatus according to any one of claims 1 to 3, wherein the temporary receipt inspection result information includes an attribute of a medical practice that specifies an attribute of the medical practice. And a corresponding disease name information storage unit that stores corresponding disease name information configured to correlate the attribute of the medical practice and the disease name corresponding to the attribute, the specifying unit includes the input receiving unit Corresponding to the attribute of the medical practice by referring to the corresponding disease name information stored in the corresponding disease name information storage means based on the medical practice attribute information included in the temporary receipt inspection result information received at A disease name is specified, and the output control means corresponds to the temporary receipt inspection result information received by the input receiving means with the disease name specified by the specifying means. That outputs the modified proposal receipt described in receipt.

  Further, the receipt analyzer according to claim 5 is the receipt analyzer according to any one of claims 1 to 4, wherein the temporary receipt check result information is a doctor identifying a doctor who has performed the medical practice. Doctor output information storage means for storing doctor achievement information configured to correlate the doctor identification information and the suspicion amount identified by the identification means, including specific information; and the output control The means outputs information on the suspicion amount for each doctor based on the doctor performance information stored in the doctor performance information storage means.

  The receipt analysis program according to claim 6 is a program for causing a computer to execute the provisional receipt check result regarding a plurality of receipts for charging the medical fee for a medical practice performed by a medical institution. Check whether there is a possibility that there is a possibility that there is a deficiency in information about the medical fee for identifying the medical fee for the medical fee and each receipt for charging the medical fee for the medical fee Input acceptance means for accepting input of temporary receipt inspection result information configured to correlate the defect possibility information specifying the result together with the type of defect, and the provisional receipt inspection accepted by the input acceptance means Based on the result information, the deficiency can be specified to specify that there is a possibility that a predetermined type of deficiency exists By extracting the medical fee amount information associated with the information and referring to the medical fee amount specified by the extracted medical fee amount information, the receipt is returned or assessed because there is a defect in the receipt. The identification means for identifying the suspicion amount that is the amount of medical treatment remuneration that may not be paid to the medical institution and the information including the suspicion amount identified by the identification means are identified by a predetermined method It is made to function as an output control means which outputs via a predetermined output means in the format.

According to the receipt analysis apparatus according to claim 1 or the receipt analysis program according to claim 6, payment to a medical institution is not made by returning or assessing the receipt because the defect is incomplete. The impact of not being paid to a medical institution due to a flaw in the receipt that is “returned” or “assessed” because a suspicious amount, which is a possible medical fee, is identified and output Can be quantitatively grasped with a specific value of suspicious amount, and it is easy to examine the improvement situation of the receipt and the measures to improve the defect of the receipt, and to understand the influence of the defect of the receipt on the management And it becomes possible to carry out accurately.
In particular, since the suspicious amount related to the predetermined type of deficiency is identified and output, for example, among multiple types, pay attention to the efficient type to reduce the suspicious amount by improving the deficiency of the receipt, It becomes possible to specify and output the suspicious amount regarding the deficiency of the efficient type. And it becomes possible to reduce a suspected amount efficiently by giving priority and improving such kind of deficiencies.

  According to the receipt analyzer of claim 2, when the medical fee amount information is duplicated for the same medical treatment for the same patient, the duplicate medical fee amount information is excluded. Since the suspicious amount is specified, even if the same record in the same receipt is determined for each rule whether or not there is deficiency, such information is generated, It is possible to specify the suspicion amount after correcting multiple pieces of medical fee amount information generated redundantly in the same record to a single medical fee amount information, and it is possible to accurately identify the suspicion amount become.

  In addition, according to the claim analysis apparatus according to claim 3, since the billable amount and the chargeable doubt amount are specified, the influence of the defect of the receipt is distinguished from the viewpoint of the chargeable amount and the chargeable doubt amount. Therefore, it is possible to easily and accurately grasp the influence of lack of receipt on management.

  In addition, according to the receipt analyzer according to claim 4, the correction proposal receipt in which the disease name corresponding to the attribute of the medical practice is described is output, so that the doctor can correct the correction proposal receipt when improving the defect of the receipt. By referring to, it becomes possible to easily and accurately grasp the name of the disease corresponding to the attribute of the medical practice, and it is possible to easily and accurately perform the work for improving the defect of the reception.

  Moreover, according to the receipt analyzer of claim 5, since the information regarding the suspicion amount for each doctor is output, it is possible to easily and accurately grasp various trends such as the size of the suspicion amount for each doctor. Thus, it becomes easy for each doctor to plan a measure for improving a receipt description error by a doctor who is the source of the defect of the receipt.

It is explanatory drawing which shows notionally the whole structure of the receptor integrated system comprised including the receptor analyzer which concerns on one embodiment of this invention. It is a figure which shows the structural example of provisional receipt information. It is a figure which shows the structural example of provisional receipt inspection result information. It is a figure which shows the structural example of corresponding disease name information. It is a figure which shows the structural example of doubt amount history information. It is a flowchart of a doubt amount calculation process. It is a flowchart of a dashboard analysis process. It is a figure which shows the example of a display of a dashboard analysis figure. It is a flowchart of a priority order analysis process. It is a figure which shows the example of a display of a priority order analysis table | surface. It is a flowchart of deficiency improvement processing. It is a flowchart of the results analysis process classified by doctor.

  Exemplary embodiments of a receipt analysis apparatus and a receipt analysis program according to the present invention will be described below in detail with reference to the accompanying drawings. First, the outline of the receptor analyzer will be described, then the structure of the receptor analyzer will be described, the processing executed by the receptor analyzer (procedures included in the receptor analysis program and the receipt analysis method), Finally, modified examples of the receipt analysis apparatus and the receipt analysis program will be described.

〔Overview〕
The receipt analysis apparatus and the receipt analysis program according to this embodiment are apparatuses that enable an analysis relating to a defect in a receptor that causes “return” or “assessment”. These “return” and “assessment” are collectively referred to as “insufficient” unless it is necessary to distinguish between them. Further, a predetermined standard for determining return and assessment is referred to as a “rule”. However, the following deficiencies and examples of rules can be changed. Moreover, in practice, medical institutions are required to request medical fees by receipt on a monthly basis, and more specifically, each month's receipt is received by a predetermined day (for example, the 10th) of the following month. Create and submit to examination payment organization. Hereinafter, the month that is the subject of the reception is referred to as “target month”. In addition, a receipt created by a medical institution but not yet submitted to the examination / payment institution is referred to as a “provisional receipt”, and a receipt submitted to the examination / payment institution created by the medical institution is referred to as a “main receipt”.

  This receipt analysis apparatus and the receipt analysis program can perform a cross-sectional analysis for a receptor created by each of a plurality of medical institutions, or analyze a receptor created by one medical institution. It is also possible to perform. In addition, as a usage form of the receipt analysis program, a receipt analysis program is configured by installing a receipt analysis program in a computer disposed in each of a plurality of medical institutions, and this receipt analysis apparatus is referred to as another receptor analysis apparatus. An ASP that can be used separately as a stand-alone type, or that is configured by installing a receipt analysis program in a server device, and that is used by a plurality of medical institutions via a network. (Application service provider) type is also possible. In this embodiment, a case where a stand-alone type is used is illustrated. Note that a medical institution that uses a receipt analysis apparatus and a receipt analysis program is referred to as a “user medical institution”.

〔Constitution〕
FIG. 1 is an explanatory diagram conceptually showing an overall configuration of a reception integrated system configured to include a reception analyzer according to the present embodiment. The reception integration system 1 is a system that is disposed inside the user medical institution 2 and integrally processes information related to the reception of the user medical institution 2. The receipt integrated system 1 includes an electronic medical chart device 10, a receipt creation device 20, a receipt inspection device 30, and a receipt analysis device 40, and these devices are communicably connected via a network 50.

[Configuration-Electronic chart device]
The electronic medical chart device 10 is a device for recording and managing medical records as electronic data. As the electronic medical chart device 10, since a known device can be used, a detailed description thereof is omitted. However, in general, a doctor working at the user medical institution 2 or When a medical staff such as a nurse inputs various information such as the patient's name, the date on which the medical practice was performed, the name of the type of medical practice, and the name of the medical practice, the information is stored in the electronic medical record. Data is accumulated in the database of the electronic medical chart apparatus 10.

[Configuration-Receipt making device]
The receipt creation apparatus 20 is an apparatus for creating provisional receipt information or main receipt information described later. Since a known device can be used as the receipt creation device 20, a detailed description thereof is omitted. However, in general, the receipt creation device 20 includes a name of a medical practice and a medical treatment for each medical practice. Reward amounts are stored in association with each other. Then, the receipt creation device 20 receives the electronic medical record data from the electronic medical record device 10, identifies the medical fee amount corresponding to the name of the medical practice included in the electronic medical record data, the identified medical fee amount, Based on other information included in the electronic medical record data, temporary receipt information or main receipt information is generated.

[Configuration-Receipt inspection device]
The receipt checking device 30 is a device for checking the provisional receipt information created by the receipt creating device 20 or the present receipt information prior to submission to the examination payment organization. As this receipt inspection apparatus 30, since a well-known apparatus like patent document 1 can be utilized, the detailed description is abbreviate | omitted, but roughly, the receipt inspection apparatus 30 has the name of a medical treatment act, Rules are stored in association with each other. And the receipt inspection apparatus 30 receives temporary receipt information or this receipt information from the receipt preparation apparatus 20, specifies the rule corresponding to the name of the medical practice included in this temporary receipt information, and based on the specified rule Then, it is determined by a known algorithm whether there is a possibility that the provisional receipt information or the present receipt information is defective. And based on the defect possibility information which is the said determination result, and the other information contained in temporary receipt information, the temporary receipt inspection result information mentioned later or this receipt inspection result information is produced | generated.

[Configuration-Receipt Analyzer]
The receipt analysis device 40 is a device for analyzing a receipt, and functionally conceptually includes a storage unit 41, a control unit 42, an input unit 43, an output unit 44, and an input / output interface (hereinafter, the interface is “IF”). 45 are communicably connected to each other via a bus. For example, the receipt analyzer 40 can be configured by a known personal computer, server device, PDA (Personal Digital Assistant), pad, smartphone, or the like.

[Configuration-Receipt Analyzer-Storage Unit]
The storage unit 41 is a storage unit that stores information and parameters necessary for various processes in a nonvolatile manner, and is configured by, for example, an HD (Hard Disk). Specifically, the storage unit 41 includes, in terms of function concept, a provisional receipt information database (hereinafter, “DB”) 41a, provisional receipt inspection result information DB 41b, corresponding disease name information DB 41c, and suspicion amount history information DB 41d. Prepare. Information stored in each DB will be described later.

[Configuration-Receipt analyzer-Control unit]
The control unit 42 is a control unit that controls each unit of the receipt analyzer 40, and includes a specifying unit 42a and an output control unit 42b in terms of functional concept. Based on the provisional receipt inspection result information received by the input unit 43, the specifying unit 42a obtains medical fee amount information associated with deficiency possibility information for specifying that there is a possibility that a predetermined type of deficiency exists. By extracting and referring to the medical fee amount specified by the extracted medical fee amount information, there is a defect in the receipt, so that the receipt is returned or assessed, and payment to the medical institution is not performed This is a specifying means for specifying the suspected amount that is a possible medical fee amount. The output control unit 42b is an output control unit that outputs information including the suspicious amount specified by the specifying unit 42a in a format specified by a predetermined method via a predetermined output unit (here, the output unit 44). . Specific processing by these units will be described later.

  Specifically, the control unit 42 includes a CPU (Central Processing Unit), various programs interpreted and executed on the CPU (control programs such as an OS, programs that define various processing procedures, and the like), and And a cache memory for storing required programs and required data. The various programs interpreted and executed on the CPU include a receipt analysis program. The receipt analysis program is stored in an arbitrary storage medium including, for example, a CD-ROM and a DVD, and then installed and stored in the storage unit. 41 is stored in a nonvolatile manner and is interpreted and executed by the CPU to constitute a substantial function of the control unit 42.

[Configuration-Receipt analyzer-Input section]
The input unit 43 is an input receiving unit that receives input of various types of information to the receipt analyzer 40, and here includes a keyboard and a mouse (not shown).

[Configuration-Receipt analyzer-Output unit]
The output unit 44 is an output unit that outputs various types of information from the receipt analyzer 40, and here is configured to include a monitor (not shown).

[Configuration-Receipt analyzer-Input / output IF]
The input / output IF 45 is a communication means for performing communication via the network 50 such as the Internet or a LAN, and is configured as a network board, for example. Since the input of information from a predetermined server is received through the input / output IF 45, the input / output IF 45 constitutes an input receiving unit, like the input unit 43. Further, since various kinds of information are output via the input / output IF 45, the input / output IF 45 constitutes an output unit in the same manner as the output unit 44. In particular, in the present embodiment, the input / output IF 45 is provisional receipt check result information regarding a plurality of receipts for claiming a medical fee for a medical practice performed by a medical institution, and specifies a medical fee amount for the medical practice. Information on the amount of medical fee to be used, and information on the possibility of deficiency identifying the result of checking whether or not there is a possibility that each receipt for claiming the medical fee for medical treatment is inadequate. , Functioning as input receiving means for receiving input of temporary receipt inspection result information configured in association with each other.

[Configuration-Receipt Analyzer-Each DB]
Next, specific contents of information stored in each DB of the receipt analyzer 40 will be described. However, the following configuration example shows an example in which only the information according to the present embodiment is stored. Actually, any information other than the information described below can be stored in each DB, or some information May be omitted as appropriate. In addition, among the information stored in each DB, the information with the same name is assumed to have the same contents except for the case of special mention, and redundant description will not be given.

[Configuration-Receipt Analyzer-Temporary Receipt Information DB]
The provisional receipt information DB 41a is provisional receipt information storage means for storing provisional receipt information. As illustrated in FIG. 2, the provisional receipt information includes an item “recept common code”, an item “doctor code”, an item “patient attribute”, an item “medical practice attribute”, and an item “medical fee”. Information corresponding to each item is associated with each other. For convenience of illustration, the provisional receipt information is divided and shown, but in actuality, it can be configured as a series of information (the same in FIG. 3).

  The item “recept common code” is receipt identification information for uniquely identifying each receipt. The item “doctor code” is doctor specifying information for specifying a doctor who performed a medical practice.

  The item “patient attribute” is patient attribute information that identifies the attribute of the patient for whom the medical practice has been performed. The item “patient name”, the item “patient code”, and the item “hospital date” are included as sub-items. It is configured to include.

  The information corresponding to the item “patient name” is patient specifying information for specifying the patient who is the subject of the medical practice, and specifically, the name of the patient. The information corresponding to the item “patient code” is patient specifying information for specifying the patient who is the subject of the medical practice, and specifically, the patient code for uniquely identifying the patient. The information corresponding to the item “date of hospitalization” is date specifying information for specifying the date of receiving the medical practice, and specifically, the date of hospitalization for receiving the medical practice.

  The item “medical practice attribute” is medical practice attribute information for specifying the attribute of the medical practice, and as sub-items, the item “medical department”, the item “medical practice identification”, the item “medical practice code”, and the item “action name” , Item "quantity", item "number of times", item "medical practice score", item "pharmaceutical drug price", item "special equipment price", and item "medical fee", and information corresponding to each of these items Configured in association.

  The information corresponding to the item “clinical department” is clinical department specifying information for specifying the clinical department that has performed the medical practice, and specifically, is the name of the clinical department. The information corresponding to the item “medical care identification” is medical practice type information for specifying the type of medical practice, and specifically, the name of the type of medical practice. Information corresponding to the item “medical practice code” is medical practice identification information for uniquely identifying a medical practice, and specifically, a medical practice code. The information corresponding to the item “action name” is medical action specifying information for specifying the medical action, and specifically, the name of the medical action.

  Information corresponding to the item “quantity” is medical practice quantity specifying information for specifying the quantity of medical practice, and is, for example, a drug dosage. The information corresponding to the item “number of times” is information on the number of times of medical care for specifying the number of times of medical care, for example, the number of injections. The information corresponding to the item “medical practice score” is a score for medical fee calculation that is predetermined for each medical practice. The item “drug price” is the price of the drug used in the medical practice. The item “specified equipment amount” is the amount of the specified equipment used in the medical practice. In addition, the temporary receipt actually includes a DPC code or the like, but the illustration is omitted (the same applies to the temporary receipt inspection result information).

  The information corresponding to the item “medical fee amount” is medical fee amount information for specifying the medical fee amount for the medical practice, and includes the items “outpatient” and “hospitalized” as sub-items. . The information corresponding to the item “outpatient” indicates the amount of medical treatment remuneration for the outpatient. The information corresponding to the item “hospitalization” indicates the amount of medical treatment remuneration for the inpatient. Each of the item “outpatient” and the item “hospital” is further divided into an item “National Health Insurance” and an item “Company Health Insurance”. The information corresponding to the item “National Health Insurance” indicates the amount of medical treatment remuneration for patients enrolled in the national health insurance, and the information corresponding to the item “company insurance” is the amount of medical remuneration for patients enrolled in the social insurance. Is shown. In addition, the temporary receipt actually includes a management fee and the like, but the illustration is omitted (the same applies to the temporary receipt inspection result information).

  The provisional receipt information configured in this way is generated for each patient and for each date, and is stored in the provisional receipt information DB 41a. A specific method for generating the temporary receipt information is arbitrary. For example, the temporary receipt information created by the receipt creation device 20 as described above is received by the input / output IF 45 via the network 50 and temporarily received. It is stored in the receipt information DB 41a. However, this temporary receipt information may be acquired from the receipt creation apparatus 20 as necessary.

[Configuration-Receipt Analyzer-Temporary Receipt Inspection Result Information DB]
The temporary receipt inspection result information DB 41b of FIG. 1 is temporary receipt inspection result information storage means for storing temporary receipt inspection result information. As illustrated in FIG. 3, the provisional receipt inspection result information is configured by adding an item “inspection result” and information corresponding to the item to the provisional receipt information of FIG.

  The item “inspection result” is inspection result information regarding the inspection result of the provisional receipt, and includes the item “rule number”, the item “rule name”, the item “question level”, and the item “inspection level” as sub-items. Yes. The information corresponding to the item “rule number” is rule specifying information for specifying a rule for determining whether or not there is a possibility that a defect exists in the receipt. Specifically, the rule is uniquely identified. It is a rule identification number for The information corresponding to the item “rule name” is rule specifying information for specifying a rule for determining whether or not there is a possibility that a defect exists in the receipt, and specifically, the name of the rule. .

  The information corresponding to the item “question level” is deficiency possibility information that specifies whether or not there is a possibility that a deficiency exists in the receipt for claiming the medical fee for the medical practice. The information is one of “no doubt”, “high possibility of return”, “high possibility of assessment”, and “there is variation in prefectures”. “No doubt” indicates that it is unlikely to be returned or assessed (no doubt of return or assessment), “Highly likely to return” indicates that it is likely to be returned, and “Assessable” “High” indicates that there is a high possibility of being assessed, and “With prefectural variation” indicates that the possibility of being returned or assessed may differ depending on the prefecture where the examination and payment institution is established. It is high. In the following explanation, if any of "High possibility of return", "High possibility of assessment", or "There is a prefectural variation", it is considered as "Questionable", and it falls under any of these. If there is not, “No doubt” is assumed. However, if it falls under “Prefectural variations”, it may be included in “No doubt”. Or you may make it determine more clearly with reference to the detailed rule information for every prefecture.

  The information corresponding to the item “inspection level” is inspection level specifying information for specifying the inspection level of the provisional receipt. The inspection level is set in correspondence with each of a plurality of predetermined rules that serve as a reference for inspection when the reception inspection device 30 checks inadequacies in the calculation of medical fees for each medical practice included in the provisional receipt. Each level corresponds to one of “restrictions on number of times”, “adaptation check”, “dose or days”, “concurrent calculation”, “missing management fee”, or “other” . For example, when a specific medical practice is inspected based on a plurality of rules, if it is determined that the rule conforms to the rule (there is incomplete according to the rule), the inspection level corresponding to the rule is set to the item “ It is recorded as information corresponding to “inspection level”. Here, the “number of times limit” is an inspection level corresponding to a rule relating to the number of medicines and tests that can be applied within a predetermined period. “Adaptive check” is a check level corresponding to a rule relating to the correspondence between the name of an applied disease and a drug. The “dose or days” is an inspection level corresponding to a rule relating to a prescription drug or a test dose or days. The “computation calculation” is an inspection level corresponding to a rule relating to the interrelationship of a plurality of medical practices that can be performed within a predetermined period. The “management fee addition omission” is an inspection level corresponding to the rule regarding the omission of the management fee for this management in the provisional receipt despite medical management such as diet management for diabetic patients. “Other” is an inspection level corresponding to a rule not included in other rules.

  The temporary receipt inspection result information configured as described above is generated for each patient and for each date, and is stored in the temporary receipt inspection result information DB 41b. The specific method for generating the provisional receipt inspection result information is arbitrary, but for example, the provisional inspection inspection result information created based on the provisional receipt information by the receipt inspection apparatus 30 as described above is the network 50. Is received at the input / output IF 45 and stored in the temporary receipt inspection result information DB 41b. However, this temporary receipt inspection result information may be acquired from the receipt inspection device 30 as necessary.

[Configuration-Receipt Analyzer-Corresponding Disease Name Information DB]
The corresponding disease name information DB 41c of FIG. 1 is a corresponding disease name information storage unit that stores corresponding disease name information configured by associating the attributes of the medical practice and the disease names corresponding to the attributes with each other. As illustrated in FIG. 4, the corresponding disease name information is configured by associating the item “medical practice attribute” and the item “disease name” with information corresponding to these items. The item “medical practice attribute” is almost the same as the item “medical practice attribute” in the provisional receipt information of FIG. 2, but the items “medical department”, item “medical identification”, and item “medical practice code” are sub-items. , And the item “action name” only. The item “disease name” is disease name specifying information for specifying a disease name corresponding to a medical practice, and is specifically a disease name.

  Corresponding disease name information configured in this way is generated in advance by an administrative institution, a doctor, or the like, and stored in the corresponding disease name information DB 41c.

[Configuration-Receipt Analyzer-Suspicious Money History Information DB]
The suspicion amount history information DB 41d in FIG. 1 is a suspicion amount history information storage unit that stores suspicion amount history information regarding the history of the suspicion amount. Further, the question amount history information DB 41d stores doctor record information configured to correlate the doctor specification information for specifying the doctor who performed the medical practice and the question amount specified by the specifying unit. Corresponds to information storage means. As illustrated in FIG. 5, the suspicion amount history information includes an item “recept common code”, an item “doctor code”, an item “patient code”, an item “hospital date”, an item “disease name suspicion amount”, The item “questionable difficulty amount for billing”, the item “suspicion amount for omission of management fee”, the item “DPC coding error doubt amount”, and information corresponding to these items are associated with each other.

  The information corresponding to the item “recept common code”, the item “doctor code”, the item “patient code”, and the item “date of hospitalization” is information corresponding to the item of the same item name in the temporary receipt information of FIG. Is the same.

  The information corresponding to the item "Disease name suspicion amount", the item "Management fee addition suspicion amount", and the item "DPC coding mistake suspicion amount" is the suspicion amount in which a certain type of deficiency exists. . Here, as the “predetermined type of deficiency”, any type of deficiency can be set. However, in the present embodiment, “in order to reduce the suspicion amount by improving the deficiency of the receipt” "Some types of deficiencies" are set. In other words, the type of deficiency that can be expected to reduce a certain amount of suspicion by improving deficiencies and that is relatively easy to improve deficiencies is defined as “predetermined deficiency”. Hereinafter, such a predetermined type of deficiency is referred to as “deficiency for improvement”. As this deficiency to be improved, in the present embodiment, specifically, “missing disease name”, “missing management fee”, and “DPC coding error” are set. “Disease name omission” is an incompleteness in which the name of a disease corresponding to this medical practice attribute is not described in the temporary receipt even though the medical practice attribute is recorded in the temporary receipt. The “missing management fee” is a deficiency that the management fee for the management is not described in the provisional receipt even though medical management such as diet management for the diabetic patient is performed. A “DPC coding error” is a deficiency that a DPC code, which is a unified code for uniquely identifying a medical practice, is not correctly described in a temporary receipt. The information corresponding to the item “Disease name omission suspected amount” is the suspected amount due to omission of the disease name, and the information corresponding to the item “Estimated omission of management fee addition” is the suspected amount due to the omission of management fee addition. Yes, the information corresponding to the item “DPC coding error suspicion amount” is a suspicion amount due to the DPC coding error. Further, the information corresponding to the item “question difficult question amount” is a question amount corresponding to deficiencies other than the deficiencies to be improved, and is a doubt amount expected to be difficult to claim from the insurer.

  The question amount history information configured as described above is generated by a question amount calculation process described later and stored in the question amount history information DB 41d.

〔processing〕
Next, a receipt analysis process performed by executing a receipt analysis program in the receipt analyzer 40 of FIG. 1 will be described. In the following description of this processing, processing that does not specify the control subject is assumed to be executed by the control unit 42 of the receipt analyzer 40, and when the information acquisition source or acquisition route is not specified, a known timing is used. And stored in advance in the storage unit 41 of the receptor analyzer 40 by a known method, or input by the provider of the receptor analyzer 40 or the person in charge of the user medical institution 2 via the input unit 43 And The “step” of each process is abbreviated as “S”.

  For example, when the person in charge instructs the receipt analysis apparatus 40 to start the receipt analysis program by a predetermined method via the input unit 43, the following processing is started.

[Processing-Suspicious amount calculation processing]
First, the suspicion amount calculation process is activated. This suspicion amount calculation process is a process for calculating the suspicion amount of deficiencies to be improved.

  In this process, the specifying unit 42a of the control unit 42 generates an analysis target specifying screen and displays it on the monitor. In this analysis target specifying screen, the person in charge specifies a temporary receipt to be analyzed. This specification is performed, for example, by specifying a range of medical departments to be analyzed and a range of patients to be analyzed.

  For example, on the analysis target identification screen, in order to specify the range of medical departments that are desired to be analyzed, text such as “Whole Hospital”, “Internal Medicine”, “Surgery”, “Psychiatry”, “Neurology” A check box corresponding to each text is displayed. “Hospital” is the analysis target for all medical departments of the user medical institution 2, “Internal Medicine” is the analysis target for only the internal medicine of the user medical institution 2, and “Surgery” is the analysis target for only the surgery of the user medical institution 2. "Psychiatry" and "Neurology" mean that each of these subdivisions belonging to internal medicine and surgery are to be analyzed. In such an analysis target specifying screen, when the person in charge selects one of these check boxes via the input unit 43, a medical department or a subsection corresponding to the selected check box is specified as an analysis target. . Hereinafter, the medical department identified in this way is referred to as “target medical department”. In addition, the specific method using each clinical department and each department or the check method using the check box is only an example, and the target medical care can be performed by any known method for any other clinical department or each department. A department may be specified.

  In addition, for example, in the analysis target specifying screen, in order to specify the range of patients to be analyzed, “Outpatient”, “National Health Insurance Outpatient”, “Company Health Care Outpatient”, “Hospitalization”, “National Health Insurance Hospitalization”, “Company Health Care Hospitalization” And a check box corresponding to each text is displayed. “Outpatient” is subject to analysis only for outpatients, “National Health Care Outpatient” is subject to analysis only for outpatients with National Health Insurance, and “Corporation Outpatient” is subject to social insurance among outpatients. “Inpatient” is the only subject to be analyzed, “National Health Insurance” is the only subject in the inpatient who is enrolled in the National Health Insurance, This means that only patients who have social health insurance among inpatients will be subject to analysis. In such an analysis object specifying screen, the person in charge selects one of these check boxes via the input unit 43, whereby the patient corresponding to the selected check box is specified as the analysis object. Hereinafter, the patient thus identified is referred to as “target patient”. The specific examples of these patient categories or the identification method using check boxes are merely examples, and the target patient may be identified by any known method for any other category. .

  When the person in charge performs a predetermined operation via the input unit 43 after specifying the target medical department and the target patient in this way, the specifying unit 42a displays the temporary receipt inspection result information stored in the temporary receipt inspection result information DB 41b. From the inside, provisional receipt inspection result information that matches the combination of the target medical department and the target patient is acquired. Hereinafter, the provisional receipt inspection result information acquired in this way is referred to as “target provisional receipt inspection result information”.

  And the specific | specification part 42a starts the suspicion amount specific process for specifying suspicion amount based on target temporary receipt check result information. FIG. 6 is a flowchart of the suspicion amount specifying process. First, the identifying unit 42a distinguishes each record included in the target provisional receipt inspection result information into a record of “return or assessment doubt” and a record of “management fee addition omission doubt” (SA1). This distinction is made based on, for example, information corresponding to the item “inspection level”, and a record in which this information is “management fee addition omission” is set as a record of “management fee addition omission doubt”. Records other than “missing management fee” shall be “return or assessment doubt” records.

  Next, the specifying unit 42a performs SA2 to SA7 on each record that is set as a “return or assessment doubt” record in SA1. Specifically, the specifying unit 42a determines whether or not the record of “return or assessment doubt” is unique (SA2). That is, when a receipt is inspected by the receipt inspection device 30, the same record in the same receipt for the same medical treatment for the same patient is also inspected for each rule, so the same in the same record In some cases, a plurality of records of receipt check results are generated for the medical fee amount information. However, even if multiple records are generated in this way, only one record can actually be charged to the insurer, so in order to accurately identify the suspicious amount, Records that need to be excluded. In the present embodiment, regarding the same record in the same reception for the same medical practice for the same patient, a non-overlapping record is referred to as a “unique” record for the same medical fee amount information. The duplicate record is referred to as a record that is not “unique”. Whether the record is “unique” is determined based on the patient attribute information or the medical practice attribute information. Specifically, “patient code” and “hospital date” are acquired as patient attribute information from each record that is set as a “return or assessment doubt” record in SA1, and “medical practice code” as medical practice attribute information. ”,“ Quantity ”, and“ Number of times ”, and“ Receipt common code ”. Then, it is determined whether or not there are a plurality of records that match the combination of the acquired information among the records of “return or assessment doubt” in SA1, and if there are not a plurality of records, the record is “unique” ”(SA2, Yes). If there are a plurality of records, it is determined that the record is not“ unique ”(SA2, No). However, if it is possible to determine whether or not it is “unique”, some information of the patient attribute information or the medical practice attribute information may be omitted, or other Information may be taken into account further.

  Next, the specifying unit 42a calculates a suspicion amount for the record determined to be “unique” in SA2 (SA3). Specifically, from the record, the number of medical practice points, the amount of pharmaceuticals, the amount of specified equipment, the quantity, and the number of times are obtained, and the amount of doubt = (the number of medical practice points x 10 + the amount of pharmaceuticals + the amount of specified equipment) x quantity x the number of times To do. The reason for multiplying the medical practice score by 10 is that the administrative practice score is set at 10 yen per point by the administration (the same applies to the calculation of various suspicious amounts and current billed amounts described later). ).

  Alternatively, the specifying unit 42a calculates a suspicion amount for a record determined not to be “unique” in SA2 (SA4). Specifically, the number of medical practice points, the amount of pharmaceuticals, the amount of specified equipment, the quantity, and the number of times are obtained from the record, and the amount of doubt = ((the number of medical practice points × 10 + the amount of pharmaceuticals + the amount of specified equipment) × quantity × number of times) / Calculated as the number of duplicates. The number of times of duplication is the number of times that the record of “return or assessment doubt” is not unique, and is calculated based on the determination criterion of SA2.

  Next, the specifying unit 42a determines whether or not the inspection level = adaptive inspection for the record determined to be “unique” in SA2 and the record determined to be not “unique” (SA5). . In other words, when the inspection level = adaptive inspection, it is found that the record is a defect found based on the rules regarding the correspondence between the name of the applicable disease and the drug, and the suspicion amount for such insufficiency is Therefore, the determination is performed in order to identify a record whose inspection level is adaptive inspection and calculate the suspicion of leakage of disease name. However, this criterion can be changed according to the setting of the inspection level. For example, a record corresponding to a plurality of inspection levels may be determined to be a record corresponding to a disease name leakage suspected amount. Alternatively, when the inspection level corresponding to the suspected leakage amount is set more strictly, only the record corresponding to the inspection level may be determined to be the record corresponding to the suspected leakage amount of disease name.

  Next, the identification unit 42a calculates the suspicion of leakage of disease name by summing the suspicion amounts calculated in SA3 or SA4 for all records determined to be inspection level = adaptive inspection (Yes) in SA5. (SA6). In addition, the identification unit 42a calculates the charge amount that is difficult to charge by summing the amount of doubt calculated in SA3 or SA4 for all the records that are determined as inspection level = not adaptive inspection (No) in SA5. (SA7).

  On the other hand, the specifying unit 42a performs SA8 to SA9 for each record that is set as a record of “suspicion of omission of management fee addition” in SA1. Specifically, the specifying unit 42a calculates the suspicion amount for the record of “suspicion of omission of management fee addition” (SA8). In other words, the number of medical practice points, the amount of medicines, the amount of specified equipment, the quantity, and the number of times are obtained from the record, and the amount of doubt = (number of points of medical practice × 10 + the amount of medicines + the amount of specified equipment) × quantity × number of times is calculated.

  Next, the specifying unit 42a calculates the management fee addition omission suspected amount by summing all the suspected amounts calculated in SA8 for all the records that are set as the “management fee addition omission suspected” record in SA1 ( SA9).

  Thereafter, the specifying unit 42a calculates the DPC coding error suspicion amount based on the target temporary receipt inspection result information (SA10). However, since this calculation can be performed by a known method, detailed description thereof is omitted.

  Then, the specifying unit 42a totals the suspicious amount of suspicion of disease name, the suspicion of difficulty of claim, the suspicion of addition of management fees, and the suspicion of DPC coding mistake calculated for each tentative receipt, and is common to all tentative receipts. The code, the doctor code, the patient code, and the hospitalization date are acquired from the temporary receipt inspection result information DB 41b, and these pieces of information are correlated with each other and accumulated in the suspicion amount history information DB 41d (SA11). This completes the suspicious amount specifying process.

[Processing-Output control processing]
Next, an output control process is started. This output control process is a process for controlling the output of various types of information. In this process, the specifying unit 42a generates an output control method specifying screen and displays it on the monitor. In this output control method specifying screen, the person in charge specifies a method to be used from predetermined output control methods. As this predetermined output control method, in this embodiment, dashboard analysis, priority order analysis, deficiency improvement, and doctor-specific performance analysis are set. Specific contents of each output control method will be described later. For example, text such as “Dashboard Analysis”, “Priority Analysis”, “Deficiency Improvement”, and “Performance Analysis by Physician” and check boxes corresponding to each text are displayed on the output control method identification screen. Yes. In such an output control method specifying screen, when the person in charge selects any of these check boxes via the input unit 43, the method corresponding to the selected check box is specified as the output control method. Hereinafter, the output control method specified in this way is referred to as “target output control method”. Specific examples of these output control methods or specifying methods using check boxes are merely examples, and target output control methods are specified by any known method for any other output control method. It may be.

[Processing-Output control processing-Dashboard analysis processing]
When dashboard analysis is specified on the output control method specifying screen, dashboard analysis processing is started. This dashboard analysis process is a process for generating and outputting a dashboard analysis chart for displaying a list of suspicious amounts of deficiencies to be improved. FIG. 7 is a flowchart of the dashboard analysis process.

  In this process, the specifying unit 42a of the control unit 42 calculates the current billing amount (SB1). The current charge amount is calculated based on the charge amount calculated based on the provisional receipt (whether there are any deficiencies in the matters described in the provisional receipt or whether there is a suspicion amount) Billing amount). Specifically, the current billing amount is calculated by adding the total of (the number of points of each medical practice × number of times) × 10 and the DPC total adjustment × 10.

  Next, the specifying unit 42a calculates the feasibility amount (SB2). The feasibility amount is an amount obtained by adding an amount that is estimated to be able to be further charged to the current billing amount when it is determined based on the medical practice described in the provisional receipt. Specifically, the feasibility amount is the sum of the current billing amount calculated previously + the sum of the alleged amount of management fee omission calculated in SA9 in FIG. 6-the sum of the alleged difficulty in billing calculated in SA7 in FIG. Calculate.

  Next, the specifying unit 42a calculates a simulation amount after return or assessment (SB3). The simulation amount after refund or assessment is an amount that is considered to be paid if a provisional receipt is submitted to the examination and payment institution without improving the deficiencies. Specifically, the simulation amount after refund or assessment is the sum of the current billing amount calculated previously-the total suspicious amount of disease name scrutiny calculated at SA6 in Fig. 6-the total suspicious amount of billing difficulty calculated at SA7 in Fig. 6 Calculate.

  Thereafter, the output control unit 42b generates a dashboard analysis chart in a predetermined format based on each suspicion amount calculated so far, and outputs it to the monitor (SB4). This completes the dashboard analysis process.

  FIG. 8 is a display example of a dashboard analysis diagram. In this dashboard analysis chart, the first axis (vertical axis on the left side in FIG. 8) is the suspicious amount (unit = thousand yen), and the second axis (vertical axis on the right side in FIG. 8) is the amount charged (unit = Thousand yen), in the order from the left to the right on the third axis (horizontal axis in FIG. 8) orthogonal to the first axis and the second axis, in the last two months, the previous month, and the current month (target month) The amount is displayed. As various amounts, the suspicion of omission of disease name, the suspicion of omission of management fee, and the suspicion of DPC coding error are displayed as a positive bar graph, and the difficulty amount of billing is displayed as a negative bar graph. The billed amount and the simulation amount after return or assessment are displayed as a line graph. By looking at such a dashboard analysis chart, the person in charge can easily and accurately grasp the absolute value and transition of each amount. In particular, the billable amount and the difficult billing amount are identified, so it is possible to identify the impact of the lack of receipt from the perspective of the billable amount and the difficult billing amount, and the impact of the lack of receipt on management. It is possible to easily and accurately grasp this. In addition, after calculating the various amounts of money for the target month, the calculated amounts are stored in the storage unit 41 for each month and called up and used as necessary. However, only various amounts for the target month may be displayed. Further, the amount of money may be displayed numerically on each bar graph or line graph.

[Processing-Output control processing-Priority analysis processing]
When priority order analysis is specified on the output control method specification screen, priority order analysis processing is started. This priority order analysis process is a process for generating and outputting a priority order analysis chart for displaying the suspicious amounts of deficiencies to be improved in order of priority. FIG. 9 is a flowchart of the priority order analysis process.

  In this process, the specifying unit 42a of the control unit 42 calculates the total of various suspicion amounts calculated in the suspicion amount calculation process for each of the receptors specified by the target provisional receipt inspection result information (SC1). For example, if a suspicious amount calculation process is performed for one provisional receipt, the total suspicious amount of the provisional receipt is calculated when the alleged amount of suspicion of illness, management fee addition suspicion amount, and DPC coding suspicion amount are calculated. = Disease name omission doubt amount + Management fee addition omission doubt amount + DPC coding error allegation amount.

  And the specific | specification part 42a integrates the sum total of the suspicious amount of each receipt, and calculates the sum total of the suspicious amount of all the receipts (SC2). Next, the specifying unit 42a calculates the occupancy ratio of the sum of the suspicious amounts of the respective receipts with respect to the sum of the suspicious amounts of all the received re- sults (SC3). For example, if the sum of the suspicious amounts of all the receipts is 2,000 million yen and the sum of the suspicious amounts of one receipt is 20 million yen, the occupancy rate of the sum of the suspicious amounts of the receipts = ( 20 / 2,000) × 100 = 1% is specified.

  Then, the specifying unit 42a arranges the receptors in descending order of the occupation ratio (SC4), and sequentially adds the occupation ratios in the arranged order to calculate the cumulative value of the occupation ratio (hereinafter, cumulative ratio) (SC5). ). For example, when the occupancy ratio of the aligned first receptors is 10% and the occupancy ratio of the second receptors is 8%, the accumulation ratio of the first receptors = 10%, the accumulation ratio of the second receptors = 10 % + 8% = 18%.

  Thereafter, the output control unit 42b generates a priority order analysis table in a predetermined format based on each numerical value calculated so far, and outputs it to the monitor (SC6). This completes the priority order analysis process.

  FIG. 10 is a display example of the priority order analysis table. This priority order analysis table includes items “medical date”, item “clinical department”, item “doctor code”, item “patient code”, item “question amount”, and item “cumulative rate”. Are associated with each other. The information corresponding to the item “medical date”, the item “clinic department”, the item “doctor code”, and the item “patient code” is the same as the information corresponding to the item having the same item name in FIG. The information corresponding to the item “question amount” is the suspicion amount calculated in SC1. The information corresponding to the item “cumulative rate” is the cumulative rate calculated in SC5. By looking at such a priority analysis table, the person in charge can know the absolute value and cumulative rate of the suspicious amount of each provisional receipt, and easily and accurately provisional receipts that can have a significant effect by improvement. It becomes possible to grasp.

[Processing-Output control processing-Defect improvement processing]
When deficiency improvement is identified on the output control method identification screen, deficiency improvement processing is activated. This deficiency improvement process is a process for improving deficiencies in the temporary receipt. FIG. 11 is a flowchart of deficiency improvement processing.

  The identification unit 42a identifies a provisional receipt that is inadequate for improvement (SD1). For example, in the priority analysis table of FIG. 10, when any one of the temporary receipts is selected by the person in charge via the input unit 43, the selected temporary receipt is regarded as a temporary receipt that is inadequate to be improved. Identify. Alternatively, a temporary receipt specifying screen for specifying the temporary receipt is generated and displayed on the monitor. On this temporary receipt specifying screen, the type of deficiency, patient attribute information, or medical practice attribute information is input by the person in charge 43. In this case, the provisional receipt may be specified based on the input content.

  Next, the identifying unit 42a identifies a disease name corresponding to the attribute of the medical practice described in the temporary receipt identified in SD1 (SD2). Specifically, the provisional receipt inspection result information of the provisional receipt specified in SD1 is acquired from the provisional receipt inspection result information DB 41b, the medical practice attribute is acquired from the acquired provisional receipt inspection result information, and the acquisition is performed. The disease name corresponding to the medical practice attribute is specified with reference to the corresponding disease name information DB 41c.

  Then, the output control unit 42b generates a deficiency improvement proposal screen and displays it on the monitor (SD3). Specifically, the provisional receipt information corresponding to the provisional receipt specified in SD1 is acquired from the provisional receipt information DB 41a, and the deficiency improvement proposal is added by adding the disease name or the like specified in SD2 to the provisional receipt information. Generate a screen. This completes the deficiency improvement process.

  This correction proposal reception screen is, for example, a disease name (correction candidate disease name, indication disease name) that is considered to be correct from a clinical practice attribute and a reason for correction to a correction candidate disease name for a known form of temporary receipt. (For example, “Is the name of the disease described in the current provisional receipt ○○○○ not judged to be an indication based on the name of the wound, etc.? "There is a text comment"). By looking at such a revised proposal reception screen, the person in charge (in this case, a doctor who improves deficiencies in the provisional receipt) refers to the revised proposal receipt when improving the deficiencies in the receipt, so It is possible to easily and accurately grasp the name of the disease corresponding to the attribute, and it is possible to easily and accurately perform the work to improve the reception defect.

[Processing-Output control processing-Performance analysis processing by doctor]
When the doctor-specific result analysis is specified on the output control method specifying screen, the doctor-specific result analysis process is started. This doctor-by-doctor performance analysis process is a process for analyzing information related to the questionable amount of each doctor. FIG. 12 is a flowchart of the doctor-based performance analysis process.

  The specifying unit 42a specifies a doctor who wants to analyze (SE1). For example, in the priority analysis table of FIG. 10, when any one of the temporary receipts is selected by the person in charge via the input unit 43, the doctor corresponding to the selected temporary receipt is selected as the doctor who wants to analyze. Identify. Alternatively, a doctor specifying screen for specifying a doctor is generated and displayed on the monitor. On this doctor specifying screen, an incomplete type, patient attribute information, a doctor code, or the like is input by the person in charge through the input unit 43. In this case, the doctor may be specified based on the input content.

  Next, the specifying unit 42a acquires all the doubt amount history information corresponding to the doctor code of the doctor specified in SE1 from the doubt amount history information DB 41d (SE2), and the output control unit 42b displays the doctor-specific result analysis screen. It is generated and displayed on the monitor (SE3). The specific configuration of the doctor-by-doctor performance analysis screen is arbitrary, but for example, it is configured as a line graph with a horizontal axis representing time and a vertical axis representing the suspected amount, The amount of money, the management fee addition omission doubt amount, and the DPC coding mistake amount are plotted on the date of hospitalization, and these plots are connected to the type of the amount of doubt with a line. By seeing such a doctor-by-doctor performance analysis screen, the person in charge (doctor or manager) can easily and accurately grasp various trends such as the magnitude of the suspicion amount for each doctor. It becomes easy for each doctor to make a plan for improving the receipt description mistake by the doctor who is the source of the problem. The doctor-by-doctor performance analysis screen can be output in various other formats. For example, when a plurality of doctors are selected in SE1, the above-mentioned various suspicious amounts of the plurality of doctors are compared. As possible, output by a line graph or bar graph on the same screen, calculate the occupancy rate of each doctor's suspicion amount in the total suspicion amount of the user medical institution, , The amount of suspicion, and the occupation rate can be displayed.

[Modification]
While the embodiments of the present invention have been described above, the specific configuration and means of the present invention can be arbitrarily modified and improved within the scope of the technical idea of each invention described in the claims. Hereinafter, such a modification will be described.

(About problems to be solved and effects of the invention)
First, the problems to be solved by the invention and the effects of the invention are not limited to the above-described contents, and the present invention solves the problems not described above or has the effects not described above. There are also cases where only some of the described problems are solved or only some of the described effects are achieved.

(About configuration and control)
Further, all or any part of the control described as being automatically performed in the above embodiment may be performed manually, and conversely, all or any one of the control described as being performed manually is performed. The part may be automated based on a known technique or the above-described idea. Moreover, you may comprise a part or all of each functional block of each component shown in the said embodiment with a hard wired logic.

(About distribution and integration)
Further, each of the electrical components described above is functionally conceptual and does not necessarily need to be physically configured as illustrated. In other words, the specific form of distribution and integration of each part is not limited to the one shown in the figure, and all or a part thereof may be functionally or physically distributed or integrated in arbitrary units according to various loads or usage conditions. Can be configured. For example, the receipt analysis device 40 may be configured by being distributed among a plurality of server devices and terminal devices, or the receipt inspection device 30 and the receipt analysis device 40 may be integrated into one server device.

(About data processing targets)
In the above-described embodiment, various treatments were performed on the temporary receipt after being inspected by the receipt inspection device 30. For example, the provisional receipt after the deficiency has been improved with respect to the initial provisional receipt. Various types of processing may be performed as a target, or various types of processing may be performed on this receipt after being submitted to an examination organization.

DESCRIPTION OF SYMBOLS 1 Receptacle integrated system 10 Electronic medical chart apparatus 20 Receipt preparation apparatus 30 Receipt inspection apparatus 40 Receipt analysis apparatus 41 Memory | storage part 41a Temporary receipt information DB
41b Temporary Receipt Inspection Result Information DB
41c Corresponding disease name information DB
41d Suspicious amount history information DB
42 Control Unit 42a Identification Unit 42b Output Control Unit 43 Input Unit 44 Output Unit 45 Input / Output IF
50 network

Claims (6)

Temporary receipt check result information on a plurality of receipts for claiming medical fees for medical fees performed by a medical institution, and information on medical fees for specifying the medical fees for the medical fees, and the medical fees Temporary Receipt Inspection configured to correlate the information on the possibility of deficiency in each receipt for claiming medical fees for the patient and the deficiency information that identifies the result of the inspection together with the type of deficiency Input receiving means for receiving input of result information;
Based on the temporary receipt inspection result information received by the input receiving means, the medical fee amount information associated with the defect possibility information specifying that there is a possibility that a predetermined type of defect exists is extracted. Then, by referring to the medical fee amount specified by the extracted medical fee amount information, the receipt is returned or assessed because there is a defect in the receipt, and the medical institution is paid. A specific means of identifying a suspicious amount that is a possible medical fee amount,
Output control means for outputting information including the suspicious amount specified by the specifying means via a predetermined output means in a format specified by a predetermined method;
A receipt analyzer comprising: The temporary receipt check result information includes patient attribute information that identifies an attribute of a patient who has undergone the medical practice or medical practice attribute information that identifies an attribute of the medical practice,
The specifying means may have a predetermined type of deficiency based on the patient attribute information or the medical practice attribute information included in the temporary receipt inspection result information received by the input receiving means. When it is determined whether or not the medical fee amount information associated with the deficiency information to be identified is duplicated for the same medical practice for the same patient, Excluding the duplicate medical fee information, specifying the suspicion amount,
The receipt analyzer according to claim 1. The specifying means is expected to be able to charge the medical institution even when the receipt is returned or assessed based on the provisional receipt inspection result information received by the input receiving means. Identifying a billable amount that is a medical fee amount and a questionable amount that is a medical fee amount that is predicted to be difficult to pay to the medical institution if the receipt is returned or assessed;
The receipt analyzer according to claim 1 or 2. The provisional receipt inspection result information includes medical practice attribute information that identifies an attribute of the medical practice,
Corresponding disease name information storage means for storing corresponding disease name information configured to correlate the attribute of the medical practice and the disease name corresponding to the attribute,
The specifying unit refers to the corresponding disease name information stored in the corresponding disease name information storage unit based on the medical practice attribute information included in the temporary receipt inspection result information received by the input receiving unit. Identify the disease name corresponding to the attribute of the medical practice,
The output control means outputs the correction proposal receipt described in the receipt corresponding to the temporary receipt inspection result information received by the input receiving means, the disease name specified by the specifying means,
The receipt analyzer according to any one of claims 1 to 3. The temporary receipt check result information includes doctor specifying information for specifying a doctor who performed the medical practice,
A doctor achievement information storage means for storing doctor achievement information configured to correlate the doctor identification information and the suspicion amount identified by the identification means;
The output control means outputs information related to a suspicion amount for each doctor based on the doctor achievement information stored in the doctor achievement information storage means.
The receipt analyzer according to any one of claims 1 to 4. A program to be executed by a computer,
The computer,
Temporary receipt check result information on a plurality of receipts for claiming medical fees for medical fees performed by a medical institution, and information on medical fees for specifying the medical fees for the medical fees, and the medical fees Temporary Receipt Inspection configured to correlate the information on the possibility of deficiency in each receipt for claiming medical fees for the patient and the deficiency information that identifies the result of the inspection together with the type of deficiency Input receiving means for receiving input of result information;
Based on the temporary receipt inspection result information received by the input receiving means, the medical fee amount information associated with the defect possibility information specifying that there is a possibility that a predetermined type of defect exists is extracted. Then, by referring to the medical fee amount specified by the extracted medical fee amount information, the receipt is returned or assessed because there is a defect in the receipt, and the medical institution is paid. A specific means of identifying a suspicious amount that is a possible medical fee amount,
Output control means for outputting information including the suspicious amount specified by the specifying means via a predetermined output means in a format specified by a predetermined method;
Receipt analysis program to function as.

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