KR20110049108A - System for injustice demand prevention of servicing visit care/visit medical treatment and method using thesame - Google Patents

Abstract

PURPOSE: An illegal service charge preventing system and method thereof in home medical service are provided to increase the transparency of cost calculation by accurately determining whether to illegally charge home medical service fee. CONSTITUTION: A visiting nurse terminal(200) installs a chip including personal information of a visiting nurse in order to perform a customer and visiting medical service. If the cost of the visiting medical service is generated by the visiting nurse terminal, a public institution server(400) confirms personal information of the chip that is installed in a customer terminal(100). The public institution server confirms the location information of the visiting nurse terminal and the client terminal.

Description

System for injustice demand prevention of servicing visit care / visit medical treatment and method using thesame}

The present invention is to prevent an unfair claim when visiting medical care (visit care, visit care), more specifically, to determine whether or not an unfair billing right for the amount of money used by each visited medical service, so that the execution of expenses The present invention relates to a system for preventing unfair billing and the method for visiting medical services, which can enhance the transparency of people and facilitate the convenience of civil complaints.

As elderly people increase, interest in health is increasing. Accordingly, various medical services are also required to be improved from the existing doctor-centered to the patient-centered. It is important for each individual to live the right lifestyle according to his or her state of health in order to prevent disease and enjoy a healthy life. Diseases, especially hypertension, heart disease, diabetes, liver disease, cancer, and other diseases that are closely related to heredity, environment, lifestyle, and stress, may take a long time to develop symptoms. There are many. These diseases can be discovered at the time of treatment through regular health checkups, and risk factors derived from lifestyles can be detected in advance to prevent progression to the disease.

Individuals who were not subject to group check-ups at school or at work had to visit medical institutions such as public health centers, hospitals, or specialized clinic centers in order to receive health checkups. As a result, those who live in uncomfortable areas such as mountainous areas, remote islands or snowy areas or living in Muichon are experiencing great inconveniences. It was difficult to receive. As such, the so-called home visit health check-up service is required for those who are unable to live in wallpaper or living in uninhabited villages and those who are inconvenient to receive health check-ups at home.

In general medical visit (care / visit care) services, applicants who want to apply for visit nursing care and visit care pay a certain premium to the National Health Insurance Corporation and apply for a grade.

The National Health Insurance Corporation examines the applicant and decides the grade, etc., and as a result, the information, such as long-term care grade, necessary services, monthly amount, standard long-term care use plan, etc. is delivered to the applicant. From this point on, the applicant becomes a customer. In the following, applicants registered with the National Health Insurance Corporation who can receive visiting nursing care are referred to as customers.

On the other hand, medical service providers for visiting nursing care or visiting nursing care service business must meet certain requirements and report the establishment to the certification authority (Ministry of Health, Welfare and Family Affairs) of each city, province, city, county, and district. While supervising / supervising the medical service providers, the National Health Insurance Corporation will support the treasury and local expenses.

Visiting service providers registered with the Ministry of Health, Welfare and Family Affairs are contracted when a customer applies for services for visited nursing care and visitation care. In some cases, the term "visiting nurse" will visit the home where the beneficiary is entitled to provide nursing or nursing care services.

Customers who have contracted for medical care services and visit care services of health care providers will file a cash benefit claim with the National Health Insurance Corporation.

In addition, after the medical service provider performs the services according to the visited nursing care and the visited nursing care, the health insurance company bills the National Health Insurance Corporation. Based on this, service fees are paid to the provider.

As is well known, the establishment of visiting nursing and nursing service organizations is free and a large number of businesses or assistants have been created. In practice, their medical service behavior is different for each customer (patient, elderly, disabled, ....), and the amount billable may vary.

In the case of the Ministry of Health, Welfare and Family Affairs / local government, which are the subjects of visiting nursing care or nursing service, if the charges for each service differ from the actual ones, it can lead to waste of national budget and increase of customer complaints. do.

For billing for existing visiting medical services, you must check whether you are a customer applying for a service for a billing by a registered visiting medical service provider and perform a payment for the billing, or if you have any doubt about the billing. In case of the visit, the method of paying the fee after checking the fact by calling or visiting the customer directly was mainly used. Therefore, this method lacks accuracy and has the disadvantage of not being able to prevent an unfair claim for visiting medical services.

In addition, when paying for an existing visiting medical service, a registrar with many visiting nurses makes a bill for the medical service performed by the visiting nurse and another person requests a batch of applications at a time (usually at the end of the month). In many cases, the Ministry of Health, Welfare and Family Affairs / Local Governments / National Health Insurance Service has been paralyzed due to the lump sum of expenses, or it is impossible for the applicants to make phone calls for payment.

Accordingly, the present invention has been proposed in order to solve various problems occurring in the existing visiting medical service as described above,

SUMMARY OF THE INVENTION The present invention has been made in an effort to provide a system and a method for preventing an unfair billing during a visited medical service, which enable the user to quickly and accurately determine whether or not an unfair billing right is used for the amount of visited medical service.

Another problem to be solved by the present invention is to provide a system and method for preventing unfair billing during medical visits, which can enhance the transparency of cost execution and facilitate the convenience of civil complaints.

Another problem to be solved by the present invention is to provide an unfair billing prevention system and method for visiting medical services to prevent others from charging for visiting medical services in addition to the person (visit nurse) who performed the visiting medical services. There is.

Another problem to be solved by the present invention is that, after performing the visiting medical service, the visiting nurse can directly claim the cost of the visiting medical service, so that the cost of the visiting medical service is collectively applied for The present invention provides a system and method for preventing unfair billing in medical visits to prevent paralysis.

In order to solve the above problems, "unfair billing prevention system when visiting medical services" according to the present invention,

A customer terminal and a visited nurse terminal equipped with a chip (USIM) containing personal information of a customer for application for a visited medical service and a visited nurse for performing the visited medical service;

When the charge for the visited medical service is generated by the visited nurse terminal, the personal information registered in the chip mounted on the customer terminal and the location information of the customer terminal and the visited nurse terminal are checked to confirm the request. Includes a public institution server to verify authenticity.

"Prevention of unfair claims when visiting medical services" according to the present invention,

The communication server may further include a communication company server that provides location information of the client terminal and the visited nurse terminal to the public institution server according to a request of the public institution server.

Preferably the public institution server,

When the charge for the visited medical service occurs from the visited nurse terminal, the visited nurse information and the customer information are checked through the personal information of the chip mounted on the visited nurse terminal, and a confirmation letter is generated for the visited medical service. The acknowledgment is transmitted to the customer terminal in which the customer information is registered, and as a result of the response, the authenticity of the claim is first confirmed, and the location information of the visited nurse terminal and the customer terminal received by requesting a communication company server are received. It is characterized in that the second to confirm the authenticity of the claim by searching the location information of.

More preferably the public institution server,

Registration of a chip (USIM) including personal information for mounting on the customer terminal and the visited nurse terminal, and a care management module for managing the information of the chip;

And generating a confirmation character to be transmitted to the customer terminal and transmitting the generated confirmation character to the customer terminal.

According to the present invention for solving the above problems, a method of preventing unfair claims during medical visits,

In the method of preventing an unfair claim by using an unfair billing prevention system for visiting medical services consisting of a customer terminal, a visited nurse terminal, a communication server server and a public institution server,

A registration step of providing a chip (USIM) containing personal information to the visiting medical service application customer and the visiting nurse performing the visiting medical service, and registering the customer and the visiting nurse;

A first authenticity checking step of first checking whether or not the authenticity of the medical service is transmitted by sending a text message to the client terminal and the medical service when a charge for the visiting medical service is generated from the visited nurse terminal;

A second authenticity checking step of inquiring the position information of the visited nurse terminal and the customer terminal to the telecommunication company server and secondly confirming the authenticity of the medical service by comparing the received position information;

And a payment control step of controlling payment for the charges based on the first authenticity / second authenticity verification result.

Preferably the first authenticity check step,

Generating a service confirmation character to transmit to the customer terminal when the billing occurs;

Transmitting the generated service confirmation character to the customer terminal;

Analyzing the response received from the customer terminal to determine whether the primary authenticity for the medical service.

Preferably the payment control step,

Determining that payment is impossible for the charges if any of the first and second authenticity is determined to be false;

If the determination of the first authenticity and the second authenticity, both of the authenticity includes the step of making a payment for the charges.

According to the present invention, it is possible to quickly and accurately determine whether the right of claim for the visited medical service is an unfair claim, and to settle, thereby improving the transparency of the execution of costs and the convenience of the civil complaints.

In addition, according to the present invention, since the person who performed the visiting medical service (visiting nurse) performs the request after performing the visiting medical service in the field directly, it is possible that another person other than the medical service provider charges for the visiting medical service. There is an advantage that can be prevented.

In addition, according to the present invention, since the billing is made through the visited nurse terminal immediately after performing the visiting medical service, the cost of the visiting medical service is collectively applied to prevent the paralysis of the processing institution. have.

DETAILED DESCRIPTION Hereinafter, exemplary embodiments of the present invention will be described in detail with reference to the accompanying drawings. In the following description, well-known functions or constructions are not described in detail since they would obscure the invention in unnecessary detail.

1 is a configuration of the "unfair billing prevention system when visiting medical services" according to the present invention, the customer terminal 100, visited nurse terminal 200, communication network 200, public institution server 400, communication company server 500 It consists of

The customer terminal 100 is a terminal used by a customer who applies to a public institution of visiting medical service and registers as a target of visiting medical service in the public institution, and the customer terminal 100 includes personal information provided by the public institution. Terminal is equipped with a chip (USIM). Such a terminal is preferably a mobile phone (cell phone) or using a personal information terminal.

The visited nurse terminal 200 is a terminal used by a visited nurse registered with the public institution as a performer for performing a visited medical service, and registered as a visited medical service operator in the public institution. The visited nurse terminal 200 includes the It is a terminal equipped with a chip (USIM) containing personal information provided by a public institution. Such a terminal is preferably a mobile phone (cell phone) or using a personal information terminal. Here, the visited nurse terminal 200 may be a terminal owned by an individual, or may be a terminal of a company registered as a company for performing a visited medical service to the public institution. In the case of a company-owned terminal, the company may recruit nurses for visiting medical services, and use the visited nurses by providing their registered terminals to the visiting nurses. In this case, personal information is also stored in the USIM.

The communication network 300 is a communication network for interconnecting the customer terminal 100, the visited nurse terminal 200, the public institution server 400, and the communication company server 500, and includes a general Internet network, a mobile communication network, a wired network, and a wireless network. It is the network that oversees.

The public institution server 400 checks the personal information registered in the chip mounted on the customer terminal 1000 and the customer terminal 100 when the charge for the visited medical service is generated by the visited nurse terminal 200. And checking the location information of the visited nurse terminal 200 to confirm the authenticity of the generated claim.

When the public institution server 400 charges for the visited medical service from the visited nurse terminal 200, the visited nurse information and the customer information are provided through personal information of a chip mounted on the visited nurse terminal 200. Confirming, generating a confirmation letter for the visited medical service and transmitting the confirmation letter to the customer terminal 100 in which the customer information is registered, and primarily confirming the authenticity of the claim as a response result; It is characterized in that the second to confirm the authenticity of the claim by searching the location information of the visited nurse terminal 200 and the location information of the customer terminal 100 received by requesting a communication company server.

As shown in FIG. 2, the public institution server 400 communicates with the customer terminal 1000, the visited nurse terminal 200, and the communication company server 500 through the communication network 200. 410, the control module 420 for registering the customer and the visiting nurse for the visiting medical service, checking the authenticity of the billing when billing the visiting medical service, and performing payment control according to the checking result; Visit nurse information management module 440 for registration of visited nurse, visit service application customer management module 450 for customer registration, and information database 430 for storing and managing a variety of data.

In addition, the registration of the chip (USIM) containing the personal information for mounting on the customer terminal 100 and the visited nurse terminal 200, and the care management module 460 for managing the information of the chip, the customer terminal Generate a confirmation character to be transmitted to the 100, the character transmission module 470 for transmitting the generated confirmation character to the customer terminal 100, the customer terminal 100 and the in connection with the communication company server 500 Receiving the location information of the visited nurse terminal 200 and checks the location information check module 480 and the control module 420 to perform the payment for the billing request requested by the visited nurse terminal 200 A payment module 490.

The communication company server 500 performs a function of providing location information of the customer terminal 100 and the visited nurse terminal 200 to the public institution server 400 at the request of the public institution server 400. The telecommunication company server 500 currently means a telecommunication company server such as SK Telecom, KT, LG Telecom, etc., but only one is shown in the figure for convenience, but the three telecommunication company servers are all linked.

According to the present invention constituted as described above, "An unfair billing prevention system for visiting medical services, a customer who wants to receive visiting medical services, such as visiting nursing care or visiting nursing service, apply to public institutions, and register as a visiting medical service subject, The personal information provided by the public institution is provided with a chip (USIM) recorded therein and mounted on its own mobile phone (or personal information terminal) .The terminal equipped with the chip containing personal information is connected to the customer terminal 100. It is called).

In addition, a company or an individual who wants to perform visiting medical services may apply to the public institution, and if it is selected as a visiting medical service agent through a predetermined examination and evaluation, register with the public institution and provide the public institution. The personal information (Visit Nurse) is given a chip (USIM) recorded therein, and is mounted on its own terminal. The terminal equipped with a chip containing personal information is referred to as a visited nurse terminal 200. In this case, when a company registers with a public institution, it applies for registration for all visiting nurses managed by the company, and receives all chips containing personal information for all visiting nurses from the public institution. It can also be provided to.

As is well known, after registering clients and visiting nurses for visiting medical services, the clients and visiting nurses sign contracts for visiting medical services, and when such contracts are made, visiting medical services, which are visiting nursing / visiting care services, are started. do.

The visited nurse carries the visited nurse terminal 200 which he carries, and visits the home of the customer to start the visited medical service, and when the visited medical service is completed, the visited nurse terminal 200 carried by him on the spot Through the billing for the visited medical service is written to bill the public institution server 400. At this time, the personal information recorded in the simplicity stored in the visited nurse terminal 200 or part of the bill is transmitted to the public institution server 400 together.

Therefore, the control module 420 of the public institution server 400 receives the bill for the visited medical service through the communication module 410, extracts the personal information of the visited nurse included in the visited nurse information management module 440 And to the care management module 460, respectively.

Attention management module 460 analyzes the chip management information included in the transmitted personal information, and confirms whether it is a normal sentiment, and visited nurse information management module 440 is the personal information is an information database Check if the registered at (430), the visited nurse will be confirmed.

If it is determined that the visited nurse is a registered visited nurse through this confirmation procedure, the text transmission module 470 generates a callback character for confirming the medical service in order to confirm that the visited nurse's bill is correct, based on the customer information. Send the callback character to the customer terminal. In this case, the bill sent by the visited nurse has customer information, and the phone number of the registered customer terminal is extracted by searching the information database 430 in the visited service application customer management module 450 based on the customer information.

Then, the callback character is transmitted from the text transmission module 470 to the customer terminal based on the extracted phone number of the customer terminal. This callback character is preferably designed to be made in real time successively when the visiting nurse sends a bill for medical services to the public institution server 400.

When the customer who has received the visited medical service receives the callback character to his or her client terminal 100, confirms the contents and presses a confirmation button when the contents are correct. 400 is received. Of course, the customer may not press the OK button if the content is wrong, another method is to specify a button corresponding to "No" when sending the callback text if the content is wrong, there is a way to press the button Can be. Such a method can be variously implemented, but in the present invention, only the pressing of the confirmation button will be described as an embodiment.

The control module 420 of the public institution server 400, if the confirmation response to the callback character occurs within a predetermined time from the customer terminal 100, and confirms whether the guilty given at the time of customer registration is correct through the care management module 460 In this case, the first check is that the visiting nurse's medical service is provided. If the acknowledgment for the callback text does not occur within a certain amount of time, the charges made by the visiting nurse will be considered unfair and will be taken afterwards.

In this way, when an on-site nurse bills bills for visiting medical care on the fly, it is possible to prevent others from charging for visiting medical services and also to prevent billing of medical bills at once. will be.

In the present invention, in order to make primary visits to the visited medical service in the same manner as above, and to confirm the authenticity of the claim more accurately, the location information of the terminal is also used.

That is, after the primary confirmation as described above, the location information confirmation module 480 of the public institution server 4000 generates a message requesting confirmation of location information and provides the message to the communication company server 500. Here, the location information confirmation request is made. The message includes terminal information of the visiting nurse and terminal information of the client terminal, and may also include date and time information, and the location information confirmation request message searches for a carrier registered in advance at the registration of the visiting nurse terminal and the client terminal. It is preferable to send a location request message only.

The communication company server 500 transmits the location information of the current visited nurse terminal and the location information of the customer terminal to the public institution server 400 in real time according to the location information confirmation request message. The location information checking module 480 compares two pieces of location information and transmits the result of the comparison to the control module 420.

The control module 420 checks the comparison result of the location information, and if it is determined to match, the control module 420 determines that the normal visiting medical service is in progress, and transmits a command to proceed with the payment to the payment module 490. Of course, if the results of the comparison of the location information is different from each other, it is determined that the unfair medical expenses are billed, and payment is not performed.

When the payment module 490 receives a command for payment progress from the control module 420, the payment module 490 performs a normal payment procedure and proceeds with a payment process for the fee charged by the visiting nurse. Through this process, secondary verification of the authenticity of billing for visiting medical services is made.

In this case, when using the location information of the identified mobile phone, it is preferable to receive the location information through agreement with the carrier in advance. In this case, the carrier server may charge a separate fee for the location service if necessary. It is also possible to generate profits from telecom companies.

3 is a flowchart showing a "prevention of unfair billing when visiting medical services" according to the present invention, which is a control flow performed by the control module of the public institution server.

As shown in FIG. 2, a registration step (S101 to S103) of providing a chip (USIM) including personal information to a visiting medical service application customer and a visiting nurse performing a visiting medical service, and registering the customer and the visiting nurse. Wow; When the charge for the visited medical service occurs from the visited nurse terminal, the first authenticity confirming step of firstly confirming the authenticity of the medical service by transmitting a text for the client terminal and the medical service (S105 to S115). )Wow; Inquiry of the location information of the visited nurse terminal and the customer terminal to the telecommunication company server, the second authenticity confirmation step of secondly confirming the authenticity of the medical service by comparing the received location information (S117 ~ S121) Wow; It includes a payment control step (S123 ~ S125) for controlling the payment for the billing based on the first authenticity / second authenticity check result.

Preferably, the first authenticity checking step (S105 to S115) comprises: generating a service confirmation letter to be transmitted to the customer terminal when the billing occurs (S105 to S107); Transmitting the generated service confirmation character to the customer terminal (S109); Analyzing the response received from the customer terminal to determine whether the primary authenticity for the medical service (S111 ~ S115).

In addition, the payment control step (S123 ~ S125), if it is determined that any one of the first authenticity and the second authenticity is false, determining that the charge is an unfair claim and determining the impossible to pay (S123) )Wow; If it is determined that both of the first authenticity and the second authenticity is genuine, it includes the step of performing a payment for the charges (S125).

In this way, the "prevention of unfair claims during visit medical services" according to the present invention, a chip (USIM) containing personal information to the visited medical service application customers and visiting nurses performing the visiting medical services in steps S101 and S103 And register the client and visiting nurse as clients and nurses for visiting medical services.

In step S105, the visited nurse performs the visited medical service to the customer, and charges for the visited medical service by using the visited nurse terminal carried by the client. In step S109, a confirmation callback character for the medical service is generated and transmitted to the customer terminal.

When the customer receives a callback character requesting confirmation about the visited medical service received by the customer terminal carried by the customer, the customer transmits a response to the public institution server to confirm whether the visited medical service matches the received medical service.

As noted herein, the customer receives the callback character, and if it is correct, only presses the OK button, and if the service is not received, the customer does not press the OK button.

The public institution server checks whether the response sent by the customer in step S111 is received, and if not received, waits for the response for a predetermined time. However, if the response is not received even after such a certain time, it is determined that this is an unfair charge, go to step S123 to determine the non-payment of the charges, and then notify the manager to follow up to take place. do.

On the contrary, if a response is received within a predetermined time, the flow proceeds to step S115, where the first confirmation is made that the medical service is normally performed.

Next, the public institution server moves to step S117 based on the telephone number of the customer terminal and the telephone number of the visited nurse terminal, and requests a location information by accessing a previously negotiated communication company server.

Subsequently, in step S119, the location information provided by the telecommunication company server is received, and in step S121, the location information of the received customer terminal and the location information of the visited nurse terminal are compared.

As a result of the comparison, if the two location information are the same, it is determined as normal billing, and the process proceeds to step S125 to make a payment for the billing. In contrast, if the two location information are different from each other, it is determined as an unfair billing. It determines the non-payment of the bill, and delivers it to the manager promptly so that the post-processing can be done.

The present invention is not limited to the above-described specific preferred embodiments, and various modifications can be made by any person having ordinary skill in the art without departing from the gist of the present invention claimed in the claims. Of course, such changes will fall within the scope of the claims.

1 is a block diagram of a system for preventing unfair claims during medical visits in accordance with the present invention.

2 is a block diagram of an embodiment of a public institution server of FIG. 1.

Figure 3 is a flow chart illustrating a method for preventing unfair claims during medical visits in accordance with the present invention.

<Explanation of symbols for the main parts of the drawings>

100... Customer terminal

200... Visiting nurse terminal

400... Public institution server

500... Carrier server

Claims (7)

A system for preventing unfair claims in visiting medical services, A customer terminal and a visited nurse terminal equipped with a chip (USIM) including personal information of a customer for applying for the visited medical service and a visited nurse for performing the visited medical service; When the charge for the visited medical service is generated by the visited nurse terminal, the personal information registered in the chip mounted on the customer terminal and the location information of the customer terminal and the visited nurse terminal are checked to confirm the request. System for preventing unfair claims during visiting medical services, characterized in that it comprises a public institution server for checking the authenticity. The system of claim 1, further comprising a telecommunication company server that provides location information of the customer terminal and the visited nurse terminal to the public institution server according to a request of the public institution server. . According to claim 2, The public institution server, When the charge for the visited medical service occurs from the visited nurse terminal, the visited nurse information and the customer information are checked through the personal information of the chip mounted on the visited nurse terminal, and a confirmation letter is generated for the visited medical service. The acknowledgment is transmitted to the customer terminal in which the customer information is registered, and as a result of the response, the authenticity of the claim is first confirmed, and the location information of the visited nurse terminal and the customer terminal received by requesting a communication company server are received. System for preventing unfair claims during the visit, characterized in that the second to determine the authenticity of the claim by searching the location information. According to claim 2, The public institution server, Registration of a chip (USIM) including personal information for mounting on the customer terminal and the visited nurse terminal, and a care management module for managing the information of the chip; And a character transmission module for generating a confirmation letter to be transmitted to the customer terminal and transmitting the generated confirmation letter to the customer terminal. In the method of preventing an unfair claim by using an unfair billing prevention system for visiting medical services consisting of a customer terminal, a visited nurse terminal, a communication server server and a public institution server, A registration step of providing a chip (USIM) containing personal information to the visiting medical service application customer and the visiting nurse performing the visiting medical service, and registering the customer and the visiting nurse; A first authenticity checking step of first checking whether or not the authenticity of the medical service is transmitted by sending a text message to the client terminal and the medical service when a charge for the visiting medical service is generated from the visited nurse terminal; A second authenticity checking step of inquiring the position information of the visited nurse terminal and the customer terminal to the telecommunication company server and secondly confirming the authenticity of the medical service by comparing the received position information; And a payment control step of controlling a payment for the charges based on the results of the first and second authenticity checks. The method of claim 5, wherein the first authenticity checking step, Generating a service confirmation character to transmit to the customer terminal when the billing occurs; Transmitting the generated service confirmation character to the customer terminal; And analyzing the response received from the client terminal to determine whether the first authenticity of the medical service is unfair. The method of claim 5, wherein the payment control step, Determining that the first and second authenticity is false, if any one is false, and determining that payment is impossible for the charges; And checking the first and second authenticity as a result of checking the authenticity of the first and second authenticity.

Images