CN114926298A - Method and system for accurately accounting hospitalization cost of patient - Google Patents
Method and system for accurately accounting hospitalization cost of patient Download PDFInfo
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- CN114926298A CN114926298A CN202210696875.4A CN202210696875A CN114926298A CN 114926298 A CN114926298 A CN 114926298A CN 202210696875 A CN202210696875 A CN 202210696875A CN 114926298 A CN114926298 A CN 114926298A
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- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
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- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
Abstract
The invention discloses a method and a system for accurately accounting hospitalization cost of a patient, wherein the method is executed by a computer according to the following steps: acquiring a medical insurance reimbursement standard and establishing a submodule with the project and the project expense; the doctor uses the computer calling submodule to generate a medical advice according to the diagnosis result; the doctor approves the medical advice items and deletes the repeated items after the computer checks; recording each item cost actually accepted by the patient in the hospitalization process by the computer; comparing the accurate medical advice cost with the project cost of the patient in the actual hospitalization process, calling the latest medical insurance charging standard if the comparison result is consistent, authorizing the medical insurance charging standard in the accurate medical advice, and sending information for reminding the modification of the contents of the submodules if the approval result is inconsistent; and if the comparison result is inconsistent, generating the questionable medical advice, searching the information of the entry personnel of the questionable medical advice through the IP address, and modifying the questionable medical advice after the information of the entry personnel is approved.
Description
Technical Field
The invention relates to the technical field of medical treatment, in particular to a method and a system for accurately accounting hospitalization cost of a patient.
Background
The treatment cost generated during the hospitalization period of the patient is commonly called as the hospitalization cost, and the patient can check the daily hospitalization cost and the charging detail through a daily list. When the patient is recovered and discharged, and the relevant procedures of discharging are handled, the staff can also print the total list of the hospitalization cost of the patient to know all the cost conditions for the patient.
The medical advice of the hospitalization period is provided by the doctor in the hospitalization process, the medical staff does not execute the corresponding treatment items according to the medical advice due to temporary increase and decrease of the treatment items and the like of the patient, so that the medical items actually executed by the patient in the hospitalization period are different from the treatment items or times opened by the medical advice, the condition that the patient pays more or less fee according to the payment of the medical advice is caused, the work of checking the hospitalization fee of the patient is more difficult along with the increase of the hospitalization days of the patient, the cost is checked clinically or only manually by reading various record sheets, a large amount of manpower and material resources are consumed for each check, the problems of memory error, counting error and the like easily occur in manual calculation, and particularly the work of checking the accuracy of the fee is more difficult for the patient who is temporarily discharged, and the problem of charging error easily occurs.
Therefore, it is an important issue in modern medical treatment to solve the problems of excessive charge, missed charge, and wrong charge caused by inconsistency between the actual medical treatment item and the prescribed treatment item during hospitalization.
Disclosure of Invention
The invention aims to solve the technical problem of charge errors caused by the fact that the actual medical treatment item is inconsistent with the prescribed medical advice treatment item in the hospitalization process, and the like, and aims to provide a method and a system for accurately accounting the hospitalization cost of a patient, so that the problems of multi-charge, missed charge and wrong charge in the hospitalization process are solved.
The invention is realized by the following technical scheme:
a method for accurately accounting for hospitalization costs of patients, said method being performed by a computer, the computer performing steps comprising:
s1: acquiring medical insurance reimbursement standards and establishing a submodule with the items and the item cost;
s2: calling the submodule to generate a medical advice according to the diagnosis result of the doctor;
s3: checking the medical advice items, judging whether repeated items exist or not, outputting the repeated items, and generating accurate medical advice after the repeated items are approved and deleted by a doctor;
s4: recording the actually accepted project expenses in the hospitalization process of the patient;
s5: comparing the accurate medical order cost with the project cost of the patient in the actual hospitalization process, if the comparison result is consistent, performing S6, and if the comparison result is inconsistent, generating the questioned medical order;
s6: calling the updated medical insurance charging standard of the medical insurance bureau in real time, approving the medical insurance charging standard in the accurate medical advice, and sending information for reminding the modification of the contents of the submodules if the approval results are inconsistent;
s7: and searching the information of the entry personnel of the questioning medical advice through the IP address, and modifying the questioning medical advice after the information of the entry personnel is approved and returning to S5.
In the scheme, a computer acquires medical insurance reimbursement standards and establishes submodules with projects and project fees, wherein each submodule comprises a fixed medical project, a charge amount and a reimbursement medical standard;
the doctor calls the submodule to generate a medical order according to the diagnosis result, and the medical order with determined amount and determined reimbursement amount is generated because the charge amount of each medical item in the submodule is fixed with the reimbursement medical standard;
the computer scans the medical items of the medical advice, and when the computer scans repeated medical items, the computer automatically outputs the repeated medical items to remind medical staff, and the accurate medical advice is generated after the medical staff approves and modifies the repeated medical items;
when a patient performs an actual treatment project, the actual treatment project is recorded on a computer by a department performing the treatment project and used as the basis of the actual treatment project of the patient;
when the patient is discharged, the computer is used for comparing whether the medical items actually done by the patient are consistent with the medical items and expenses prescribed on the medical advice;
if the comparison result is consistent, the latest medical insurance reimbursement standard is called by the computer to check the medical insurance reimbursement standard on the medical advice, if the reimbursement standard is consistent, normal payment is carried out, if the reimbursement standard is inconsistent, the computer transmits the medical insurance charging standard with inconsistent approval result to a system manager, and after the system manager modifies the medical insurance reimbursement standard in the submodule after approval, the patient pays according to the latest medical insurance standard;
if the comparison result is inconsistent, searching the entry personnel of the inquiry medical advice through the IP address by using the computer, modifying the inquiry medical advice after the entry personnel approve, repeating the steps S5-S6 by using the computer again until the medical item in the medical advice is consistent with the actual medical item and is the latest medical insurance standard, and then paying the fee by the patient.
In some embodiments, the S5 includes a method for accurately calculating the hospitalization cost of the patient:
a1: scanning the accurate medical advice items, and performing item proofreading with items which are actually performed in the hospitalization process of the patient, wherein if the proofreading result is inconsistent, the questioning medical advice is generated, and if the proofreading result is consistent, A2 is executed;
a2: and scanning the times and the cost of the accurate medical advice items, and checking the times and the cost of the accurate medical advice items with the times and the cost of the items which are actually done in the hospitalizing process of the patient, wherein the results are inconsistent to generate the questioning medical advice, and the checking results are consistent to normally pay the cost.
In this scheme, the accurate doctor's advice is scanned to the computer to whether to have the treatment item of neglected doing of checking as the reference system with accurate doctor's advice, can effectively approve on the one hand and pay expenses, on the other hand can check whether to deposit treatment item and do not go on, utilize the computer to check medical item earlier, if find that the item does not generate the medical advice of questioning the very first time, compare in checking in the synchronous of the item in the accurate doctor's advice and the item number of times, efficiency is higher.
And if the medical items in the accurate medical advice are consistent with the actually performed medical items, comparing the item times and the payment amount.
In some embodiments, the S5 includes a method for accurately calculating the hospitalization cost of the patient:
b1: scanning the items which are done in the actual hospitalization process of the patient, and proofreading the items with the accurate medical advice items, wherein if the proofreading result is inconsistent, the questioning medical advice is generated, and if the proofreading result is consistent, B2 is executed;
b2: and (4) scanning the times and cost of items which are actually done in the hospitalization process of the patient, and checking the items with the accurate medical advice, wherein the results are inconsistent to generate the questioning medical advice.
In the scheme, the computer scans the actually performed medical items and mainly checks whether more treatment items exist or not by taking the actually performed medical items as a reference system, so that the medical items which are not paid are avoided.
In some embodiments, the S3 includes a method for accurately calculating the hospitalization cost of the patient:
c1: checking general items in the medical orders and judging whether repeated items exist or not, if so, outputting the repeated items, and executing C2 after the repeated items are approved and deleted by a doctor;
c2: and checking the special items in the medical orders and judging whether repeated items exist, and if so, outputting the repeated items, and generating the accurate medical orders after the repeated items are approved and deleted by the doctor.
In the scheme, the medical items are divided into the general departments and the special medical items, so that the checking efficiency is improved, and the medical staff in the department can be conveniently and accurately classified and positioned.
In some implementations, a system for accurately accounting for hospitalization costs of a patient is based on a system for accurately accounting for hospitalization costs of a patient, comprising:
the database comprises submodulars, each submodule comprises items, item cost and a medical insurance reimbursement proportion, and the submodulars are called to generate medical advice;
the checking module is used for approving whether repeated items exist in the medical advice prescribed by the doctor, deleting the repeated items and generating accurate medical advice;
the charging module is used for recording the project cost and the total cost actually done by the patient;
the fee clearing module is used for comparing whether the accurate medical advice is consistent with the fee in the charging module;
and the query module is used for determining the items with inconsistent cost in the accurate medical advice and the charging module through the cost clearing module and querying the information of the personnel offering the items through a computer.
In the scheme, the database establishes a plurality of sub-modules according to different medical projects, each sub-module comprises a fixed medical project, a fixed medical expense and a medical insurance reimbursement standard, and a doctor calls the sub-modules to generate a doctor's advice for determining the expense and determining the medical insurance reimbursement amount.
The generated medical advice is screened by the checking module to determine whether repeated items exist in the medical advice, the medical advice is determined to be the repeated items after being approved by a doctor, the items are deleted to generate accurate medical advice, the content of the medical advice is screened to a certain extent, and unnecessary medical items are prevented from being repeatedly performed by a patient.
When a patient is in a hospital, recording once when an item is actually made, comparing whether the accurate medical advice is consistent with the cost of the medical item actually performed by the patient by using the cost clearing module, wherein the cost comprises each medical expense and medical reimbursement cost, if the accurate medical advice is approved and is consistent with the cost of the medical item actually performed by the patient, normally clearing the cost, if the accurate medical advice is not approved and is inconsistent with the cost clearing module, inquiring a person for placing the medical advice along a fixed IP address by using the inquiry module, after the person verifies and modifies the accurate medical advice, approving whether the modified accurate medical advice is consistent with the cost in the charging module by using the cost clearing module, and if the accurate medical advice is compared by using the cost clearing module and is consistent with the cost of the charging module repeatedly, normally clearing the cost by the patient.
In some implementations, a system for accurately accounting for hospitalization costs of a patient, said reconciliation module further comprises:
the special department checking module is used for approving whether repeated items exist in the general treatment items in the medical advice;
and the general department checking module is used for checking whether repeated items exist in the special treatment items in the medical advice.
In this scheme, through dividing medical treatment project into general branch of academic or vocational study and specialty medical treatment project, improve and check efficiency, the medical personnel of convenient accurate categorised location department.
In some implementations, a system for accurately accounting for patient hospitalization further includes a medical insurance approval module for invoking the medical insurance charge criteria updated by the medical insurance bureau in real time and approving with the medical insurance reimbursement criteria specified by the medical advice in the audit module.
According to the scheme, the latest medical insurance reimbursement standard is prevented from being generated in the approval process, the medical insurance charging standard updated by the medical insurance bureau in real time is called before the accurate medical advice is generated, the approval is carried out on the medical insurance reimbursement standard of the medical advice in the checking module, if the approval result is inconsistent, a system manager is reminded, and the medical insurance reimbursement amount in the sub-module is completely modified after the approval of the system manager.
In some implementations, a system for accurately accounting for patient hospitalization costs includes a forward approval module configured to determine whether there is a multi-charge for an accurate medical order by scanning the accurate medical order and comparing the accurate medical order with a billing module.
In the scheme, the forward accounting module mainly takes accurate medical advice as a reference standard and is mainly used for screening medical items with or without missed examinations, so that the condition of multi-charge exists.
In some implementations, a system for accurately accounting hospitalization costs of a patient, the cost clearing module further includes a reverse approval module, and the reverse approval module is configured to compare the accurate medical advice with a scanning billing module to determine whether the accurate medical advice is subject to a low-rate charge.
In the scheme, the reverse accounting module mainly takes the actually performed medical items as a reference standard, and is mainly used for screening whether the medical items are checked more or not, so that the condition of low charge exists.
In some implementations, a system for accurately accounting hospitalization costs of a patient includes a medical insurance cost checking module, and the medical insurance cost checking module is configured to invoke a medical insurance charge standard updated by a medical insurance bureau in real time when the costs are cleared and to check the medical insurance reimbursement standard in an accurate medical advice.
In the scheme, when the expense is cleared before the patient is discharged from the hospital, the expense clearing module calls the medical insurance charging standard updated by the medical insurance bureau in real time and checks the medical insurance reimbursement standard in the accurate medical advice, so that the patient is guaranteed to be discharged from the hospital to settle the expense according to the latest medical insurance reimbursement standard.
Compared with the prior art, the invention has the following advantages and beneficial effects:
the computer acquires medical insurance reimbursement standards and establishes submodules with project and project expenses, each submodule comprises fixed medical projects, charge amount and reimbursement medical standards, and a doctor calls the submodules to generate a medical advice according to a diagnosis result to generate the medical advice with determined amount and determined reimbursement amount; practice thrift the manpower and calculate doctor's advice expense and avoid the manual calculation error.
The computer scans the medical items of the medical advice, and when the computer scans repeated medical items, the computer automatically outputs the repeated medical items to remind medical staff, and the accurate medical advice is generated after the medical staff approves and modifies the repeated medical items; the medical advice content is screened to a certain extent, and unnecessary medical items are prevented from being repeatedly carried out by the patient.
The latest medical insurance reimbursement standard is called by the computer to check the medical insurance reimbursement standard on the medical advice, so that the patient can pay according to the latest medical insurance standard; the computer is used for comparing whether the medical items actually made by the patient are consistent with the medical items and fees issued by the medical advice, and screening whether the condition of multi-charge, missed charge or wrong charge exists in the hospitalization process; if the comparison result is inconsistent, searching for an entry person of the questioning medical advice through the IP address by using the computer, and modifying the questioning medical advice after the entry person approves until the medical item in the medical advice is consistent with the actually-performed medical item; the problems of multiple charges, missed charges and wrong charges in the hospitalization process are solved.
Drawings
In order to more clearly illustrate the technical solutions of the exemplary embodiments of the present invention, the drawings that are required in the embodiments will be briefly described below, it should be understood that the following drawings only illustrate some embodiments of the present invention and therefore should not be considered as limiting the scope, and that those skilled in the art may also derive other related drawings based on these drawings without inventive effort. In the drawings:
FIG. 1 is a flow chart of a method for accurately accounting for hospitalization costs of a patient according to example 1;
FIG. 2 is a flowchart of a system for accurately accounting for hospitalization costs of a patient according to example 2;
FIG. 3 is a flowchart of a system for accurately accounting the hospitalization cost of a patient and an additional medical insurance approval module provided in example 2;
FIG. 4 is a schematic view of a collation module provided in embodiment 2;
FIG. 5 is a schematic diagram of the charge clearing module provided in example 2.
Reference numbers and corresponding part names in the drawings:
1-database, 11-sub-module, 2-checking module, 21-special checking module, 22-general checking module, 3-medical insurance approving module, 4-charging module, 5-expense clearing module, 51-medical insurance expense checking module, 52-forward approving module, 53-reverse approving module, 6-query module, 7-accurate medical advice and 8-doubtful medical advice.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is further described in detail below with reference to examples and the accompanying drawings, and the exemplary embodiments and descriptions thereof are only used for explaining the present invention and are not used as limiting the present invention.
Example 1
As shown in fig. 1, the present embodiment 1 provides a method for accurately calculating the hospitalization cost of a patient, which is executed by a computer, and the computer executes the following steps:
s1: acquiring a medical insurance reimbursement standard and establishing a submodule 11 with the project and the project cost;
s2: calling the submodule 11 to generate a medical advice according to the diagnosis result of the doctor;
s3: checking the medical advice items and judging whether repeated items exist or not, outputting the repeated items, and generating an accurate medical advice 7 after the repeated items are approved and deleted by a doctor;
s4: recording the actually accepted project expenses in the hospitalization process of the patient;
s5: comparing the cost of the accurate medical advice 7 with the project cost of the patient in the actual hospitalization process, if the comparison result is consistent, performing S6, and if the comparison result is inconsistent, generating a questionable medical advice 8;
s6: calling the updated medical insurance charging standard of the medical insurance bureau in real time, approving the medical insurance charging standard of the accurate medical advice 7, and sending information for reminding the modification of the contents of the submodules if the approval results are inconsistent;
s7: and searching the information of the entry personnel of the inquiry medical advice 8 through the IP address, modifying the inquiry medical advice 8 after the information of the entry personnel is approved, and returning to S5.
In a specific embodiment, the items include doctor diagnosis and treatment cost, medicine cost, treatment cost, examination cost, medical appliance cost and the like, the computer obtains medical insurance reimbursement standard and establishes sub-modules 11 with the items and the item cost, and each sub-module 11 includes a fixed medical item, a charge amount and a reimbursement medical standard;
the doctor calls the submodule 11 to generate a medical order according to the diagnosis result, and because the charge amount of each medical item in the submodule 11 is fixed with the reimbursement medical standard, the medical order with determined amount and determined reimbursement amount is generated;
the computer scans the medical items of the orders, if the patient needs to draw blood twice, the electronic orders ordered by the doctor are displayed as follows: 2 times of blood drawing, 2 times of blood drawing and possibly wrong content of the medical advice caused by wrong input are carried out, the computer automatically outputs and prompts medical staff that the wrong medical advice is possibly carried out, and the medical staff generates an accurate medical advice 7 after modifying and verifying after discovering that the content of the repeated medical advice really exists after approval;
when a patient performs an actual treatment item, the department for performing the treatment item is recorded on a computer and used as a basis for the actual treatment item of the patient, for example, an identity card sensor is used for identifying the identity information of the patient, the identity card sensor is connected with the computer, when the actual treatment item is performed on the patient, the item to be checked is recorded under the name of the patient identified by the identity card sensor, and when the patient is discharged, the actual treatment item of the patient in the hospitalization process is checked by scanning the identity card of the patient;
when the patient is discharged, the computer is used for comparing whether the medical items actually done by the patient are consistent with the medical items and expenses prescribed on the medical advice;
if the comparison result is consistent, the latest medical insurance reimbursement standard is called by the computer to check the medical insurance reimbursement standard on the medical advice, if the reimbursement standard is consistent, normal payment is carried out, if the reimbursement standard is inconsistent, the computer transmits the medical insurance charging standard with inconsistent approval result to a system manager, and after the system manager approves the system manager, the patient pays the fee according to the latest medical insurance standard after modifying the traditional Chinese medicine reimbursement standard of the submodule 11;
if the comparison result is inconsistent, searching the entry personnel of the inquiry medical advice 8 through the IP address by using the computer, modifying the inquiry medical advice 8 after the entry personnel approve, repeating the steps S5-S6 by using the computer again until the medical item in the inquiry is consistent with the actual medical item and is the latest medical insurance standard, and then paying the fee by the patient.
Example 2
the database 1 comprises sub-modules 11, each sub-module 11 comprises items, item cost and medical insurance reimbursement proportion, and the sub-modules 11 are called to generate medical orders;
the checking module 2 is used for approving whether repeated items exist in the medical advice prescribed by the doctor, deleting the repeated items and generating accurate medical advice 7;
the charging module 4 is used for recording the cost of the items actually made by the patient and the number of the items;
the fee clearing module 5 is used for comparing whether the fee in the accurate medical advice 7 is consistent with the fee in the charging module 4;
and the query module 6 is used for determining the item with inconsistent cost in the accurate medical advice 7 and the charging module 4 through the cost liquidation module 5 and querying the information of the personnel offering the item through a computer.
In a specific embodiment, the database 1 establishes a plurality of sub-modules 11 according to different medical items, each sub-module 11 includes a fixed medical item, a fixed medical expense and a medical insurance reimbursement standard, and a doctor invokes the sub-modules 11 to generate a medical order for determining the expense and determining the amount of the medical insurance reimbursement.
The database 1 also comprises reference medical orders which are composed of the sub-modules 11, and aiming at certain diseases, medical staff can directly replace certain items in the reference medical orders by using the sub-modules 11 by calling the reference medical orders and the sub-modules 11 in the database 1, so that the main doctor has one medical order reference and the medical orders are convenient to generate.
The generated medical advice is screened by the checking module 2 to determine whether repeated items exist in the medical advice, the items are determined to be the repeated items after being approved by a doctor, the items are deleted to generate the accurate medical advice 7, the content of the medical advice is screened to a certain extent, and unnecessary medical items are prevented from being repeatedly performed by a patient.
When a patient is in hospital, recording once each item actually made, comparing whether the cost of the medical advice 7 is consistent with the cost of the medical item actually made by the patient by using the cost clearing module 5, wherein the cost comprises each medical expense and medical reimbursement cost, if the cost clearing module 5 is approved to be consistent, normally clearing and paying the cost, if the cost clearing module 5 is approved to be inconsistent, inquiring personnel for placing the medical advice along a fixed IP address by using the inquiry module 6, after the personnel verify and modify, approving whether the modified accurate medical advice 7 is consistent with the cost in the charging module 4 by using the cost clearing module 5, and if the accurate medical advice 7 is compared by using the cost clearing module 5 and the cost of the charging module 4 is consistent repeatedly, normally clearing the cost for the patient.
In a specific embodiment, after a doctor orders a patient A, the doctor can select the checking module 2, the computer can analyze all the medical orders ordered by the current doctor for the patient, check whether repeated medical items exist and remind the doctor to approve, the result of the checking module 2 is approved to delete the repeated items after the doctor checks, the confirmation can be clicked, and the computer automatically generates an accurate medical order 7;
the computer analyzes all orders prescribed by the current doctor for the patient, and the analysis does not have repeated items, i.e. the accurate order 7 is generated without modification.
In a specific embodiment, the fee clearing module 5 is not only suitable for accounting the fee of the patient before the patient is discharged from the hospital and the patient is in the hospital, but also suitable for clearing the fee of the previous day, for example, the patient D who is in 4 months and 7 days is admitted to the hospital and should be subjected to the pulmonary function examination according to the medical advice, but the patient is too weak to complete the examination, the doctor stops the examination item and forgets to pay back the fee from the patient, the 4 months and 8 days system monitors that the pulmonary function examination of the patient in the previous day is charged but does not have the corresponding examination result through the fee clearing module 5, a day fee reminding sheet is generated for each patient, when the doctor enters the clinical information system, the system reminds the doctor to generate a fee reminding sheet for the patient that the actual charge and the advice charge are not consistent through the fee clearing module 5 for 4 months and 7 days, whether the fee is paid or not, if so, the system generates the appointment fee returning sheet for the respiratory department, the respiratory department can pay for the patient in time according to a daily appointment fee-paying bill. Similarly, if the patient does not have a medical item on the medical order, if the patient is not charged for the hospital account of the patient in time, the fee clearing module 5 is used for monitoring that the patient has an examination result list but does not have a charging item, the patient is positioned to a doctor who does the examination item for the patient according to the fixed IP address by the query module 6, and the accurate medical order 7 is adjusted after verification, so that the condition of charge leakage is avoided.
In a specific embodiment, the system for accurately accounting the hospitalization cost of the patient further comprises a medical insurance approval module 3, wherein the medical insurance approval module 3 is used for calling the medical insurance charging standard updated by the medical insurance bureau in real time and approving the medical insurance reimbursement standard of the medical advice in the checking module. The latest medical insurance reimbursement standard is prevented from being generated in the approval process, the medical insurance charging standard updated by the medical insurance bureau in real time is called before the accurate medical advice 7 is generated, the medical insurance reimbursement standard is approved by the medical advice standard in the check module 2, if the approval result is inconsistent, a system administrator is reminded, and the medical insurance reimbursement amount in the submodule 11 is completely modified after the approval of the system administrator.
In a specific embodiment, the fee settlement module 5 includes: the medical insurance fee checking module 51, the medical insurance approval module 3 is used for calling the medical insurance charging standard updated by the medical insurance bureau in real time and approving the medical insurance reimbursement standard of the medical advice in the checking module 2; a forward approval module 52, configured to compare the scanned accurate medical advice 7 with the billing module 4, and determine whether the accurate medical advice 7 is subject to multi-charge; and the reverse approval module 53 is used for comparing the scanning billing module 4 with the accurate medical advice 7 to judge whether the accurate medical advice 7 is charged less.
In a specific embodiment, the fee settlement module 5 includes: the checking module 2 comprises a special checking module 21 and a general checking module 22, wherein the special checking module 21 is used for checking whether the general treatment items in the medical advice have repeated items; the general checkup module 22 is used to approve whether repeated items exist in the special treatment items in the medical advice, determine departments first, and then determine treatment items, thereby improving approval efficiency.
The above-mentioned embodiments are intended to illustrate the objects, technical solutions and advantages of the present invention in further detail, and it should be understood that the above-mentioned embodiments are only illustrative of the present invention and are not intended to limit the scope of the present invention, and any modifications, equivalent substitutions, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.
Claims (10)
1. A method for accurately accounting for hospitalization costs of a patient, said method being performed by a computer, the computer performing steps comprising:
s1: acquiring medical insurance reimbursement standards and establishing a submodule (11) with the projects and project expenses;
s2: calling the submodule (11) to generate a medical order according to the diagnosis result of the doctor;
s3: checking the medical advice items and judging whether repeated items exist or not, outputting the repeated items, and generating a precise medical advice (7) after the repeated items are approved and deleted by a doctor;
s4: recording the actually accepted project cost of the patient in the hospitalization process;
s5: comparing the cost of the accurate medical advice (7) with the project cost of the patient in the actual hospitalization process, if the comparison result is consistent, performing S6, and if the comparison result is inconsistent, generating a questionable medical advice (8);
s6: calling the updated medical insurance charging standard of the medical insurance bureau in real time, approving the traditional Chinese medicine insurance charging standard of the accurate medical advice (7), and sending information for reminding the modification of the contents of the submodule (11) if the approval results are inconsistent;
s7: searching the entry personnel information of the inquiry medical advice (8) through the IP address, modifying the inquiry medical advice (8) after the entry personnel information is approved, and returning to S5.
2. The method of claim 1, the S5 comprising:
a1: scanning an accurate medical advice (7) item, and performing proofreading on the item which is actually performed in the hospitalization process of the patient, wherein if the proofreading result is inconsistent, the questioning medical advice (8) is generated, and if the proofreading result is consistent, A2 is executed;
a2: and (3) scanning the item times and cost of the accurate medical advice (7), and checking the item times and cost with the item times and cost which are actually done in the hospitalization process of the patient, wherein the result is inconsistent to generate the questioning medical advice (8), and the checking result is consistent to normally pay the cost.
3. The method of claim 1, wherein the step S5 comprises:
b1: scanning the items which are actually done in the hospitalization process of the patient, and proofreading the items with the accurate medical advice (7), if the proofreading result is inconsistent, generating the questioning medical advice (8), and if the proofreading result is consistent, executing B2;
b2: and (3) scanning the times and the cost of the items which are actually done in the hospitalization process of the patient, and checking the items with the accurate medical advice (7), wherein the results are inconsistent to generate the questioning medical advice (8).
4. The method of claim 1, the S3 comprising:
c1: scanning general items in the medical orders and judging whether repeated items exist, if so, outputting the repeated items, and executing C2 after the repeated items are approved and deleted by a doctor;
c2: and (7) scanning the special items in the medical orders, judging whether repeated items exist, and outputting the repeated items to generate a precise medical order after the repeated items are approved and deleted by a doctor if the repeated items exist.
5. A system for accurately accounting for hospitalization costs of patients based on a system for accurately accounting for hospitalization costs of patients, comprising:
the database (1) comprises sub-modules (11), each sub-module (11) comprises items, item cost and a medical insurance reimbursement proportion, and the sub-modules (11) are called to generate medical orders;
the checking module (2) is used for approving whether repeated items exist in the medical orders prescribed by the doctor, deleting the repeated items and generating accurate medical orders (7);
the charging module (4) is used for recording the project cost and the total cost actually done by the patient;
the charge clearing module (5) is used for comparing whether the charges in the accurate medical advice (7) and the charging module (4) are consistent or not;
and the query module (6) is used for determining the item with inconsistent cost in the accurate medical advice (7) and the charging module (4) through the cost clearing module (5), and querying the personnel information for offering the item through a computer.
6. A system for accurate accounting of patient hospitalization costs according to claim 5, wherein said reconciliation module (2) further comprises:
a special department checking module (21) for approving whether repeated items exist in the general treatment items in the medical orders;
and the general department checking module (22) is used for approving whether repeated items exist in the special treatment items in the orders.
7. A system for accurate accounting of patient hospitalization costs according to claim 5, further comprising a medical insurance approval module (3), said medical insurance approval module (3) being adapted to invoke the medical insurance charge criteria updated by the medical insurance bureau in real time and to approve with the medical insurance reimbursement criteria ordered in the reconciliation module (2).
8. A system for accurate accounting of patient hospitalization costs according to claim 5, wherein said cost clearance module (5) comprises a forward approval module (52) for determining if there is a multi-charge for said precision order (7) by scanning the precision order (7) against the billing module (4).
9. A system for accurate accounting of patient hospitalization costs according to claim 8, wherein said cost clearing module (5) further comprises a reverse approval module (53) for determining if there is under-charge for said precision order (7) by comparing the scan billing module (4) with the precision order (7).
10. A system for accurate accounting of hospitalization costs of patient according to claim 5, wherein said cost liquidation module (5) comprises a medical insurance cost check module (51), said medical insurance cost check module (51) is used for calling the medical insurance charge standard updated by the medical insurance bureau in real time when the cost is liquidated, and checking with the medical insurance reimbursement standard of the precise medical advice (7).
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| CN202210696875.4A CN114926298A (en) | 2022-06-20 | 2022-06-20 | Method and system for accurately accounting hospitalization cost of patient |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN115511521A (en) * | 2022-09-21 | 2022-12-23 | 中科超精(南京)科技有限公司 | Hospital radiotherapy charging method, device, equipment and storage medium |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
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| CN115511521A (en) * | 2022-09-21 | 2022-12-23 | 中科超精(南京)科技有限公司 | Hospital radiotherapy charging method, device, equipment and storage medium |
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