JP2002169882A - System and software for processing medical office work for medical bill preparation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a new accounting processing system with which a medical institution side being a user can efficiently perform medical bill preparation office work without being aware of changing the points of insurance. SOLUTION: A client computer 1 provided in the medical institution gives each patient an inherent patient ID, prepares patient data for managing the name, address, age, insurance certificate number, etc., of the patient under the patient ID, prepares clinical record data under an inherent clinical chart ID by making the patient ID of the patient correspond to a treatment code showing treatment contents by medical practice when the medical practice is applied to the patient, writes the treatment code under the clinical chart ID of the prepared clinical record data, also temporarily prepares accounting data while leaving the points of insurance column corresponding to the treatment code blank as it is, and calculates the points of insurance by transmitting the points of insurance calculation request including the clinical record ID, the treatment code, a treatment month and patient age to an external server provided with the points of insurance master database. The server receives the calculates points of insurance data in response to it, writes the received points of insurance data in the points of insurance column the temporarily prepared accounting data and completes accounting data preparation.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical business processing system capable of efficiently calculating insurance points required for making a claim, and to program software for realizing this system on a computer.

[0002]

2. Description of the Related Art According to Japan's medical insurance system (social insurance and national health insurance), the cost of medical treatment when a medical institution provides medical treatment to a patient is the cost of the medical insurance to which the patient subscribes. The patient's personal contribution and the insurer's contribution are proportionally distributed at a predetermined burden ratio determined according to the type, and at the accounting counter of a medical institution, only the former is billed to the patient and the fee is received.

[0003] Regarding the medical expenses to be paid by the insurer, a medical remuneration statement (recept) is prepared for each medical treatment month and charged to the insurer. The insurer who receives the claim,
After examining the receipt and confirming that the medical treatment is legitimate, the fund that manages it will pay the medical institution paid by the insurer to the requesting medical institution.

[0004] In the receipt, the total insurance points for the month and the breakdown of medical treatment items are described for each patient. To make the claim, specifically, look at the medical record created by the doctor, identify the medical treatment, find out the medical treatment from the medical fee score table, convert it to points, and write this in the receipt. Done.

[0005] In recent years, many medical institutions, not only large medical institutions but also relatively small ones, use computers to create and manage medical records and receipts. For example, at the time of the first consultation, the patient's insurance card data is created, the medical treatment data is created for each medical treatment, the insurer's share is calculated according to the medical treatment, and accounting data is created. To be kept for each patient. The calculation of the insurance score is performed by running a program embedded in a computer.

[0006]

However, the insurance points are determined for each medical treatment item, but are frequently revised, and different insurance points are applied if the month changes even if the same treatment is performed. There is.

Therefore, it is necessary to upgrade the insurance score calculation software program incorporated in the computer of the medical institution every time the insurance score is changed, and conventionally, this was performed by the medical institution as the user.

[0008] Once the version is upgraded, the old program stops operating, so that it is impossible to process the last month's claim from this month, which is extremely inconvenient.

[0009]

SUMMARY OF THE INVENTION Accordingly, the present invention solves the above-mentioned problems in the prior art, and enables a medical institution as a user to efficiently perform a receipt preparation work without being conscious of a change in insurance points. The purpose is to provide a new accounting system.

In order to achieve this object, according to the present invention, a client computer provided in a medical institution is linked with a server provided in a management center, and data relating to patient privacy is managed only by the client computer and leaked to the outside. To prevent this, only the data necessary for the insurance score is transmitted to the server, the insurance score is automatically calculated by the insurance score master database stored in the server, and is returned to the client computer of the transmission source.

That is, the present invention relates to a medical business processing system for preparing a receipt performed by using a computer provided in a medical institution, wherein a unique patient ID is given to each patient, and the patient is registered under the patient ID. Create patient data that manages the name, address, age, health insurance number, etc. of the patient, and associates the patient ID of the patient with the contents of the treatment by the medical practice when performing a medical practice on the patient, and makes a unique medical record. Create chart data under the ID, and the chart I of the created chart data
Under D, a treatment code indicating the treatment content of the chart data is entered, and the insurance data is temporarily created while the insurance score column corresponding to the treatment code is left blank.
D, a treatment code, a treatment month, and a patient age are transmitted to an external server provided with an insurance point master database to obtain an insurance point calculation, and the insurance point data calculated by the server in response to the request. It is characterized in that the received insurance point data is entered in the insurance point column of the tentatively created accounting data to complete the creation of the accounting data.

In the above system, the transaction data may be provided with a transaction ID unique to the transaction data, and the insurance point calculation request data may include the transaction ID instead of or together with the chart ID.

Further, the present invention provides a patient ID unique to each patient.
Requesting input of patient data for managing the patient's name, address, age, health insurance number, etc. under the patient ID, and the patient ID of the patient when a medical treatment is performed on the patient Requesting the user to input chart data under a unique chart ID by associating the medical chart with the treatment content of the medical practice;
A step of writing a treatment code indicating the treatment content of the chart data under D and requesting to enter accounting data while leaving the insurance score column corresponding to the treatment code blank; chart ID, treatment code and treatment Requesting an insurance point calculation request including a month and a patient age to be transmitted to an external server having an insurance point master database, and in response to the request, converting the insurance point data received from the server into an insurance point column of the accounting data. To complete the accounting data creation by filling out the
In a computer provided in a medical institution.

The above software can be provided by storing it on a recording medium such as a CD-ROM or FD, or can be distributed using communication such as the Internet.

[0015]

FIG. 1 is an overall configuration diagram showing a medical business processing system for creating a claim according to an embodiment of the present invention, in which a client computer 1 provided in each medical institution and a client computer are provided. And a server 5 which is connected between the devices via the Internet or the like so as to be able to transmit and receive data.

Each client computer 1 includes a patient database 2, a medical chart database 3, and an accounting database 4.

The patient database 2 stores patient data for all patients handled by the medical institution. Each patient is given a unique patient ID, and the patient data is managed under the patient ID in association with data such as the patient's name, address, age, and insurance card number. Patient data is created at the time of the first consultation reception, and is updated when there is a change in the address, health insurance number, or the like. The age of the patient included in the patient data is automatically updated by a calendar function built in the client computer 1.

The chart database 3 stores chart data created each time a medical treatment is performed on a patient having a patient ID. Each medical record data is provided with a unique medical record ID, and recorded under the medical record ID in association with a patient ID of the patient and a treatment code indicating a treatment content by the medical practice.

The accounting database 4 stores accounting data created each time chart data is created. In the accounting data, a treatment code is entered below the chart ID, and an insurance score column is provided for entering an insurance score corresponding to the treatment code.

The server 5 includes a customer database 6, an insurance score master database 7, and an operation unit 8.

The customer database 6 stores data on each registered user (medical institution) participating in this system. For example, after receiving a regular login from the client computer 1 and checking it against the customer database 6 to confirm that the user is a registered user, a system use permission message is transmitted to the client computer 1.

The insurance score master database 7 stores a table (medical remuneration score table) in which the insurance score corresponding to the treatment code indicating the medical treatment given to the patient by the medical institution is shown every month. .

The server 5 refers to the medical remuneration score table in the insurance score master database 7 based on the insurance score calculation request transmitted from the client computer 1 and executes a corresponding insurance score by a predetermined insurance score calculation program. Is provided. The insurance score calculation program includes various calculation logics (first consultation addition logic, age addition logic, etc.) used when calculating the insurance score with reference to the medical fee score table.

The medical processing in the system configured as described above will be described with reference to FIGS.

On the medical institution side having the client computer 1, first, the above-mentioned patient data, chart data and accounting data are created. In FIG. 2, patient ID 00
One patient was 60 years of age (patient data) and this patient underwent three medical treatments including the first consultation in October 2000 (assuming the first consultation on October 4), and each patient had a medical record ID 004 , 014, and 015 are created, and accounting data is created for each chart. Here, although the medical record ID and the treatment code are entered in the accounting data, the insurance score column corresponding to the treatment code has not been calculated at this time, so the insurance score column is left blank.

It should be noted that since the accounting process is usually performed on the same day, there are few cases where the insurance points are not calculated at all for accounting data having different dates. It is assumed that calculations are performed.

In a medical institution, 2000
Since he wants to know the total insurance points for October of the year, he accesses the server 5 and sends an insurance point calculation request to the server 5.

The insurance point calculation request includes the server 5
Calculation unit 8 refers to the insurance score master database 7 to calculate the insurance score according to the contents of the medical treatment on the side and the data required for associating with the specific accounting data in the client computer 1 on the medical institution side. Data only.

As the former data, in addition to program designation for accessing the insurance score calculation program used by the arithmetic unit 8 of the server 5, a treatment code, a treatment month and a patient age are required. The treatment month can be easily known by referring to the chart data on which the accounting data is based, and the patient age can be easily known by referring to the patient data of the patient.

As the latter data, the chart ID (or the accounting ID if the accounting data itself has a unique accounting ID) is used.
D) is required.

FIG. 3 shows an example of such an insurance point calculation request. The insurance point calculation request shown in FIG. 3 is a request for the patient with the patient ID 001 shown in FIG.
A logical expression for calculating the total number of insurance points for October 2000, a part for specifying a program storage location and a file on the server side, a part indicating October 2000 as a treatment month, and a patient age (60) -Consists of the number of data items (3) and a portion indicating data contents. The data contents are displayed by arranging the medical record ID and the treatment code in three accounting data for obtaining the insurance score calculation in order.
“00400126” for accounting data and “01400
"256" specifies the accounting data, and "01500200" specifies the accounting data.

As described above, the insurance score calculation request transmitted to the server 5 includes the chart ID for specifying the chart, but is not directly linked to the patient ID, so that the data relating to the privacy of the patient is not included. Can be minimized.

The server 5 has a medical insurance score table in the insurance score master database 7 as described above. For example, the treatment table 7a and the score table 7 as shown in FIG.
b. The treatment table 7a describes the treatment name corresponding to the treatment code, and the score table 7b describes the insurance score corresponding to the treatment code for each treatment month. The treatment table 7a is provided as needed and is not essential.

The server 5 that has received the insurance score calculation request shown in FIG. 3 runs the designated program, and the calculation unit 8 executes the data (treatment code,
The treatment month and the patient age are taken out, and the insurance score corresponding to each treatment is calculated with reference to the score table 7b (medical insurance score table) provided in the insurance score master database 7.

FIG. 5 shows the contents of the insurance score calculation process. October 2000 is taken out from the treatment month display portion included in the received insurance score calculation request, and 60 years old is taken out from the patient age display portion. Further, "00" displayed after the chart ID is displayed from the data content display section.
126 "," 00256 ", and" 00200 "are taken out as treatment codes, and these are applied to the score table 7b to obtain the corresponding insurance points, and various calculation logics included in the insurance point calculation program are applied, and finally, Calculate your insurance points.

When the intramuscular injection indicated by the treatment code "00126" (see the treatment table 7a) was performed in October, 2000, the insurance score was 1,250 from the score table 7b.
Since the patient is 60 years old, 10 points are added by the age addition logic, and since it is the first visit, 10 points are added by the first consultation addition logic.
Points are recorded as insurance points corresponding to the chart ID 004.

The insurance score obtained when the D medication indicated by the treatment code “00256” (see the treatment table 7a) was given in October 2000 is 2,200 points from the score table 7b, but the patient age is 60 years old. Therefore, 10 points are added by the age addition logic, and a total of 2,210 points are recorded as insurance points corresponding to the chart ID 014.

The insurance score when the B medication indicated by the treatment code "00200" (see the treatment table 7a) was given in October 2000 is 900 points from the score table 7b, but since the patient is 60 years old, 10 points are added by the age addition logic, and a total of 910 points are the chart ID 01
It is recorded as an insurance score corresponding to 5.

The result of such insurance score calculation is created as data as shown in FIG. 6, which is stored as a designated file in the program storage location of the server 5 and returned to the client computer 1 of the transmission source.

The client computer 1 which has received the data shown in FIG. 6 disassembles the data, finds out the insurance points of each transaction data, and inputs them into the blank insurance points column in FIG. This gives this patient 2000
Accounting for October of the year was completed and the total insurance points were 4,39
Since it is known that the score is 0, it is possible to create a claim.

Although one embodiment of the present invention has been described in detail above, the present invention is not limited to this, and can take various forms within the scope of the invention defined by the claims. For example, the insurance score calculation data (FIG. 6) returned from the server 5 to the client computer 1 in the above-described embodiment includes the insurance score “001270” calculated by the calculation unit 8 corresponding to the treatment code or the like for which the insurance score calculation request was made. , "002210" and "000910" are sequentially connected to form a series of data. In addition to this, other necessary data (for example, a treatment code) is added and the data is returned to the client computer 1. Good. The insurance point calculation data in this case is, for example, “00126001270000256”.
00221000200000910 ”.

[0042]

As described above, according to the present invention, it is not necessary for the medical institution, which is the user, to perform a troublesome calculation of insurance points. Since the calculation of insurance points is obtained by the insurance points master database held, the calculation result is received and the posting is made to the accounting data, and the accounting process is completed.
Recipes can be created easily.

According to the system of the present invention, since the medical institution only needs to transmit the data necessary for calculating the insurance score to the server, it is possible to minimize the risk that the data relating to the privacy of the patient leaks to the outside. It is a system that can be introduced with confidence for medical institutions.

[Brief description of the drawings]

FIG. 1 is an overall configuration diagram showing a medical business processing system for creating a receipt according to an embodiment of the present invention.

FIG. 2 is an explanatory diagram showing the creation of patient data, chart data, and accounting data performed by a medical institution.

FIG. 3 is an explanatory diagram illustrating a logical expression of an insurance point calculation request transmitted from a medical institution to a server.

FIG. 4 is an explanatory diagram exemplifying a treatment table and a score table in an insurance score master database provided in a server.

FIG. 5 is an explanatory diagram illustrating an insurance score calculation process performed by a server with reference to the insurance score master database of FIG. 4;

FIG. 6 is an explanatory diagram illustrating data contents created by a server as a result of the insurance score calculation processing of FIG. 5 and returned to a medical institution;

FIG. 7 is an explanatory diagram showing a state where the medical institution receives the data of FIG. 6 and fills in each transaction data.

[Explanation of symbols]

 Reference Signs List 1 Client computer provided in medical institution 2 Patient database 3 Medical chart database 4 Accounting database 5 Server 6 Customer database 7 Insurance score master database 8 Operation unit

Claims (3)

[Claims] 1. A medical clerical work processing system for making a receipt using a computer provided in a medical institution, wherein a unique patient ID is given to each patient, and the name and address of the patient are provided under the patient ID.・ Create patient data for managing age, insurance card number, etc., and associate a patient ID of the patient with a treatment code indicating the treatment content by the medical practice when performing medical treatment on the patient, and provide a unique medical record. The medical record data is created under the ID, the treatment code is entered under the medical record ID of the created medical record data, the accounting data is provisionally created by leaving the insurance score column corresponding to the treatment code blank, and the medical record ID is created. A request for calculating an insurance score is sent to an external server having an insurance score master database to request an insurance score calculation. Receiving the insurance score data calculated by the server and filling the received insurance score data in the insurance score column of the provisionally created accounting data to complete the creation of the accounting data; Medical paperwork system. 2. A temporary accounting ID is assigned to the accounting data and the accounting data is temporarily created.
2. The medical business processing system for preparing a claim according to claim 1, further comprising an accounting ID. 3. Each patient is given a unique patient ID,
Requesting input of patient data for managing the patient's name, address, age, health insurance number, etc. under D; and performing a medical treatment on the patient; Requesting the user to input chart data under a unique chart ID in association with a treatment code indicating the treatment content, and a chart I of the input chart data
Writing a treatment code under D and requesting that the accounting data be entered while leaving the insurance score field corresponding to the treatment code blank; insurance including the chart ID, treatment code, treatment month and patient age Requesting a score calculation request to be sent to an external server having an insurance score master database, and writing insurance score data received from the server in response to the request in the insurance score column of the accounting data to generate accounting data A medical processing software for creating a receipt, wherein the step of requesting the completion of the step is performed by a computer provided in a medical institution.