JP2016027466A - Medical fee invoice creation system, medical fee invoice creation program, and recording medium - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical fee invoice creation system, a medical fee invoice creation program, and a recording medium capable of creating workmen's accident compensation insurance medical fee invoice data, and simply and accurately creating a compulsory automobile liability insurance receipt or the like compliant with compulsory automobile liability standards.SOLUTION: A medical fee invoice creation system comprises: recording means recording a first database; information extraction means extracting health insurance receipt data to be processed from health insurance receipt data; data conversion means comparing each medical fee point or amount with the first database in order of code information, rewriting the medical fee point or amount to a medical fee point or amount compliant with workmen's compensation standards if determining that the medical fee point or amount differs from the first database, and converting the medical fee point or amount to workmen's accident compensation insurance receipt data; and workmen's-accident-compensation-insurance medical-fee-bill-data creation means creating workmen's accident compensation insurance medical fee invoice data on the basis of the workmen's accident compensation insurance receipt data.SELECTED DRAWING: Figure 1

Description

  The present invention utilizes medical insurance health insurance (social insurance, national health insurance) receipt data (hereinafter referred to as “health insurance receipt data”), and is referred to as an occupational accident medical expenses calculation standard (hereinafter referred to as an “employment accident standard”). ) To create a work accident insurance standard receipt data, and to create a work compensation insurance claim claim, and based on the work accident standard receipt data, the self-insurance insurance medical fee calculation standard (hereinafter referred to as “self-responsibility standard”). The present invention relates to a medical fee claim document preparation system, a program, and a recording medium capable of generating a claim for self-insurance insurance medical fee claim as a claim document conforming to the above.

  2. Description of the Related Art Conventionally, medical institutions use a medical fee remuneration statement called a receipt to claim a medical fee from a reception review organization, insurance association, insurance company, or the like (hereinafter referred to as “insurer”). In recent years, electronic receipts that have been converted into electronic forms have been widely used. From 2011, as a general rule, all receipts in medical and pharmacy have been digitized for the purpose of improving the efficiency of medical insurance operations. Yes.

  When requesting using health insurance, the medical institution will submit a completed receipt, except for special cases, and the insurer will check the medical contents and score calculation for the receipt. After passing the inspection of the insurer, etc., the medical fee can be received from the insurer. Insurers are assessed at the receipt check (increase / decrease in the requested medical fee), and if there is any deficiency etc., the medical institution is informed and payment is not made.

  The creation of a receipt required high expertise and complex calculations, which was a heavy burden for medical institutions. In recent years, it has become possible to create a receipt by calculating a medical remuneration score using a receipt computer (hereinafter referred to as “Rececon”). In addition, it has become possible for medical institutions to check receipts using electronic receipts before submitting them to insurers. Furthermore, it has become possible for insurers to use a computer or the like for receipt inspection.

  For example, in order to reduce the burden on a medical institution, a receipt creation support system that can accurately and easily create a receipt for health insurance has been proposed (for example, Patent Document 1).

  The receipt creation support system described in Patent Document 1 digitizes a receipt created by a medical institution by computer processing, automatically examines the legitimacy of this electronic receipt by computer processing, and further automatically conducts electronic receipts that have undergone visual examination processing. It is sent so that payment can be obtained from the insurer.

JP 2005-50245 A

  However, the conventional receipt creation support system including the one described in Patent Document 1 is a system in which an office worker who has knowledge of medical standards inputs data to a receipt computer and automatically examines the created receipt. Compared to the labor accident standards and self-responsibility standards, which require more complicated billing methods, there is a problem in that it is difficult to input data into the receptacle.

  In order for a medical institution to create a liability insurance claim that complies with the occupational accident standards using the conventional receipt creation support system, the office worker is not allowed to make a claim under health insurance, but the occupational accident standards allow the claim. Understand that there is a unique calculation rule for each part of the name of the injured and injured and the act to be treated, and further understand and enter the unique items that can be calculated in the self-responsibility standard in addition to the labor accident standards There is a need to.

  In addition, when making a claim to an insurance company, it is necessary to understand its own tabulation and calculation methods for the self-responsibility standard. Specifically, in the self-responsibility standard, it is possible to make a claim that takes into account the doctor's treatment technique. Therefore, the treatment action (claimed item) performed by the doctor, such as surgery, is journalized as “technical”, and drugs, materials, etc. It was necessary to perform addition calculation as a “technique” (fee) for the technology, in distinction from “mono”, which is a treatment content other than the above technology.

  Therefore, there has been a demand for a system and software for creating a receipt that complies with the labor accident standards and the self-responsibility standards, without knowing the calculation rules for the labor accident standards and the independent claim method for the self-responsibility standards.

  The number of patients due to occupational accidents and automobile accidents is considerably smaller than the number of patients who receive health insurance, so there is a lack of experience and knowledge at medical institutions regarding claims for occupational accident insurance and claims for personal liability insurance. Therefore, there is a lack of billing for items that can be billed according to the labor accident standards and self-responsibility standards while actually performing treatment. In addition, items that are calculated as points for health insurance, items that are calculated as monetary amounts according to the workmen's accident standards, and items such as treatment that can be added for a predetermined number of health insurance are missing There is a problem that under-billing and scoring errors are likely to occur, making it difficult to make accurate billing.

  It is difficult to hire a full-time clerical staff for claiming self-responsibility standards because the number of car accident patients who receive medical examinations at many clinics and clinics is less than 10%. . In addition, even if a person in charge of claiming health insurance is educated and a person in charge who can make a claim for self-responsibility can be trained, there is a problem that if the person in charge retires, the claim for self-responsibility cannot be made.

  Furthermore, insurers that receive a liability insurance receipt often receive a receipt with a calculation error, which increases the amount of inspection work for the receipt and increases the inspection cost.

  Therefore, the present invention solves the above-mentioned problems of the prior art, and an object of the present invention is to create labor accident standard receipt data based on health insurance receipt data created by a medical institution and It is an object of the present invention to provide a medical fee billing document creation system, a program, and a recording medium capable of creating billing document data easily and accurately.

  Another object of the present invention is to create occupational accident standard receipt data based on health insurance receipt data created by a medical institution, and based on the occupational accident standard receipt data, easily and accurately calculate a liability insurance receipt based on the occupational accident standard. An object of the present invention is to provide a medical fee billing document creation system, a program, and a recording medium that can be created.

  According to the present invention, the medical fee claim document creation system is a medical fee claim document creation system that creates a document including a receipt for claiming a medical fee based on health insurance receipt data created by a medical institution. In order to replace the health insurance receipt data with the occupational accident insurance receipt data that complies with the occupational accident standards, manage the treatment act on the occupational accident insurance claim that can be claimed corresponding to the injury / illness name data in the health insurance receipt, The treatment data in the health insurance receipt is linked to the health insurance medical fee claim standard, and is presumed at least for each item to which code information has been assigned in advance based on the labor accident insurance medical fee claim standard. Recording means provided with a first database that stores reward points or amounts in correspondence with each other, acquired from a medical institution, and recorded Extracted from the health insurance receipt data stored in the stage by the information extracting means for extracting the health insurance receipt data of the processing object related to the workers' compensation insurance or the liability insurance based on the ID information of the target patient, and the information extracting means Information providing means for assigning the same code information as the code information stored in the first database to the item of at least sick name and treatment action in the health insurance receipt data, and recording in the recording means, and the item of treatment action For the health insurance receipt data to which the code information is attached, the treatment action and the medical remuneration score or amount are read from the recording means, and the read treatment action and the medical remuneration score or amount are the corresponding items of the first database. Compared with the expected name of the disease, the number of medical treatment rewards, or the amount of money Only when the number of injuries / patients is assumed, or when it is determined that the medical fee points or amounts are different, the health insurance receipt claim item or the medical fee points or amount is added to the standard item The health insurance receipt data is converted into the work accident insurance receipt data by rewriting the data or the medical treatment reward score or amount, and the data conversion means for recording in the recording means and the work compensation insurance medical remuneration claim document data based on the work accident insurance receipt data are created. And an industrial accident insurance medical remuneration claim data creation means.

  For this reason, it is possible to easily and accurately create a work accident insurance receipt based on the health insurance electronic receipt data created by the medical institution. Early payment can be realized.

  A second database that stores calculation rules based on the self-indemnity standards for each item, in order to translate the work-related accident insurance receipt data into self-insurance insurance receipt data, and to link to the work-injury standards and complete the claim form for self-insurance insurance. The industrial accident insurance receipt data is read out from the recording means based on the code information, and the calculation rule of the self-responsibility standard corresponding to the code information of the read industrial accident insurance receipt data is read out from the second database, and the self-responsibility is determined by the read calculation rule. Calculate the standard medical treatment remuneration score or amount and rewrite the medical remuneration insurance treatment remuneration score or amount corresponding to the code information to the newly calculated self remuneration standard medical remuneration point or amount and convert it to self-insurance insurance receipt data. The self-responsibility insurance claims data is created and recorded in the recording means Preferably further comprises a insurance medical fee billing document data creation unit. This makes it possible to easily and accurately create a self-insurance insurance claim that complies with the Industrial Accident Standards based on the electronic receipt data of the health insurance that is created by a medical institution, making it possible to make a claim that complies with the standards for self-compensation medical fees. By making the receipt inspection at the insurance company more efficient, early payment to the medical institution can be realized.

  In addition, by automatically forming a liability insurance receipt from health insurance receipt data, medical institutions can inquire about the basis for calculating the receipt from an insurance company, negotiate such as negotiations on the amount of the claim, and create a liability insurance receipt. The associated billing burden can be reduced.

  Also, if the item name, billing amount, or points are different when processing by the data conversion means and the display means that displays a message composed of characters or images, the processing of the data conversion means is stopped and a warning is issued. A warning means for displaying a message on the display means; and an input means for inputting correction information. When the warning information is displayed, correction information in accordance with the self-responsibility standard is input via the input means. When it is determined, it is preferable to restart the processing of the data conversion means. This makes it possible to easily and accurately create a claim for self-insurance insurance medical treatment claim.

  Moreover, it is preferable to further include a transmission means for transmitting the created work accident insurance medical fee claim document data or self-insurance insurance medical fee claim document data to the insurer or the like. Thereby, online billing is possible via a communication network.

  Furthermore, it is preferable to further include receiving means for receiving health insurance receipt data from a medical institution via a communication network. This eliminates the need to incorporate a medical fee claim document creation system into a personal computer on the medical institution side, and allows the medical fee claim document creation system to be used in a cloud environment. This clarifies the demarcation point between the medical institution's personal computer-side receipt creation system and the medical fee billing document creation system.

  It further comprises a judging means for judging whether or not an instruction to create data for claiming medical compensation insurance medical remuneration data is converted by converting the labor accident insurance receipt data into self liability insurance receipt data, and the self-responsibility insurance medical compensation billing document is determined by the judging means. When it is determined that there is no instruction to execute data creation, it is preferable that the workers 'compensation insurance medical fee claim document data is output based on the workers' accident insurance receipt data. As a result, when the self-responsibility insurance medical fee claim document is not required, only the occupational accident insurance medical fee claim document can be output.

  According to the present invention, the medical remuneration claim preparation program prepares the computer for each item of at least injury name, treatment action, injury site and symptom to which code information is given in advance based on the labor compensation insurance fee claim standard. From the health insurance receipt data acquired from the medical institution and stored in the recording means, the recording means having the first database storing the medical remuneration score or amount for each item in correspondence with each other Information extracting means for extracting the health insurance receipt data to be processed related to the workmen's accident insurance or liability insurance based on the ID information of the patient, and at least the name of the health insurance receipt data extracted by the information extracting means Information adding means for assigning the same code information as the code information stored in the first database to the item and recording the information in the recording means; For the treatment action item, the treatment action and the medical fee score or amount of the health insurance receipt data to which the code information is attached are read from the recording means, and the read item and the medical fee score or amount are associated with the first database. Compared with the assumed injury / illness name, medical treatment reward score or amount for each item to be performed, it is judged that the injury / illness name in the health insurance receipt is different or multiple injury / injury names are assumed and the medical treatment reward score or amount is different Only when the health insurance receipt claim item, medical remuneration score or amount is added to the labor insurance medical remuneration claim standard item or rewritten to the medical remuneration fee score or amount, the health insurance receipt data is converted to work accident insurance receipt data. The data conversion means to record in the recording means and the work compensation insurance fee compensation based on the work accident insurance receipt data. Wherein the function as accident insurance medical fee billing document data creation means for creating document data.

  In addition, the computer reads a recording means provided with a second database storing calculation rules based on the self-responsibility standard for each item, and reads the industrial accident insurance receipt data from the recording means based on the code information. The compensation rule calculation rule corresponding to the code information of the insurance receipt data is read from the second database, the medical compensation score or the amount of the compensation liability standard is calculated by the read calculation rule, and the industrial accident insurance receipt corresponding to the code information Self-responsibility insurance that creates the self-insurance insurance remuneration claim data by rewriting the medical remuneration score or amount to the newly calculated self-compensation standard medical remuneration score or amount, and converts it into self-insurance insurance receipt data. It is preferable to function as medical fee claim document data creation means.

  Also, if the item name, billing amount, or score is different when processing the computer with the display means for displaying a message composed of characters or images and the data conversion means, the processing of the data conversion means is stopped. The warning means for displaying the warning message on the display means and the input means for inputting the correction information. In the state where the warning message is displayed, the correction information in accordance with the self-responsibility standard is input via the input means. If it is determined, it is preferable to make the function of the data conversion means resume.

  In addition, the computer transmits a worker's accident insurance medical fee claim document data or self-responsibility insurance medical fee claim document data to the insurer, etc., and a receiver for receiving health insurance receipt data from a medical institution via a communication network It is also preferable to make it function.

  Further, the computer functions as a judgment means for judging whether or not an instruction to convert the accident insurance receipt data into the self-insurance insurance receipt data and to create the self-insurance insurance medical remuneration claim document data is input. If it is determined that there is no instruction to create the self-insurance insurance medical fee billing document data, it is preferable to output the occupational accident insurance medical fee billing document data based on the labor accident insurance receipt data.

  According to the present invention, the recording medium is a computer-readable recording medium in which an occupational accident insurance medical fee claim document or a self-insurance insurance medical fee claim document preparation program is recorded.

  According to the present invention, it is possible to easily and accurately create a work accident insurance receipt based on the health insurance receipt data created by the medical institution. Early payment to can be realized. In addition, it is possible to easily and accurately create a self-responsibility insurance receipt or the like that calculates based on the labor accident standards. Therefore, it becomes possible to make a claim for self-responsibility medical treatment based on the self-responsibility standard, and for the insurer who received the receipt, the work of inquiries, etc. due to inadequate receipt or error in the amount of the charge, etc. will be reduced, the check of the receipt will be smooth, and to the medical institution Early payment can be realized.

  In addition, by automatically forming an occupational accident insurance receipt or a self-insurance insurance receipt from health insurance receipt data created by the medical institution, the medical institution can reduce the burden of paperwork associated with the self-insurance standard.

  In addition, it is possible to make an online claim for a work compensation insurance fee or a personal liability insurance treatment fee via a communication network.

  Furthermore, when the contents described in the health insurance receipt are under-billed or there is an error in the score, it can be warned and can be automatically corrected or corrected based on information inputted from the outside. In addition, a QR code (registered trademark) or the like for certifying the replacement can be printed on the receipt that has been replaced.

  For insurers who have received a receipt printed with a QR code (registered trademark) to prove the replacement of the received receipt, the inspection work for the receipt will be made more efficient, and the payment operation will be made more efficient. Thus, the inspection cost can be reduced and the efficiency of the survey work can be improved.

It is a figure which shows roughly the structure of the medical fee claim document preparation system in one Embodiment of this invention. It is a figure which shows roughly the example of application of the medical fee claim document preparation system shown in FIG. It is a flowchart which shows the process of the medical fee claim document preparation system shown in FIG. It is a flowchart which shows the flow of replacement of health insurance receipt data. It is a figure which shows the example which provides code | cord | chord information to the item of treatment action (billing item). It is a figure which shows the example of a relationship, such as a wound disease name, a treatment action (claimed item), a wound disease part, and a symptom. It is a flowchart which shows the flow of work accident insurance receipt data preparation processing preparation. It is a flowchart which shows the flow of an industrial accident insurance receipt data inference process. It is an example which shows the difference in the standard which calculates the medical treatment fee of health insurance and the labor accident standard. It is a flowchart which shows the flow of a self-liability insurance receipt creation process. It is an example which shows the difference of the medical treatment fee calculation standard in the labor accident standard and the self-responsibility standard. It is a flowchart which shows the flow of an industrial accident insurance receipt and a receipt result output. It is a figure which shows the example (part) of a self-liability insurance receipt.

  Embodiments of a medical fee claim document preparation system, a program, and a recording medium according to the present invention will be described below with reference to the drawings.

  FIG. 1 shows a configuration of a medical fee billing document creation system 100 according to the present invention, and FIG. 2 schematically shows an application example of the medical fee billing document creation system 100.

  As shown in FIG. 1, the medical fee claim document preparation system 100 includes a receiving unit 10, an input unit 20, a recording unit 30, a data processing unit 40, a control unit 50, a display unit 60, and a transmission unit 70. And a computer having an output means 80, which creates an occupational accident insurance receipt based on health insurance receipt data from a medical institution, and further creates a self-insurance liability receipt that meets the self-insurance standards. The data processing means 40 includes an information extracting means 41, an information giving means 42, a data converting means 43, a billing document data creating means 44, a judging means 45, and a warning means 46.

  The receiving means 10 provides basic information of medical institutions such as hospitals, medical fee details (health insurance receipts) created by medical institutions, and information necessary for calculating medical fees issued by the Ministry of Health and Welfare at the time of law revision, such as the Internet It is configured to receive via a communication network. Information acquired by the receiving means 10 is stored in the recording means 30.

  The input means 20 is composed of a keyboard, a touch panel, or the like, and is used for inputting a processing operation start command, necessary correction information, and the like. It should be noted that information stored by using a reading device for a medium such as FD (floppy (registered trademark) disk), CDROM (compact disk), MO (magneto-optical disk), DVD (digital video disk) or the like as input means is read and input. You may use it.

  The recording means 30 is mainly composed of a hard disk (HDD) and RAM and ROM memories. The recording means 30 includes, in addition to the control program, a program 31 for creating a self-insurance insurance medical fee claim document, a health insurance related master 32, an occupational accident insurance related master 33 as a first database, and a second database. The self-responsibility liability related master 34 and the like are stored. In addition, information such as the received health insurance receipt 35, the created industrial accident insurance receipt 36, and the created self-responsibility insurance receipt 37 can be stored.

  The program 31 causes the computer to function as the recording unit 30 and the data processing unit 40. The occupational accident insurance related master 33 of the recording means 30 is a treatment action (claimed details) that may be implemented in advance corresponding to the injury / illness name data (injured part and applicable symptoms) in the health insurance receipt. Item) and the treatment action data (billing details item) in the health insurance receipt, linked to the name of the wound (site or symptom) that was assumed to have been treated for each item, and the health insurance medical fee claim standard , A first database configured by associating at least medical fee points or amounts to which code information has been given in advance based on the labor compensation insurance medical fee claim standard, and the self-responsibility standard-related master 34 of the recording means 30 is It is the 2nd database which has memorized the calculation rule based on for every item.

  The health insurance-related master 32 is a database having standard information such as names of injuries and sickness related to health insurance, treatment contents, the number of medical treatment points corresponding to them, and medical fees.

  The industrial accident insurance-related master 33 is a first database that includes a treatment act (claim item) on the work accident insurance claim that may be implemented in correspondence with the name of the wound (injured site or applicable symptom). For actions (claimed items), the name of the injured disease (part or symptom) assumed to have been treated for each item and the health insurance medical fee claim standard, The calculation rule corresponding to each item is stored by associating at least the medical remuneration score or the amount to which the code information is given with each other. In other words, it is standard information of calculation rules such as disease names, treatment details, and the number of medical treatment points corresponding to them, and medical treatment fees. The Industrial Accident Insurance-related master 33 includes “Outpatient Management Addition”, “Special Operation”, “CT (Computed Tomography) Examination”, and “ADL (Activities of Daily Living)” ) ”And the like, the information relating to each addition rule and the like is included with reference to the industrial accident insurance related master 33. Further, the industrial accident insurance related master 33 includes an industrial accident reasoning master by injury and illness name. The injury / injury reasoning master by injury / illness name indicates which part of the injury / illness name recorded in the health insurance receipt data corresponds to, what kind of injury (symptom) the part is, and the part or injury (symptom). ), What kind of variation is likely to be treated, and what kind of claim is made as an occupational injury standard for the treatment that may be performed (claim item) A database is used to manage whether or not additions can be made to billing.

The injury / injury name-based industrial accident reasoning master manages information necessary for calculating the work accident / insurance insurance for each injury / illness name. The outline of the management items of the work injury reasoning master by injury and illness name is as follows.
-Injury / Sickness Code: National Master's Injury / Sickness Name Code- Site Code: Code to manage the site information of the wound / sickness name- Group (Symptom) Code: Code to manage the symptom information of the injury / sickness name Sickness name / burn treatment that can be calculated: Sick name / severe pressure ulcer treatment capable of calculating burn treatment: Sick name / dermatology ointment treatment capable of calculating severe pressure ulcer treatment : Sickness name that can be used to calculate dermatological ointment treatment / instructor traction calculation is possible: Sickness / sickness name that is able to calculate instructor traction / fixed correction can be calculated.・ Deformation mechanical corrections can be calculated: Name of wounds that can be subjected to deformation mechanical corrections “Treatment for anti-inflammatory analgesia”
・ Therapies can be calculated by procedures such as massages: The names of wounds and diseases that can be calculated for therapies such as massages. Possible: Wound and sick name that can be used to calculate poultice treatment for anti-inflammatory analgesia, etc. ・ Lumbar or chest fixation band fixation calculation possible ： Wound and disease name that can be calculated for waist or chest fixation band fixation ・ Low-power laser irradiation calculation Possible: Wound name and anal treatment capable of calculating low-power laser irradiation calculation Possible: Wound and disease name capable of calculating anal treatment calculation “Rehabilitation by disease”
・ Cardiovascular disease rehabilitation: Name of wound / disease capable of calculating cardiovascular disease rehabilitation / Cerebrovascular disease rehabilitation: Name of wound / disease capable of calculating rehabilitation such as cerebrovascular disease / Motor rehabilitation: Motor organ rehabilitation Name / respiratory rehabilitation that can be calculated: “Injury special item” that can calculate respiratory rehabilitation
・ Brushing fee at the first visit: Name of injury / sickness for which the brushing fee at the first visit can be calculated ・ Additional instruction for recovery of finger function: Name of injury / sickness for which operation can be calculated for addition of instruction for recovery of finger function ・ Fixed elastic bandage: Name of injury / sickness that can be used to calculate the elastic bandage for fixation, site information of XP image: site information for imaging XP

  The self-responsibility standard related master 34 stores a calculation rule based on the self-responsibility standard for each item as a second database. Specifically, for each treatment act (claimed item) that has been treated, it is translated into “things” such as drugs and materials and “techniques” such as treatment and surgery. “Technology” (fee) is added because there are many injuries. In addition, although it is not permitted by health insurance, there is an original claim item such as “First-time admission expenses” that can be calculated only for the first day of hospitalization when hospitalized at the first visit.

  The data processing means 40 includes an information extracting means 41, an information giving means 42, a data converting means 43, a billing document data creating means 44, a judging means 45, and a warning means 46. The information extracting means 41 is configured to extract health insurance receipt data to be processed related to self-insurance based on patient ID information from health insurance receipt data acquired from a medical institution. The information assigning means 42 is configured to assign code information to at least the name of the sickness and the treatment of the health insurance receipt data extracted by the information extracting means 41 and the treatment action (claimed item). The data conversion means 43 compares the health insurance receipt data extracted by the information extraction means 41 with reference to the first database and compares the medical remuneration score or amount in the order of the code information. The health insurance medical treatment remuneration score of the insurance receipt is rewritten to a medical remuneration medical treatment remuneration score and converted to work accident insurance receipt data. Further, the data conversion means 43 further includes an industrial accident standard calculation rule that can be billed per day with respect to the treatment item, and an inference means for inferring a medical fee. The billing document data creation means 44 can create insurance medical compensation fee billing document data based on the labor accident insurance receipt data obtained by the data conversion means 43 as the labor accident insurance medical fee billing document data creation means, As a means for creating self-liability insurance medical remuneration claim data, the work compensation insurance data obtained by the data converting means 43 is referred to the second database to calculate the medical remuneration score or amount, and the self-liability insurance receipt conforming to the self-liability standard The data is converted into data, and further, self-insurance insurance medical fee claim document data is created. The judging means 45 judges whether or not an instruction to convert the labor accident insurance receipt data into the self-insurance insurance receipt data and create the self-insurance insurance medical remuneration claim data is input. If it is determined by the determining means 45 that there is no instruction to execute the creation of self-responsibility insurance medical remuneration claim document data, the claim document data generating means 44 outputs the work accident insurance medical remuneration claim document data based on the work accident insurance receipt data. It is configured as follows.

  Further, the warning means 46 stops the processing of the data conversion means 43 and displays a warning message on the display means 60 when there is an error in the item name, billing amount or score when processing by the data conversion means 43. It is configured to let you. Thereby, in the state where the warning message is displayed, when it is determined that correction information in accordance with the self-responsibility standard is input via the input unit 20, the processing of the data conversion unit 43 is resumed.

  The program 31 also causes the computer to function as the display unit 60, the input unit 20, and the output unit 80 described above. The display means 60 includes a CRT (Cathode-Ray Tube), an LCD (Liquid Crystal Display), an EL display (Electroluminescence Display), and the like, and is composed of characters or images (that is, alarm information), various receipt data, It is configured to display self-insurance insurance medical fee claim document creation guidance information and the like. The output means 80 outputs the created work accident insurance receipt and claim document data, or the liability insurance claim and claim document data to the display means 60, the recording means 30, or the transmission means 70, or the printer 500, and prints it on paper or the like. It is configured.

  Further, the program 31 causes the computer to function as the transmission unit 70 and the reception unit 10 described above. The transmission means 70 is configured to transmit the created self-responsibility insurance receipt and billing document data to the insurer 300 via the communication network 400.

  The control means 50 includes a CPU (Central Processing Unit) and controls the overall operation of the medical fee billing document creation system 100.

  As shown in FIG. 2, the medical fee claim document creation system 100 is connected to a medical institution 200 and an insurer 300 via a communication network 400. Further, the medical fee claim document preparation system 100 is connected to the printer 500 by wired or wireless communication means.

  Here, the communication network 400 can be realized by various networks such as the Internet or a LAN (local area network). Further, since the communication line is encrypted by a technology such as SSL or VPN, the possibility of leakage / interception is extremely low.

  In the medical institution 200, the health insurance receipt is issued using the health insurance receipt issuing system. The created health insurance receipt data is transmitted to the medical fee billing document creation system 100 via the communication network 400.

  In the medical fee claim document preparation system 100, the health insurance receipt data sent from the medical institution 200 is recorded in the recording means 30. When creating a self-insurance insurance receipt, for example, by clicking a button such as a process start button displayed on the display means, "create self-insurance insurance receipt", etc., the health insurance receipt data is read from the recording means 30, A processing operation for extracting processing target receipt information is started.

  The self-responsibility liability standard is based on the labor accident insurance medical treatment remuneration claim standard, and it is a mechanism to add according to the occupational accident special case. Therefore, in the present embodiment, the health insurance receipt information is temporarily changed to the labor accident insurance receipt based on the labor accident insurance medical treatment remuneration standard, and then converted into an additional medical care score according to the occupational accident insurance exception to create a self-insurance insurance receipt. .

  Hereinafter, the processing procedure when creating the work compensation insurance medical fee claim document and the self-insurance insurance medical fee claim document using the medical fee claim document creating system 100 will be described with reference to FIGS. FIG. 3 is a flowchart showing an example of processing steps of the medical fee claim document creation system 100.

  As shown in FIG. 3, the medical remuneration bill preparation system 100 first reads the health insurance receipt data acquired from the medical institution and stored in the recording means 30 from the recording means 30, and the read health Based on the patient's ID information, the health insurance receipt data to be processed related to the liability insurance is extracted from the insurance receipt data (S10).

  Next, the extracted health insurance receipt data is checked (S20). FIG. 4 shows details of the health insurance receipt data check process in step S20. As shown in FIG. 4, first, a treatment action that may be a subject of the occupational accident special notice that is assumed from the wound name and part of the wound name in the health insurance receipt data to be processed, and the symptom and wound name Item) Information is given (see FIG. 6). For example, a therapeutic action that may be a target of an occupational accident that is implemented when the name of the injury is traumatic right upper arm bruise, right forearm abrasion, cervical spine sprain, or right thumb sprain is illustrated. Next, injury / illness name information is assigned to the treatment action (claimed item) as the same code information as that of the occupational accident insurance related master 33. For example, if there are treatments for anti-inflammatory analgesia (massage and other techniques) and wound treatment (100 cm2) in the health insurance treatment, the anti-inflammatory and analgesic (massage and other techniques) is used for traumatic right upper arm bruise. Cervical spine, right thumb sprain may be performed. In addition, the wound treatment may have been performed on the right forearm abrasion (see FIG. 6). A disease name code, a site code, a group code, a sub number, and the like are assigned and associated and recorded in the recording means 30 (S21). Next, based on the code information (for example, in the order of treatment of the receipt), the treatment of health insurance receipt data (claimed item) and the medical remuneration score or amount are read from the recording means 30 (S22). Next, based on the code information, it is determined whether or not the treatment action corresponding to the predetermined treatment action (claimed item) is an occupational injury special item (S23). Here, if it is an occupational accident special item, the process proceeds to step S30 (FIG. 3). If it is not a special item for industrial accidents, the number of medical treatment fees (or health insurance fees) compared to the name of the wound (symptom or symptom), medical fees or amount assumed for each corresponding item in the health insurance related master 32 (or It is determined whether or not (amount) is appropriate (S24). If it is determined that the number of medical treatment points (or money) is appropriate, the process returns to step 22, the next treatment action (claimed item) is read, and the above processing (S22 to S24) is repeated. If it is determined that the number of medical treatment points (or the amount) is not appropriate, alarm information is displayed on the display means 60 (S25). As the alarm information, for example, “the number of medical points is input in the previous year. Confirmation is required. Automatic correction? Manual correction?” Is displayed. When automatic correction is selected (or when the automatic correction mode is set in advance), the correction value is automatically input and corrected with reference to the health insurance related master 32. On the other hand, when manual correction is selected, the operator inputs a correction value from the input means 20. Next, it is determined whether there is correction input information (S26). If it is determined that there is correction input information, the number of medical treatment points (or money) is corrected (S27). Next, it is determined whether or not reading of all treatment action (claimed item) data has been completed (S28). Here, when reading of all the treatment action (billing item) data is not completed, it returns to step 22, reads the next treatment action (billing item) data, and performs the above processing (S22 to S28). Repeat. If it is determined that all the treatment action (claimed item) data has been read, the process proceeds to step S30 (FIG. 3).

  Next, preparations are made for industrial accident insurance receipt data creation processing (S30). FIG. 7 shows details of the work accident insurance receipt data preparation processing preparation in step S30. As shown in FIG. 7, first, wound name data and treatment action data of health insurance receipt data, medical treatment reward score or amount of treatment action are read from the recording means 30, and treatment action data in the health insurance receipt (claim item) Work injury insurance that may be implemented in response to injury / illness name (site or symptom) that may be subject to treatment and injury / illness name data (injured site or applicable symptom) in the health insurance receipt. It is determined whether or not the medical treatment score is appropriate by comparing with the treatment action data on the request (S31). If it is determined that the number of medical treatment points is appropriate, the process proceeds to step 35. If it is determined that the number of medical treatment points or the amount of money is not appropriate, alarm information is displayed on the display means 60 (S32). As alarm information, for example, “correction is necessary. Automatic correction? Manual correction?” Is displayed. Here, when automatic correction is selected (or when the automatic correction mode is set in advance), a correction value is automatically input and corrected with reference to the industrial accident insurance related master 33. On the other hand, when manual correction is selected, the operator inputs a correction value from the input means 20. Next, it is determined whether there is correction input information (S33). If it is determined that there is correction input information, the number of medical treatment points (or the amount) is corrected based on the correction input information (S34). Next, it is determined whether or not reading of all treatment action codes has been completed (S35). Here, when reading of all the treatment action codes is not completed, the process returns to step 31, the next treatment action code is read, and the above processing (S31 to S35) is repeated. If it is determined that all the treatment action codes have been read, the process proceeds to step S40 (FIG. 8).

  In step S30, “outpatient management addition”, “specialized surgery”, “CT (Computed Tomography) examination”, “ADL (Activities of Daily Living)”, etc. in the occupational accident special items The medical accident insurance related master 33 is referred to the item, and the number of medical points or the amount is added according to each addition rule. Based on the occupational accident standards, the occupational accident special items not described in the health insurance receipt data are automatically added.

  Next, an industrial accident insurance receipt data inference process is performed (S40). FIG. 8 shows details of the work accident insurance receipt data inference process in step S40. As shown in FIG. 8, first, an inference is made as to which injury and illness name is performed as a treatment action with reference to the industrial accident insurance related master 33 (S41). For example, when there is a treatment such as anti-inflammatory analgesia (therapy by a technique such as massage) in the health insurance data, an inference is made as to which injury or illness name has undergone the treatment (per day). In the health insurance claim, treatments such as anti-inflammatory and analgesia can be calculated only once per day, regardless of the number of times or the number of sites, but the number of treatments actually performed on patients according to the work accident standards. Can be charged. Specifically, traumatic right upper arm bruise, cervical vertebra sprain, and right thumb sprain have bruises and sprains as symptoms, so wounds and illnesses to be treated for anti-inflammatory analgesia (therapy such as massage) Become a name. When treatments such as anti-inflammatory analgesia are actually performed, it is possible to calculate as 3 sites. When there are multiple names of injuries, there is a possibility of performing anti-inflammatory analgesia (therapy by techniques such as massage), and when the treatment content includes anti-inflammatory analgesia (therapy by techniques such as massage) The alarm information prompting confirmation is displayed as “Which name of the injury / sickness did the treatment such as anti-inflammatory analgesia (therapeutic therapy such as massage)”? When there is only one target injury / illness name, the extinction / analgesic treatment (therapy by a technique such as massage) is automatically associated with the injury / disorder name information. In addition, if there is no target injury or illness name, alarm information that prompts you to confirm, “Which injury or illness did the treatment for anti-inflammatory analgesia etc. (therapy by techniques such as massage) performed?” indicate. Next, an inference value is calculated as to whether or not the special treatment fee of the implemented treatment content is subject to the site information of the name of the disease (S42). In the labor accident standards, the calculation standards are organized by dividing the parts into fingers, toes, limbs, and others. For example, medical management resources (troublesome treatment) such as when compressing is divided into fingers that are difficult to treat, then limbs that have joints that are difficult to treat, and other parts that do not have joints such as shoulders. It is changing. For example, when a treatment such as anti-inflammatory analgesia (therapy by a technique such as massage) is performed, an inference value is calculated because the addition rate differs depending on the site of the name of the wound or disease performed. Specifically, for the above traumatic right upper arm bruise, cervical sprain, right thumb sprain, etc., treatments such as anti-inflammatory analgesia (therapy by techniques such as massage), the right upper arm for traumatic right upper arm bruise and right thumb sprain This part corresponds to the extremity because the part is an arm and the part of the right thumb is a finger, and can be multiplied by 1.5 times the health score. However, cervical spine has only a health score because the site is the neck and not the extremities. In addition, when the wound treatment is performed on the right forearm abrasion, the right forearm is an arm, the arm is an extremity, and can be added as a special case. You can ride. Next, it is judged with reference to the labor accident insurance related master 33 whether the wound name and wound treatment area are appropriate (S43). Here, if it is determined that items such as wound treatment are not included based on the therapeutic action code information, the process proceeds to step S48. In addition, if there is an item such as wound treatment in the treatment action code information, the area is inferred from the size and symptom of the wound site based on the wound name information, and the wound treatment area of the health insurance treatment action data To determine whether or not the treatment action (the area to be claimed) is appropriate (S43). Here, it is determined whether or not the medical treatment score regarding the treatment action (the area to be claimed) is appropriate (S44). If it is determined that the number of medical treatment points regarding the treatment action (area to be claimed) is appropriate, the process proceeds to step S48. If it is determined that the number of medical treatment points regarding the treatment action (area to be claimed) is not appropriate, alarm information is displayed on the display means 60 (S45). As the alarm information, for example, “Which disease / sickness name has been implemented? Please check the health / sickness name” is displayed. Next, it is determined whether there is correction input information (S46). If it is determined that there is correction input information, the number of medical treatment points is corrected (S47). Here, when there is input information for automatic correction (or when the automatic correction mode is set in advance), the correction value corresponding to the area estimated from the name of the injury or illness is automatically referred to the labor accident insurance related master 33. Is entered and corrected. On the other hand, when manual correction is selected, the operator performs additional input of the treatment action item actually treated from the input means 20 according to the correction value, the reason for correction, and the name of the wound. Next, it is determined whether or not all the treatment action codes have been read (S48). Here, when the reading of all the treatment action codes has not been completed, the process returns to step 43, the next treatment action code is read, and the above processing (S43 to S48) is repeated. If it is determined that all the treatment code has been read, the process proceeds to step S50.

  The name of the illness is composed of an injured part and an aspect (symptom) caused by receiving the injury, such as traumatic right upper arm bruise. Furthermore, in order to express the disease name more specifically, modifiers such as trauma and right and left are added. For example, when there is a traumatic right upper arm bruise as a wound name, it can be seen that the right upper arm has been bruised due to the trauma.

  The doctor checks the injury mechanism, symptoms, and findings when performing treatment, and conducts a diagnosis as necessary to make a diagnosis. When a diagnosis is made, a disease name (diagnosis name) is set as a diagnosis result. Based on the disease name (diagnostic name), a treatment policy is established and treatment is performed.

  If a person falls down on a motorcycle and injured his / her hand, back, legs, etc., the health insurance is a standard for calculating according to the injured area regardless of the injured part. However, in the case of workmen's accident insurance and self-responsibility insurance, since it is insurance against injury, it is a standard according to the number of treatments actually performed.

  Specifically, in health insurance, the area is calculated as one part regardless of the part, but in the case of the labor accident standard and the self-responsibility standard, up to three parts are recognized and calculated for the part that was injured. Is supposed to be good.

  Therefore, select “bruise,” “sprain,” “contusion (wound),” “scratch (wound),” “laceration (wound)” that may treat the injury from the disease name that has been read. Inferring whether there is a possibility of injuries. In addition, because there are synonyms that have the same medical meaning even though they have the same injury and illness name, various disease names are inferred from the standard disease names established by the Ministry of Health, Labor and Welfare (for example, whiplash, Cervical sprain, cervical contusion, and traumatic cervical syndrome will be replaced by standard names as traumatic cervical syndrome).

  Next, the industrial accident insurance receipt data inference result is displayed (S50). In step S50, for example, the inference result is displayed on the display means 60.

  Then, if there is a work accident insurance for a part that may be treated, it can be multiplied by 1.5 or 2 times the health insurance score for each treated part. Make an inference about whether or not For example, in the case of traumatic right upper arm bruise, treatments such as anti-inflammatory analgesia etc. will be performed on the upper arm, and 1.5 times the predetermined number of health insurance can be calculated, so 1.5 times Accident insurance receipt data creation processing is performed so as to obtain a score multiplied by (S60). In this step S60, referring to the health insurance related master 32 and the work accident insurance related master 33, the format of the health insurance receipt is changed to the format of the work accident insurance receipt, and the work accident insurance receipt data is created and recorded in the recording means 30. To do.

  FIG. 9 is an example showing the difference between health insurance and work accident standards. As shown in FIG. 9, in the case of health insurance, wound treatment is a standard according to the area, but in the labor accident standard, it is a standard according to the number of parts that have been injured. Different. In addition, according to the labor accident standard, addition is performed according to the wounded part.

  Next, it is determined whether or not there is an instruction to execute creation of self-insurance insurance receipt data (S70). Here, if it is determined that there is no instruction to execute the creation of self-insurance insurance receipt data (that is, only the work-insurance insurance medical remuneration claim document data is required and the creation of self-insurance insurance receipt data is not required), step Proceeding to S90, the work compensation insurance medical fee claim document data is output based on the work accident insurance receipt data. For example, the created data is output to the printer 500 and printed. If it is determined that there is an instruction to execute creation of self-insurance insurance receipt data, the process proceeds to step S80.

  Next, self-insurance insurance receipt data creation processing is performed (S80). FIG. 10 shows the details of the self-insurance insurance receipt creation process in step S80. As shown in FIG. 10, first, the labor accident insurance receipt data is read from the recording means 30 based on the code information, and the self-responsibility standard-related master 34 corresponding to the self-responsibility standard calculation rule corresponding to the code information of the read industrial accident insurance receipt data is obtained. The medical fee score or amount based on the self-responsibility liability is calculated based on the read calculation rule, and the medical fee score or amount of the labor accident insurance receipt corresponding to the code information is calculated as the medical fee score or amount based on the newly calculated self-responsibility liability And converted into self-insurance insurance receipt data to form a self-insurance insurance receipt (S81). Next, self-insurance insurance claim information (for example, billing address, receipt invoice, etc.) is created (S82). The medical remuneration score is largely revised once every two years in April. The medical remuneration score or amount is read from the related master for each year based on the billing date of the read data.

  FIG. 11 shows differences in medical fee calculation standards in health insurance, workmen's accident insurance and self-responsibility insurance. As shown in FIG. 11, the method of calculating the medical remuneration score and the amount of money for the health insurance and the workmen's accident standard are different. For example, in the case of occupational accidents, the unit price of medical care is 12 yen (11.5 yen for tax-free medical institutions), so the medical expenses calculated by multiplying the medical unit price of 10 yen for health insurance by 1.2 times (health) (See “Amount” column for insurance claims and “Amount” column for industrial accident claims.) In addition, in the claim for liability insurance, “amount (technology)” is calculated from “technology: points × times” × 1.2 times.

  Next, self-insurance insurance receipt data is output (S90). FIG. 12 shows details of the self-insurance insurance receipt and the receipt result output process in step S90. In step S90, as shown in FIG. 12, first, it is determined whether or not there is an instruction to save the created liability insurance receipt data (S91). Here, if it is determined that there is no instruction to save the liability insurance receipt data, the process proceeds to step 83. If it is determined that there is a save instruction, the created data is saved in the recording means 30 (S92). Next, it is determined whether or not there is an instruction to print the prepared liability insurance receipt data (S93). If it is determined that there is no instruction to print the liability insurance receipt data, the process proceeds to step S95. If it is determined that there is a print instruction, the created data is output to the printer 500 and printed (S94). Next, it is determined whether or not there is an instruction to transmit the created liability insurance receipt data (S95). Here, if it is determined that there is no instruction to transmit the liability insurance receipt data, the process ends. If it is determined that there is a transmission instruction, the created self-insurance insurance receipt data is transmitted to the insurer 300 (S96).

  FIG. 13 is a diagram showing an example of a part of the self-liability insurance receipt. However, in FIG. 13, the specific medical score is not displayed, but is displayed as “health score”. “Health insurance score” is a medical score based on health insurance standards. As shown in FIG. 13, in the self-responsibility insurance receipt, the number of medical treatment points is calculated based on the self-responsibility standard. For example, in the “wound treatment” medical treatment item in the “treatment fee” column, the medical treatment score for the “hand / finger” portion is 2.0 times the health insurance score. On the other hand, the medical score of the medical item of “injection technique fee” in the “injection fee” column is the same as the health insurance score.

  As described above, the medical fee billing document creation system 100 according to the present embodiment includes the receiving unit 10, the input unit 20, the recording unit 30, the data processing unit 40, the control unit 50, the display unit 60, and the transmission unit. 70 and a computer comprising output means 80. The data processing means 40 includes an information extracting means 41, an information giving means 42, a data converting means 43, a billing document data creating means 44, a judging means 45, and a warning means 46.

  As a result, based on the health insurance receipt data created by the medical institution, it is possible to easily and accurately create a work liability insurance medical remuneration claim document data and / or a self liability insurance receipt that conforms to the self liability standard. Therefore, it can be reduced that the insurer is returned due to a defect in the receipt, etc., the receipt can be smoothly inspected, and early payment to the medical institution can be realized.

  In addition, by automatically forming an occupational accident insurance receipt and a self-insurance insurance receipt from health insurance receipt data created by a medical institution, it is possible to reduce the burden of paperwork associated with the occupational accident insurance receipt or the self-insurance standard.

  In addition, online billing is possible via the communication network.

  Further, if the contents described in the health insurance receipt are under-billed or the score is incorrect, a warning can be issued. It can be automatically corrected or corrected based on information input from the outside.

  In addition, for insurers, etc., by receiving a receipt that has been read by a system with logic that meets certain standards, the inspection work of the receipt is made more efficient, and the inspection cost is reduced, It is possible to improve the efficiency of medical expenses payment survey work.

  The program for the medical remuneration claim document creation system 100 as another embodiment of the present invention realizes the processing functions described above for a computer. A recording medium according to another embodiment of the present invention is a recording medium that can be read by a computer in which the program is recorded.

  That is, the recording medium of the present invention is a hard disk (HDD), flash memory, FD (floppy (registered trademark) disk), CDROM (compact disk), MO (magneto-optical disk), or DVD (digital disk) on which the above program is recorded. Video disc).

  In the above-described embodiment, the medical fee claim document creation system 100 is configured independently of the medical institution 200 and the insurer 300, but the present invention is not limited to this. The medical fee claim document creation system 100 may be configured integrally with a receipt computer of the medical institution 200 or a receipt inspection computer of the insurer 300 or the like.

  The medical fee claim document creation system 100 may not be connected to the medical institution 200 through the communication network 400. In this case, health insurance receipt data from a medical institution is acquired via a medium such as FD (floppy (registered trademark) disk), CDROM (compact disk), MO (magneto-optical disk), or DVD (digital video disk). .

  INDUSTRIAL APPLICABILITY The present invention can be used for the purpose of billing medical fees based on the work compensation insurance compensation fee or the self-responsibility standard based on the occupational injury standard.

DESCRIPTION OF SYMBOLS 10 Receiving means 20 Input means 30 Recording means 31 Program 32 Health insurance related master 33 Industrial accident insurance related master (1st database)
34 Liability insurance related master (second database)
35 Health Insurance Receipt 36 Industrial Accident Insurance Receipt 37 Self Liability Insurance Receipt 40 Data Processing Means 41 Information Extraction Means 42 Information Giving Means 43 Data Conversion Means 44 Claim Document Data Creation Means 45 Judgment Means 46 Warning Means 50 Control Means 60 Display Means 70 Transmission Means 80 Output means 100 Medical fee billing document creation system

Claims (12)

A medical fee claim document creation system for creating a document including a receipt for claiming a medical fee based on health insurance receipt data created by a medical institution,
In order to replace the health insurance receipt data with occupational accident insurance receipt data that complies with the occupational accident standards, the medical care insurance treatment treatment that can be claimed corresponding to the injury / illness name data in the health insurance receipt is managed, and health The treatment data in the insurance receipt is linked to the health insurance medical fee claim standard, and is presumed at least for each item to which code information is assigned in advance based on the labor accident medical fee claim standard and the medical fee. A recording means comprising a first database storing points or amounts in correspondence with each other;
Information for extracting health insurance receipt data to be processed related to workmen's accident insurance or personal liability insurance from the health insurance receipt data acquired from the medical institution and stored in the recording means based on the ID information of the target patient Extraction means;
Information provision that records the same code information as the code information stored in the first database to at least the name of injury and illness of the health insurance receipt data extracted by the information extraction means and the item of treatment, and records it in the recording means Means,
For the treatment action item, the treatment action and the medical fee score or amount of the health insurance receipt data to which the code information is assigned are read from the recording means, and the read therapeutic action and the medical fee score or money are read from the first means. Compared with the names of wounds and sicknesses, medical treatment reward points or amounts assumed for each corresponding item in the database, if there are different wounding names on the health insurance receipt or if multiple wounds or sickness names are assumed, and the medical treatment reward points or amounts Only when it is determined that the health insurance receipt data is different, the health insurance receipt data is rewritten by adding the items of the labor insurance insurance medical fee claim standard or rewriting the medical insurance fee points or money to the health insurance receipt data. Data conversion means for converting into insurance receipt data and recording in the recording means;
2. A medical fee claim document creation system, comprising: a work accident insurance medical fee claim document data creating means for creating work accident insurance medical fee claim document data based on the work accident insurance receipt data. A second database that stores calculation rules based on the self-indemnity standards for each item, in order to translate the industrial accident insurance receipt data into self-insurance insurance receipt data, in order to complete the claim form for self-insurance insurance linked to the labor accident standard. When,
The industrial accident insurance receipt data is read from the recording means based on the code information, and the calculation rule of the self-responsibility standard corresponding to the code information of the read industrial accident insurance receipt data is read from the second database, and the read calculation rule Calculate the medical compensation score or amount based on the self-responsibility liability, and rewrite the medical compensation score or amount of the workers' compensation insurance claim corresponding to the code information with the newly calculated medical compensation score or amount based on the self-compensation criteria. 2. The medical fee according to claim 1, further comprising: a self-insurance insurance medical fee claim document data converted into data, and a self-insurance insurance medical fee claim document data creating unit that records the data in the recording unit. Billing document creation system. Display means for displaying a message composed of characters or images;
When processing by the data conversion means, if the item name, the billing amount or the score is different, the warning means for stopping the processing of the data conversion means and displaying a warning message on the display means,
An input means for inputting correction information;
3. The processing of the data conversion means is resumed when it is determined that correction information in accordance with a self-responsibility standard is input via the input means in a state where the warning message is displayed. Medical fee billing document creation system described in 1.   4. The medical fee claim document according to claim 2, further comprising a transmission means for transmitting the created work accident insurance medical fee claim document data or the self-insurance insurance medical fee claim document data to an insurer or the like. Creation system.   The medical remuneration claim preparation system according to any one of claims 1 to 4, further comprising receiving means for receiving health insurance receipt data from a medical institution via a communication network. A judgment means for judging whether or not an instruction to convert the industrial accident insurance receipt data into the self-insurance insurance receipt data and to create the self-insurance insurance medical remuneration claim data is input;
If it is determined by the determining means that there is no instruction to create the self-insurance insurance medical fee claim document data, the worker accident insurance medical fee claim document data is output based on the industrial accident insurance receipt data. The medical remuneration claim preparation system according to any one of claims 2 to 5, wherein Computer
Each item of at least injury name, treatment action, injury site and symptom to which code information is given in advance based on the labor compensation insurance medical fee claim standard, and medical fee points or amounts for each item are stored in association with each other. Recording means comprising a first database,
Information for extracting health insurance receipt data to be processed related to workmen's accident insurance or personal liability insurance from the health insurance receipt data acquired from the medical institution and stored in the recording means based on the ID information of the target patient Extraction means;
Information provision that records the same code information as the code information stored in the first database to at least the name of injury and illness of the health insurance receipt data extracted by the information extraction means and the item of treatment, and records it in the recording means Means,
For the treatment action item, the treatment action and medical fee score or amount of health insurance receipt data to which code information is assigned are read from the recording means, and the read item and medical fee score or money are read from the first database. Compared with the assumed injury / illness name, medical treatment reward score or amount for each corresponding item, the health insurance receipt injury / disaster name is different or when multiple injury / injury names are assumed and the medical treatment reward score or amount is different Only when it is determined that the health insurance receipt data, the health insurance receipt data or medical fee points or amount is replaced with the labor accident insurance medical fee claim criteria item or the medical fee points or amount is rewritten, Data conversion means for converting into data and recording in the recording means;
A medical fee claim document preparation program that functions as an industrial accident insurance fee payment document data creation means for creating an occupational accident insurance fee payment document data based on the labor accident insurance receipt data. Recording means comprising a second database that stores, for each item, a calculation rule based on the self-responsibility standard,
The industrial accident insurance receipt data is read from the recording means based on the code information, and the calculation rule of the self-responsibility liability standard corresponding to the code information of the read industrial accident insurance receipt data is read from the second database, and the read calculation rule Calculate the medical compensation score or amount based on the self-responsibility liability, and rewrite the medical compensation score or amount of the industrial accident insurance receipt corresponding to the code information with the newly calculated medical compensation score or amount based on the self-compensation standard. The medical fee billing document preparation according to claim 7, wherein the medical fee billing document data is created by converting the data into data, and the data is recorded in the recording unit. program. Display means for displaying a message composed of characters or images on the computer;
When processing by the data conversion means, if the item name, the billing amount or the score is different, the warning means for stopping the processing of the data conversion means and displaying a warning message on the display means,
It also functions as an input means for inputting correction information,
9. The processing of the data conversion unit is resumed when it is determined that correction information in accordance with a self-responsibility liability standard is input through the input unit in a state where the warning message is displayed. Medical fee billing document preparation program described.   The computer receives the health insurance receipt data from the medical institution via a communication network, and transmission means for transmitting the created work accident insurance medical fee claim document data or the self-insurance insurance medical fee claim document data to an insurer or the like. 10. The medical fee claim document preparation program according to claim 8 or 9, wherein the medical fee claim document preparation program functions as means. The computer also functions as a determination means for determining whether or not an instruction to convert the industrial accident insurance receipt data into the self-insurance insurance receipt data and execute the creation of the self-insurance insurance medical fee claim document data is input,
When it is determined by the determining means that there is no instruction to execute creation of the self-insurance insurance medical remuneration claim data, the work accident insurance medical remuneration claim data is output based on the industrial accident insurance receipt data. Item 11. The medical fee claim document preparation program according to any one of Items 8 to 10. A computer-readable recording medium on which the program according to any one of claims 7 to 11 is recorded.

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