JP4827985B1 - Hospital accounting system, hospital accounting program, and computer-readable recording medium recording hospital accounting program - Google Patents

Abstract

[PROBLEMS] After the checkout, the medical fee for both the insurer's share and the patient's share can be changed and corrected, and the medical treatment fee that is consistent with the medical institution, examination payer, insurer and patient Provided are a hospital accounting system, a hospital accounting program, a computer-readable recording medium recording a hospital accounting program, and a hospital accounting method.
When a medical fee share calculation means 21 charges a patient for a medical fee, the patient's share of the medical fee and the insurer's share are calculated based on the medical fee details, and the temporary account ledger Record in file 33. Further, the monthly totaling means 25 performs monthly totalization on the medical fee details, and the monthly management means 26 calculates the monthly data used for the monthly aggregation and the temporary account ledger data recorded in the temporary account ledger file 33. To detect whether or not they match.
[Selection] Figure 1

Description

The present invention relates hospital accounting system for accounting for the patient's care allowance, hospital accounting program, and the hospital accounting programmable computer-readable recording the recording medium body.

  Development of the conventional receipt computer processing system has been promoted as a method for realizing a social system that connects medical institutions, examination and payment institutions, and insurers with a consistent system for requesting medical fees. .

  However, this social system approach has been partially cramped and frustrated in order to accurately capture medical costs (medical fees) and complete operation of information storage management. The reason for this is that, due to the influence of the government's medical cost control measures, the medical fee system is applied with complicated and difficult calculation conditions based on the so-called score table (official fee table indicated by the Ministry of Health, Labor and Welfare notification). . Previously, a pay-as-you-go system was adopted in which remuneration was determined based on how much the treatment cost, but in recent years, diagnosis has been determined based on the diagnosis group classification of what disease the hospitalized treatment is. The Group Classification Comprehensive Evaluation System (DPC) has been introduced, and it has been said that the medical fee system has been simplified and simplified. Differences are also seen, making it even more complex.

  The DPC classification item in the calculation method for hospitalization expenses in the April 2008 revision is 2451 classification. Among them, the diagnostic group classification targeted for comprehensive evaluation is 1572 classification. You will be billed for medical fees with the volume of the street paid. The scope of comprehensive evaluation is mainly hospital fee-related elements (hospital basic fees, examinations, diagnostic imaging, medications, injections, facility rewards such as treatment less than 1000 points), and doctor-feature elements (surgical fees, anesthesia charges, Medical technology fees (such as treatments of 1000 points or more) are not subject to the calculation, and are calculated by the volume payment method as before. If the medical fees calculated for inpatients subject to DPC are applied to conventional scores, it is said that approximately 70% is included in the comprehensive range. In addition, this is the average of the whole, and in the case of hospitalization without surgery etc., the comprehensive part may exceed 90%, and conversely, in the case of hospitalization for short-term surgical purposes, the comprehensive part may be less than 10% is there.

  Against this background, complicated and difficult calculation conditions, or those that are subject to deduction in the assessment, for example, off-label (disease name, clinical non-clinical indication, etc.), excess (normal dose or more) Administration, multidrug administration, expensive drug administration, frequent examinations, etc.), duplication (simultaneous administration of similar drugs, internal use and injection similar to drug effects, etc.), violation of rules (in contraindications, inappropriateness, non-administrative use, etc.) and unnecessary As a result, there are increasing cases of disagreement between the medical institution and the examination payer or insurer that conducts the assessment of the receipt. The error appraisal is a disposition that covers the entire amount of the medical treatment fee, and is effective not only for the requested medical fee (insurer share) but also for the cleared medical fee (patient burden). . A large amount of change in medical fees, including over-years, due to a change in the amount of medical care, which is a civil issue, is a change that also includes a refund refund directly related to the patient's overpayment claim. This is an accounting settlement that ensures debt management.

  In the case of the payment from the examination / payment institution for the medical fee claim, the current business year and the past business year are confused and remittance, and as a result of matching with the insurance dispensing pharmacy claim in the out-of-hospital prescription, the content is In the treatment of out-of-hospital prescription repayments that are reduced as inappropriate, the budget for the current fiscal year is spent as an out-of-hospital prescription repayment loss, and the previous fiscal year's previous fiscal year's profit and loss adjustment loss (out-of-hospital prescription repayment) As a result of the budget expenditure, a supplementary procedure is required to allocate to the storage amount that is excessive or insufficient due to the replacement of benefits.

  In addition, the replenishment of the storage amount that has been increased due to the replacement of the benefits for the medical fee charged for the current business year is replenished with the storage amount equivalent to the reduction of the settlement amount for the current business year. The amount of storage for the case where the settlement amount has increased due to the replacement of benefits at the amount of medical treatment for the current amount is the loss adjustment for the previous year's profit and loss (hospital return / outpatient return) insurer share / patient share As a result of budget expenditure, the amount of storage that has become excessive or insufficient will be appropriated, and in cases where the amount has been reduced, the adjustment amount will be reduced as the insurer's share of the previous year's profit and loss adjustment loss (hospital income / outpatient revenue). . In other words, a system that can quickly and accurately and rationally arrange additional collection, refund procedures, and allocation processing based on refund deposits was necessary.

JP 2003-296442 A

  However, in the conventional receipt computer processing system, due to the simplification of the paperwork, the mainstream is a compression book that does not have to be recorded in the case where the non-accrual account that is the counterpart of the stored cash is processed as stored. Due to the awareness of the settlement amount (investigation decision amount) as a decision-making disposition and the lack of recognition of revenue management, strict cash and deposit management was not performed. Also, if the balance of the accounts receivable is cash or deposit and it matches the deposit, the balance management of accounts receivable can function. Process the case for refunding the renewal amount of the determined settlement amount and the case processing for the transfer allocation, and correct the situation where the receivables are overpaid because they cannot be refunded immediately and transferred to the deposit account The system could not keep up with the occurrence of incidents that had to be done.

  Furthermore, in the conventional receipt computer processing system, the remuneration is calculated with the insurance points based on the medical treatment information details, the insurance is requested to the examination paying organization etc. by the summary summary table for each receipt and the insurer, and the patient is partially burdened (1- The main purpose was to store and manage the insurer's share (90 to 70%) excluding the 30% medical fee. Therefore, the examination management for each patient in cases such as amendment, change change revision case, receipt return and benefit replacement etc. was insufficient in the examination fee assessment conducted after filing the request.

  In addition, the collection of accounts receivable for insurance groups such as health insurers takes approximately two months to store after claim. By reimbursement of receipts due to examination assessments, increase / decrease of assessments, replacement of benefits including out-of-hospital prescription payments, etc. The assessment reduction process included in accrued receivables, which has become a so-called bill-like account, that was determined by the examination and payment institution (primary examination assessment) in the insurance group claims, is linked to the patient's burden as well. However, in actuality, there are cases where the settlement amount has to be reduced. could not.

  Furthermore, in the case of a case in which benefits are replaced by an insurance group and offset, measures must be corrected for each insured and dependent, such as a health insurer, separated from earnings and organized as deposits. In addition to responding to system incidents, various incidents have been difficult to manage normally simply by receivable accounting.

The present invention has been made on the basis of such a problem, and after the counter accounting, the medical fee for both the insurer's share and the patient's share can be changed and corrected. Another object of the invention is to provide a hospital accounting system which can be consistent with medical fee billing for four-party patient, hospital accounting program, and the hospital accounting programmable read computer recorded the recording medium body.

  Note that Patent Document 1 relates to a hospital accounting system that can reliably perform correction work of patient medical information accompanying a change in the name of the medical department or insurance after the accounting process is completed. The configuration is different.

The hospital accounting system of the present invention calculates the patient share and the insurer share of the medical fee based on the medical fee details when charging the patient for the medical fee, and the calculation result is stored in the temporary ledger file. and medical cost burden component calculation means for recording, when to claim the medical cost for the insurer, based on the medical fee specification, and monthly aggregation means for performing a monthly summary of each insurer for medical bills, this month Based on the medical fee details at the time of monthly aggregation by the next aggregation means, the insurer share of the medical fee is calculated, and the insurer burden of the medical fee calculated from the medical fee details at the time of this monthly aggregation and the temporary ledger It is provided with monthly management means for matching the insurer's share of the medical expenses recorded in the file and detecting whether or not they match.

The hospital accounting program of the present invention calculates the patient share and the insurer share of the medical fee based on the medical fee details when the computer charges the medical fee to the patient, and the calculated result is a temporary account. and medical cost borne by the calculating means to be recorded in the ledger file, when you request a medical allowance for the insurer, based on the medical fee specification, and monthly aggregation means for performing a monthly summary of each insurer for medical bills Based on the medical fee details at the time of monthly aggregation by this monthly aggregation means, the insurer's share of the medical fee is calculated, and the insurer's burden of the medical fee calculated from the medical fee details at the time of this monthly aggregation, It matches the insurer's share of the medical expenses recorded in the temporary account ledger file, and functions as a monthly management means for detecting whether or not they match.

The computer-readable recording medium in which the hospital accounting program of the present invention is recorded is based on the medical fee details when the computer charges a medical fee to the patient. is calculated, and the medical cost burden component calculation means for recording the calculation result to the suspense account ledger file, when you request a medical allowance for the insurer, based on the medical fee specification, monthly for each insurer for medical bills Based on the monthly totaling means that performs the totalization and the medical fee details at the time of monthly totaling by this monthly totaling means, the insurer's share of the medical fee is calculated and calculated from the medical fee details at the time of this monthly totaling and insurance's share of medical bills, said against the insurer's share of medical bills that were recorded in the suspense account ledger file, is intended to function as a monthly management means for detecting whether or not the match.

Hospital accounting system, hospital accounting program of the present invention, and according to hospital accounting program and computer readable recording medium body, when requesting the medical cost to the patient, the patient share of medical bills and insurer Calculate the burden and record it in the temporary account ledger file, and calculate the medical insurance fee calculated from the medical fee details at the time of monthly aggregation , and the insurer burden on the medical table recorded in the temporary account ledger file. The medical fee details were corrected after the patient was charged for the medical fee and the patient's share of the medical fee was corrected accordingly. Matches can be detected and corrected. Therefore, consistency between the insurer's share and the patient's share can be taken at the time of claiming the insurer's share of the medical treatment fee. In addition, even when the payment from the examination / payment organization is increased or decreased, the patient's share can be easily corrected according to the increase / decrease of the insurer's share. Therefore, it is possible to change and correct the medical fees for both the insurer's share and the patient's share after the end of the counter accounting, and to make a consistent medical remuneration claim for the medical institution, examination and payment institution, insurer and patient. Can do.

  In addition, the patient's share of the medical treatment fee is calculated at predetermined time intervals based on the medical fee details within that time, and matched with the medical fee charged to the patient to detect whether or not they match. Thus, it is possible to periodically detect the presence or absence of an error, and more easily achieve consistency.

It is a block diagram of the hospital accounting system which concerns on one embodiment of this invention. It is a block diagram of the hospital accounting program shown in FIG. It is a figure showing the procedure at the time of billing a medical treatment fee with respect to a patient. It is a figure showing the procedure at the time of correcting when an error is found after charging a patient for medical care. It is a figure showing the example of a recording of a temporary account ledger file. It is a figure showing the procedure at the time of performing daily management of medical treatment cost. It is a figure showing the procedure at the time of billing medical care charges with respect to an insurer. It is a figure showing the procedure at the time of payment about the insurer share for medical expenses. It is a figure showing the procedure at the time of managing a temporary account ledger file.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. In the following embodiments, a case of a municipal hospital will be described as an example.

  FIG. 1 is a diagram showing a configuration of a hospital accounting system 1 according to an embodiment of the present invention. The hospital accounting system 1 has a hardware configuration as a normal computer capable of executing a program. For example, the main memory 10, a central processing unit 20, a file device 30, an input device 40, and an output Device 50.

  In the main memory 10, for example, a hospital accounting program 60 is recorded. For example, the hospital accounting program 60 may be copied on a computer-readable recording medium, or may be downloaded using a computer network such as the Internet.

  The central processing unit 20 receives a command from the hospital accounting program 60 in the main memory 10 and receives a medical fee share calculating means 21, a rewriting means 22, a deposit input means 23, a daily management means 24, a monthly counting means 25, a monthly count. It functions as a management means 26 and a temporary account ledger file management means 27.

  The medical fee share calculation means 21 calculates the patient share and the insurer share of the medical fee based on the medical fee details when charging the patient for the medical fee, and the calculation result is stored in the temporary account ledger file. 33 is recorded. The rewriting means 22 rewrites the temporary account ledger data recorded in the temporary account ledger file into the account ledger file 35. The deposit input means 23 is for inputting deposit data when a deposit is made. The daily management means 24 calculates the patient share of the medical treatment fee based on the medical fee details within that time every predetermined time, matches the medical fee charged to the patient, and determines whether or not they match. It is to detect. Monthly tabulating means 25 tabulates monthly for medical fees based on the medical fee details. The monthly management unit 26 matches the monthly data used for the monthly totaling by the monthly totaling unit 25 with the temporary account ledger data recorded in the temporary account ledger file 33 and detects whether or not they match. Is. The temporary account ledger file management means 27 is for managing data recorded in the temporary account ledger file 33 and not rewritten in the account ledger file 35.

  In the file device 30, for example, a medical fee details file 31, a delivery / refund notice file 32, a temporary account ledger file 33, a monthly total file 34, an account ledger file 35, and the like are recorded. The medical fee detail file 31 is a file for recording the medical fee details. The delivery / refund notice file 32 is a delivery notice issued to the patient, that is, a bill for the patient's share of the medical fee, or a refund notice issued to the patient, that is, refund of the excessively received medical fee. Is a file to record the document. The temporary account ledger file 33 is a file to be recorded before the patient share and the insurer share of the medical fee are recorded in the account ledger. The monthly tabulation file 34 is a file that records monthly tabulation results for the medical fee details. The account ledger file 35 is a file that records medical billing and payment.

  FIG. 2 is a conceptual diagram showing the configuration of the hospital accounting program 60 shown in FIG. This hospital accounting program 60 allows a medical fee share calculation unit 61 to function a computer as a medical fee share calculation unit 21, a rewrite unit 62 to function a computer as a rewrite unit 22, and a computer to function as a deposit input unit 23. A deposit input unit 63, a daily management unit 64 that causes the computer to function as the daily management unit 24, a monthly totaling unit 65 that causes the computer to function as the monthly totaling unit 25, and a computer that functions as the monthly management unit 26 It has a monthly management unit 66 and a temporary account ledger file management unit 67 that causes the computer to function as the temporary account ledger file management means 27.

  FIG. 3 is a flowchart showing a procedure when a medical fee is charged to a patient. For example, in this hospital accounting system 1, when an electronic medical record or ordering information input by a doctor in charge of a medical institution's medical practice is performed, the department in charge of medicine, radiation, examination, etc., executes a procedure according to the order. , To that effect is transmitted to the medical affairs department as the finalized information of the medical information details. Based on the confirmed information, a medical fee detail is created by the medical staff and stored in the medical fee detail file 31 (step S101). The medical information details are details that describe the medical contents such as the name of the patient, the name of the insurance to be applied, the date of medical care, the medical department, the diagnosis group classification item (DPC item) related to the medical care contents, and the name of the disease by the volume payment system. is there. The medical fee details linked to the medical information details include the name of the patient, the name of the insurance to be applied, the date of medical treatment, the medical department, the diagnostic group classification item (DPC item) related to the medical treatment content, and the medical name such as the disease name by the pay-per-pay system This is a statement regarding medical treatment remuneration that describes the contents, insurance points corresponding to the medical treatment, medical treatment fee, and the like.

  Next, for example, when an input to create a delivery notice / receipt issued to a patient is made from the input device 40 by a medical staff, the medical fee share calculation means 21 is based on the medical fee details. Then, the patient share and the insurer share of the medical treatment fee are calculated (step S102). Subsequently, the medical fee share calculation means 21, for example, based on the calculated patient share of the medical fee, a delivery notice / receipt and medical statement issued to the patient, and a delivery notice stored in the hospital A completed document is created and recorded in the delivery / refund notice file 32 and output from the output device 50 (step S103). The medical fee share calculation means 21 is a table in which journal patterns prepared in advance in the temporary account ledger file 33 are registered by automatic journals based on the coding system corresponding to the data format of the delivery / refund notice file 32, for example. Based on each journal entry corresponding to the transaction journal, the patient burden and the insurer burden for the medical fee are recorded in the temporary account ledger file 33 (step S104).

  When requesting input of a journal entry item, it may be automatically performed using a table in which journal patterns prepared in advance are registered. In addition, a list of journalized subjects may be displayed and selected by the medical staff. The temporary account ledger file 33 is recorded by the account ledger method based on the principle of accrual accounting. In addition, the temporary account ledger file 33 may be recorded separately for the patient burden and the insurer burden, or may be separately recorded for outpatient and hospitalization. . Further, in the temporary account ledger file 33, when there is a deposit deposited at the time of out-of-hours treatment, the deposit may be described.

  Next, for example, the rewriting means 22 rewrites the patient share data recorded in the temporary account ledger file 33 into the account ledger file 35 (step S105). For example, the rewriting means 22 does not delete the data from the temporary account ledger file 33, but records offset data for offsetting the data to be rewritten to the temporary account ledger file 33 and records the data in the account ledger file 35. At that time, the insurer share data is reserved and not rewritten. The account ledger file 35 is recorded by the account ledger method based on the principle of accrual accounting. Subsequently, when receiving the payment of the medical treatment fee from the patient (Step S106; Y), the medical staff inputs that the payment has been made from the input device 40. At that time, the deposit input means 23 is, for example, a table in which journal patterns prepared in advance in the account ledger file 35 are registered. Based on each journal item corresponding to the transaction journal, the deposit amount input by the medical staff is stored in the account ledger. It records in the patient share of the file 35 (step S107). In addition, when requesting entry of a journal entry item, a list of tables in which journal patterns describing the journal entry item are registered in advance may be displayed so that a medical staff can select the journal entry item.

  FIG. 4 is a flowchart showing a procedure for correcting when an error is found after the patient is charged for medical treatment. For example, in this hospital accounting system 1, if an error is found in the medical fee details etc. after charging the patient for the medical fee (step S 201; Y), the medical fee details are corrected by the medical staff, and the medical fee details file 31 (Step S202). Next, for example, when a medical staff member inputs that the medical fee is to be corrected from the input device 40, the medical fee share calculation means 21 calculates the patient's share of the medical fee and the insurer based on the medical fee details. The share is calculated (step S203). Subsequently, for example, when the recalculated medical fee is an increase (step S204; increase), the medical fee share calculation means 21 applies to the patient based on the calculated patient share of the medical fee. A delivery notice / receipt to be issued and a corrected medical statement and a delivery notice completed in the hospital are created and recorded in the delivery / refund notice file 32 and output from the output device 50 (step S205). . When the recalculated medical treatment fee is reduced (step S204; reduction), based on the calculated patient's share of the medical treatment fee, a refund notice and a revised medical statement issued to the patient, and at the hospital A refund resolution / receipt to be stored is created, recorded in the delivery / refund notice file 32, and output from the output device 50 (step S206).

  The medical fee share calculation means 21 is also a table in which journal patterns prepared in advance in the temporary account ledger file 33 are registered by automatic journals based on the coding system corresponding to the data format of the delivery / refund notice file 32, for example. Based on each journal entry corresponding to the transaction journal, the patient burden and the insurer burden for the medical fee recalculated are recorded in the temporary account ledger file 33 (step S207). At that time, the medical fee share calculation means 21 adds new data rather than rewriting and correcting the previously recorded data. Further, the medical fee share calculation means 21 also records offset data for offsetting the previously recorded data that has been previously recorded in the temporary account ledger file 33 (step S208). This may be performed based on an input from a medical staff or may be performed automatically.

  Next, for example, the rewriting means 22 rewrites the patient share data described in the temporary account ledger file 33 to the account ledger file 35 in the same manner as in step S105 of FIG. 3 (step S209). Subsequently, if the patient receives payment of the insufficient medical fee or refunds the excessive medical fee to the patient (step S210; Y), the medical staff inputs the fact from the input device 40. The deposit input means 23 records it in the account ledger file 35 (step S211).

  FIG. 5 shows an example of recording of the temporary account ledger file 33, and shows an example in which the patient A receives medical care in an outpatient setting. As shown in FIG. 5, the temporary ledger file 33 includes an outpatient burden file, an outpatient insurer burden file, and a provisional receipt file. The outpatient burden file and the outpatient insurer. Each share file is provided with a revenue receivable file and a revenue file, and each provisional file is provided with a cash file and a deposit file.

  First, for example, if patient A (30% of patient share, 70% of insurer share) received medical treatment on outpatient on March 10th and the medical fee was 11,700 yen, revenue of outpatient share file Record 3,510 yen, 30% of the patient's share, in the debit of the accounts receivable file and the credit of the profit file. Also, 80% of the insurer's share of 8,190 yen is recorded in the debit of the revenue receivable file of the outpatient insurer share file and the credit of the profit file.

  Next, on March 13th, if you found an error in the medical fee for March 10th and the correct medical fee was 12,800 yen, the debit of the revenue receivable file and the revenue Record 3,840 yen, which is 30% of the patient's share that was recalculated, in the credit of the file. Also, the recalculated insurer share of 70%, 8,960 yen, is recorded in the debit of the revenue receivable file and the credit of the profit file of the outpatient insurer share file. In addition, offset data 3,510 yen for offsetting the uncorrected data recorded on March 10 is recorded in the credit of the revenue receivable file and the debit of the revenue file of the outpatient burden share file, and the outpatient The offset data of 8,190 yen is recorded in the credit of the revenue receivable file and the debit of the revenue file of the insurer share file.

  Next, if you received medical care at an outpatient on March 13th and the medical fee was 9,500 yen, the patient's share would be 30% for the debit of the revenue receivable file of the outpatient share file and the credit of the profit file. Record 2,850 yen. Also, 70% of the insurer's share of 6,650 yen is recorded in the debit of the revenue receivable file and the credit of the profit file of the outpatient insurer share file.

  After that, on March 20, if you found an error in the medical fee for March 13, and the correct medical fee was 8,700 yen, Record 2,610 yen, 30% of the calculated patient burden, in the credit of the profit file. In addition, the recalculated 70% of the insurer share of 6,090 yen is recorded in the debit of the revenue receivable file and the credit of the profit file of the outpatient insurer share file. In addition, offset data 2,850 yen for offsetting the pre-correction data recorded on March 13 is recorded in the credit of the revenue receivable file of the outpatient burden file and the debit of the revenue file, and the outpatient The offset data of 6,650 yen is recorded in the credit of the revenue receivable file and the debit of the revenue file of the insurer share file.

  Next, if you receive medical care at an emergency night outpatient on March 23, the medical fee is 8,400 yen, and you receive 10,000 yen as a deposit, the debit of the cash file of the temporary file and the deposit file Record 10,000 yen in the credit. In addition, record 2,520 yen, 30% of the patient's share, in the debit of the revenue receivable file of the outpatient burden file and the credit of the profit file, Record 7,880 yen, 70% of the insurer's share, in the credit of the profit file.

  Next, assuming that the cash received on March 24 and the deposit received on March 23 are transferred to the account ledger file 35, the credit file of the deposit file and the debit of the deposit file will be debited. Record 10,000 yen.

  FIG. 6 is a flowchart showing a procedure for performing daily management of medical treatment fees. For example, in this hospital accounting system 1, first, the daily management means 24 performs a predetermined amount of time, for example, every day at 16:00, for the medical fee details from 16:00 the day before to 16:00 today, Are calculated respectively (step S301). As the medical fee details, data recorded in the medical fee details file 31 at that time, that is, daily data at the time of check is used.

  Next, the daily management means 24 compares the calculated patient's share of the medical fee from 16:00 on the previous day to today's 16:00 with the medical fee charged to the patient and detects whether or not they match ( Step S302). The medical fee billed to the patient may refer to the temporary account ledger file 33, the account ledger file 35, or the delivery / refund notice file 32. When inconsistent data is detected (step S303; Y), the medical fee details calculation means 21 reads out the medical fee details from the medical fee details file 31 for the mismatched data, The insurer share is calculated (step S304). At this time, it may be performed based on an input from a medical staff or may be performed automatically.

  Next, in the same manner as in steps S204 to S206 in FIG. 4, a delivery notice / receipt / delivery notice completed or refund notice / return resolution / receipt and a revised medical statement are prepared, and delivered / refunded. The notification file 32 is recorded and output (step S305), and is recorded in the temporary account ledger file 33 in the same manner as in steps S207 and S208 of FIG. 4 (step S306). 4 is rewritten to the account ledger file 35 in the same manner as in step S209 in FIG. 4 (step S307), and the deposit or refund is recorded in the account ledger file 35 in the same manner as in steps S210 and S211 in FIG. 4 (step S308). ). As a result, if the medical fee details are corrected after the medical fee is charged to the patient, and there is a mismatch such as the patient share of the medical fee not being corrected correctly, it is detected as a mismatch and corrected correctly. .

  FIG. 7 is a flowchart showing a procedure when a medical fee is charged to an insurer. For example, in this hospital accounting system 1, first, the monthly totaling means 25 performs monthly totalization on the medical fee details for charging the insurance fee to the insurer at a predetermined date and time, for example, at the beginning of every month at 9:00, It records in the monthly total file 34 (step S401). As the medical fee details, data recorded in the medical fee details file 31 at that time, that is, monthly data at the time of aggregation is used. The monthly total is mainly the medical fee details of the previous month, for example, but the medical fee details of the previous month are excluding those that hold the charge even if it is the previous month's medical fee details. However, it is also possible to add those that have been unclaimed by reservation and whose reservation has been canceled. Monthly tabulations are compiled for each patient, and the medical expenses are tabulated for each insurer. Next, the monthly management unit 26 uses the monthly totaling unit 25 to calculate the monthly data of the medical fee used for the monthly totaling, that is, the medical fee for each medical fee detail recorded in the medical fee detail file 31 at the time of aggregation. The insurer share is calculated (step S402).

  Subsequently, the monthly management means 26 matches the insurer share of the calculated monthly data with the insurer share data of the temporary account ledger data recorded in the temporary account ledger file 33 so that they match. Whether it is present or not is detected (step S403). When inconsistent data is detected (step S404; Y), the medical fee details calculation means 21 reads out the medical fee details from the medical fee details file 31 for the mismatched data, The insurer share is calculated (step S405). At this time, it may be performed based on an input from a medical staff or may be performed automatically.

  Next, in the same manner as in steps S204 to S206 in FIG. 4, a delivery notice / receipt / delivery notice completed or refund notice / return resolution / receipt and a revised medical statement are prepared, and delivered / refunded. Recorded in the notification file 32 and output (step S406), and in the same manner as in steps S207 and S208 of FIG. In addition, offset data is recorded (step S407). Subsequently, the patient share data is rewritten to the account ledger file 35 in the same manner as in step S209 in FIG. 4, and the deposit or refund is recorded in the account ledger file 35 in the same manner as in steps S210 and S211 in FIG. S408). Subsequently, whether or not a mismatch is detected in steps S403 and S404, the rewriting means 22 rewrites the insurer share data in the temporary account ledger file 33 to the account ledger file 35 (step S409). For example, the rewriting means 22 does not delete the data from the temporary account ledger file 33, but records offset data for offsetting the data to be rewritten to the temporary account ledger file 33 and records the data in the account ledger file 35. As a result, if there is inconsistency such that the medical fee details are corrected after the daily management process and the patient share of the medical fee is not corrected accordingly, it is detected as a mismatch and corrected correctly.

  FIG. 8 is a flowchart showing a procedure when payment is made for the insurer share of the medical treatment fee. First, when the examination fee is paid from the examination paying institution (step S501; Y), the medical staff records the payment from the input device 40 in the account ledger file 36, and the payment amount matches the invoiced amount. It is confirmed whether or not (step 502). If there is mismatched data (step S503; Y), the medical staff details the medical fee detail for the mismatched data and records it in the medical fee detail file 31 (Sstep 504).

  Next, for example, in the same manner as in step S203 in FIG. 4, the patient share and the insurer share of the medical fee are calculated based on the medical fee details (step S505), and in the same manner as in steps S204 to S206 in FIG. , Create a delivery notice / receipt / delivery notice completed or refund notice / refund resolution / receipt, and revising medical statement, record it in the delivery / refund notice file 32 and output (step) In step S506), in the same manner as in steps S207 and S208 in FIG. 4, the recalculated patient burden and insurer burden and offset data are recorded in the temporary account ledger file 33 (step S507). Subsequently, the patient share data is rewritten to the account ledger file 35 in the same manner as in step S209 in FIG. 4, and the deposit or refund is recorded in the account ledger file 35 in the same manner as in steps S210 and S211 in FIG. S508). Subsequently, whether or not a mismatch is detected in steps S502 and S503, the rewriting means 22 converts the insurer share data in the temporary account ledger file 33 to the account ledger in the same manner as in step S409 in FIG. The file 35 is rewritten (step S509). As a result, even when an increase or decrease is made in the payment from the examination / payment institution, the patient's share is corrected in accordance with the increase / decrease of the insurer share.

  FIG. 9 is a flowchart showing a procedure for managing the temporary account ledger file 33. For example, in this hospital accounting system 1, first, the temporary account ledger file management means 27 extracts unbilled data that has not been rewritten to the account ledger file 35 from the temporary account ledger file 33 as needed or periodically. The corresponding medical fee details are read from the fee details file 31 (step S601). When the medical fee details read from the medical fee details file 31 has a description or check indicating that the insurer's burden is reserved, that is, when the unclaimed data in the temporary account ledger file 33 is that of the demand reserve (Step S602; Y) The temporary bill ledger file management means 27 matches the unclaimed data read from the temporary bill ledger file 33 with the insurer share of the medical fee calculated from the corresponding medical fee details. It is confirmed whether or not (step S603).

  If the unbilled data is not reserved (step S602; N), whether or not the next request is made by the temporary account ledger file management means 27 when the reserved charge is released. Or, it is confirmed whether or not it is within the target period of the current monthly aggregation, for example, the medical fee details for this month (step S604). If the reservation is canceled or within the target period of the current monthly aggregation (step S604; Y), the temporary account ledger file management means 27 reads it from the temporary account ledger file 33. The unclaimed data is matched with the insurer share of the medical fee calculated from the corresponding medical fee details, and it is confirmed whether or not they match (step S603).

  If the reservation is not released or not within the target period of the current monthly total (step S604; N), the temporary account ledger file management means 27 extracts it as irregular reservation data, for example, The contents are confirmed by the medical staff (step S605). Further, the temporary account ledger file management means 27 matches the unclaimed data read from the temporary account ledger file 33 with the insurer share of the medical fee calculated from the corresponding medical fee details and determines whether or not they match. Confirmation is made (step S603). If they do not match (step S606; Y), the temporary account ledger file management means 27 calculates the patient share of the medical fee from the corresponding medical fee details, and delivers it in the same manner as in steps S204 to S206 in FIG. A notice / receipt / delivery notice completed or refund notice / refund resolution / receipt and a correction medical statement are created, recorded in the delivery / refund notice file 32 and output (step S607). .

  Next, in the same manner as in steps S207 and S208 of FIG. 4, the recalculated patient burden and insurer burden and offset data are recorded in the temporary account ledger file 33 (step S608). Subsequently, the patient share data is rewritten to the account ledger file 35 in the same manner as in step S209 in FIG. 4, and the deposit or refund is recorded in the account ledger file 35 in the same manner as in steps S210 and S211 in FIG. S609). As a result, when there is an inconsistency in the unbilled data in the temporary account ledger file 33 at any time or periodically, it is corrected correctly. Further, when there is irregular reservation data in the temporary account ledger file 33, the contents can be confirmed.

  As described above, according to the present embodiment, when the medical fee is charged to the patient, the patient burden and the insurer burden for the medical fee are calculated and recorded in the temporary account ledger file 33, and the monthly Since it matches the data and detects whether or not they match, the medical fee details are corrected after the patient is charged for the medical fee, and the patient share of the medical fee is not corrected accordingly. Matches can be detected and corrected. Therefore, consistency between the insurer's share and the patient's share can be taken at the time of claiming the insurer's share of the medical treatment fee. In addition, even when the payment from the examination / payment organization is increased or decreased, the patient's share can be easily corrected according to the increase / decrease of the insurer's share. Therefore, it is possible to change and correct the medical fees for both the insurer's share and the patient's share after the end of the counter accounting, and to make a consistent medical remuneration claim for the medical institution, examination and payment institution, insurer and patient. Can do.

  In particular, if the insurer share is calculated from the monthly data and matched with the insurer share data of the temporary account ledger data, the accounting process can be performed efficiently and easily.

  Further, if the temporary ledger file 33 is recorded by the account ledger method based on the principle of accrual accounting, it is easy to find an error and more easily achieve consistency.

  In addition, the patient's share of the medical treatment fee is calculated at predetermined time intervals based on the medical fee details within that time, and matched with the medical fee charged to the patient to detect whether or not they match. Thus, it is possible to periodically detect the presence or absence of an error, and more easily achieve consistency.

  The present invention has been described with reference to the embodiment. However, the present invention is not limited to the above embodiment, and various modifications can be made. For example, in the above-described embodiment, each component has been specifically described. However, not all the components may be provided, and other components may be provided. For example, the rewriting means 22, the deposit input means 23, the daily management means 24, the temporary account ledger file management means, etc. may be provided as necessary.

  Can be used for hospital accounting.

  DESCRIPTION OF SYMBOLS 1 ... Hospital accounting system, 10 ... Main memory, 20 ... Central processing unit, 21 ... Medical treatment share calculation means, 22 ... Rewriting means, 23 ... Payment input means, 24 ... Daily management means, 25 ... Monthly aggregation means , 26 ... Monthly management means, 27 ... Temporary ledger file management means, 30 ... File device, 31 ... Medical fee details file, 32 ... Delivery / refund notice file, 33 ... Temporary ledger file, 34 ... Monthly aggregation File, 35 ... Account Ledger file, 40 ... Input device, 50, Output device, 60 ... Hospital accounting program, 61 ... Medical fee share calculation unit, 62 ... Rewrite unit, 63 ... Payment input unit, 64 ... Daily management unit , 65 ... Monthly totaling unit, 66 ... Monthly management unit, 67 ... Temporary ledger file management unit

Claims (5)

Medical charge share calculation means for calculating the patient share and the insurer share of the medical care fee based on the medical treatment fee details and recording the calculation result in the temporary ledger file when charging the medical care fee to the patient When,
When requesting a medical allowance against insurer, based on the medical fee specification, and monthly aggregation means for performing monthly summary of each insurer for medical fee,
Based on the medical fee details at the time of monthly aggregation by this monthly counting means, the insurer share of the medical fee is calculated, and the insurer burden of the medical fee calculated from the medical fee details at the time of this monthly aggregation, A hospital accounting system, comprising: a monthly management unit that matches the insurer's share of medical expenses recorded in the temporary ledger file and detects whether or not they match.   Furthermore, daily management that calculates the patient's share of the medical treatment fee based on the medical fee details within that time at a predetermined time and compares it with the medical fee charged to the patient to detect whether or not they match The hospital accounting system according to claim 1, further comprising means.   The hospital accounting system according to claim 1 or 2, further comprising rewriting means for rewriting temporary account ledger data recorded in the temporary account ledger into an account ledger file. Computer
Medical charge share calculation means for calculating the patient share and the insurer share of the medical care fee based on the medical treatment fee details and recording the calculation result in the temporary ledger file when charging the medical care fee to the patient When,
When requesting a medical allowance against insurer, based on the medical fee specification, and monthly aggregation means for performing monthly summary of each insurer for medical fee,
Based on the medical fee details at the time of monthly aggregation by this monthly counting means, the insurer share of the medical fee is calculated, and the insurer burden of the medical fee calculated from the medical fee details at the time of this monthly aggregation, A hospital accounting program that functions as a monthly management means that matches the insurer's share of medical expenses recorded in a temporary ledger file and detects whether or not they match. Computer
Medical charge share calculation means for calculating the patient share and the insurer share of the medical care fee based on the medical treatment fee details and recording the calculation result in the temporary ledger file when charging the medical care fee to the patient When,
When requesting a medical allowance against insurer, based on the medical fee specification, and monthly aggregation means for performing monthly summary of each insurer for medical fee,
Based on the medical fee details at the time of monthly aggregation by this monthly counting means, the insurer share of the medical fee is calculated, and the insurer burden of the medical fee calculated from the medical fee details at the time of this monthly aggregation, A computer-readable recording of a hospital accounting program that functions as a monthly management means that matches the insurer's share of medical expenses recorded in the temporary ledger file and detects whether they match. Recording medium.

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