JPH0793407A - Method for deciding whether or not patient is charged for medical fee - Google Patents

Abstract

PURPOSE:To speedily judges whether or not the patient is charged and to improve services to the patient by reading out patient information and insurance information, which are stored in a storage device at the time of the first medical examination, when the patient visits the hospital again and performing a collating process. CONSTITUTION:The patient when visiting the hospital shows the consultation card, etc., at the reception counter and asks for an examination or treatment. A counter staff inputs the identification number of the patient, the code of the object medical fee, etc., through an input device 101 and registers them in a sick list registration system 100. An automatic decision procedure for charging or noncharging is stored in a control unit 104 and followed while the patient information and insurance information stored in the storage device 103 are referred to. Namely, the patient information, the insurance information that the patient uses, and the decision table showing whether or not the patient is charged are read out of the storage device 103 at the time of a 1st examination or treatment and the read information is collated to decide whether or not the patient is charged for the medical free. Consequently, it is automatically decided whether or not the patient is charged and a artificial miss in the decision making is prevented.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a method of determining whether or not a medical care cost is borne by a patient in a re-entry registration system of a hospital.

[0002]

2. Description of the Related Art Conventionally, although various systems have been developed as re-entry registration systems used in hospitals, etc., they are usually connected to a hospital information system centering on a medical expense accounting system or as a subsystem. In general, it is incorporated. An example developed as a subsystem in a hospital information system is Japanese Patent Laid-Open No. 4-28.
No. 340 publication is detailed.

The main purpose of the conventional recurrence registration system is
The purpose is to transmit outpatient information from the revisit reception desk to the medical department and to instruct the medical department to issue the chart.
A form output from a printer is generally used for transmitting such information.

This form is generally called a "reception form", but when it is developed for the purpose of supporting the work from reception to accounting by connecting with an accounting system, it also prints information necessary for accounting. It is a form that prints out and adds a column that allows you to enter hand-in information such as re-examination classification and whether or not to add after-hours. Generally, there are slips called "consultation summary slip", "outpatient basic slip", "accounting basic slip", etc. use.

In the following, the term "accounting basic slip" will be used.

[0006] Such an accounting basic slip is transmitted in the hospital in parallel with the patient after the reception until it arrives at the accounting window, and is used as a basic slip for a medical record delivery instruction sheet and medical expenses calculation.

At the accounting counter, the medical expenses are calculated based on various slips such as "accounting basic slip" and billed to the patient. Under the medical insurance system, the patient only has to pay a part of the medical expenses, and pays the patient's share at the accounting window before returning home.

By the way, there are various types of insurance (about 50 types), and the burden on each patient is different. Therefore, depending on the patient, it may not be necessary to pay medical fees at the counter.

[0009] Generally, a certain percentage of the medical treatment cost is borne by the patient, and the burden is paid each time the medical treatment is received, but in some cases, the burden ratio is set at 0%.

Depending on the patient, such as the elderly, it may be sufficient to pay a fixed amount every month regardless of the amount of medical treatment, and after paying the fixed amount, the month will be spent at the counter. No payment.

Therefore, at the accounting window, before starting the calculation process, it is judged whether or not the patient needs to pay the medical treatment fee by looking at the type of insurance used printed on the accounting basic slip and determining whether the patient is useless. Patients need to be advised not to wait for payment.

[0012]

However, in the past, as described above, the accounting clerk determines the presence / absence of patient burden by checking the type of insurance used printed on the basic accounting slip. Therefore, if the burden on the patient varies depending on the patient and the day of consultation,
Sometimes the judgment was wrong.

In a large hospital, the number of outpatients per day usually exceeds 1,000 to 2,000, and more patients can be treated within a limited time.
Shortening the waiting time per patient is essential from the perspective of improving patient service.

However, in the conventional method, it takes a certain amount of time to make a decision, which is an obstacle to shortening the waiting time.

It is an object of the present invention to provide a method for determining the presence / absence of a medical expense patient burden, which is capable of quickly determining the presence / absence of a patient burden and improving the service to the patient.

[0016]

In order to achieve the above object, the present invention is such that the patient information registered in the storage device at the time of the first medical examination and the insurance information used by the patient are registered in the storage device in advance. The determination table for the presence or absence of the burden on the patient is read at the time of re-acceptance, and the presence or absence of the burden on the patient for the medical expenses is determined by collating the read information.

[0017]

[Function] Upon receiving the medical examination, the medical examination fee such as the initial medical examination fee or the re-treatment is calculated regardless of the necessity of treatment. In other words, although all medical examinations are charged, it is possible to determine whether there is a patient's burden based on the type of insurance to be used, etc., even if the specific medical treatment is not clarified if there is merely a patient's burden.

Therefore, the patient information registered in the storage device at the time of the first medical examination, the insurance information used by the patient, and the judgment table of the presence or absence of the patient's burden are read out at the time of re-acceptance, and the patient with the medical expenses is collated by the read-out information collation processing. Determine the burden.

As a result, it is possible to determine whether or not the patient will bear the burden at the time of re-acceptance.

If the insurance information is changed, it is sufficient to register again after the change processing.

[0021]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described in detail below with reference to illustrated embodiments.

FIG. 1 is a system configuration diagram showing an embodiment of a re-entry registration system to which the present invention is applied. The system of this embodiment includes a return visit registration system 100 and an accounting system 1.
Since the 10 are connected, first, the re-entry registration system 100
Let's start with.

The recurrence registration system 100 is composed of a recurrence registration input device 101, an output device 102, a storage device 103, and a recurrence registration control unit 104.

The re-entry registration input device 101 is composed of a CRT, a keyboard, etc., and has a function of inputting the identification number of the patient who came to the hospital and re-entering the system. A printer or the like is used as the output device 102, and has a function of printing the result of the re-entry registration process on a form and outputting it. The determination result of the presence or absence of the patient's burden of medical treatment, which is a feature of the present invention, is printed and output on this form.

The storage device 103 stores patient information and insurance information used by the patient. The recurrence registration control device 104 has a built-in control procedure for executing a series of recurrence registration processes while referring to the information stored in the storage device 103, and determines whether or not the patient burden of the medical expenses is charged.

Next, the accounting system 110 will be briefly described.

The accounting system 110 includes the accounting input device 10.
5 and the accounting control unit 106. The accounting input device 105, like the re-entry registration input device 101, is a CRT.
It is composed of a keyboard and the like, and you can enter the medical care code, medication code, etc. based on various slips after medical treatment,
It has a function to request the calculation of medical expenses. Accounting control unit 1
Reference numeral 06 stores a control procedure for executing calculation processing and a calculation procedure while referring to the contents of the storage device 103. Also,
If necessary, the contents of the storage device 103 are updated according to the calculation result.

The form output from the output device 102 is an accounting basic slip, which serves as a patient chart output slip and a basic medical bill accounting slip.

An example of the "accounting basic slip" 200 is shown in FIG. In the example of FIG. 2, one accounting sheet serves as both the accounting basic slip and the prescription, but the description of the prescription is omitted in this embodiment.

The "basic accounting slip" 200 is output from the output device 1 on a sheet of paper on which predetermined characters, frame lines, etc. are preprinted.
When outputting from 02, create by printing necessary items.

In FIG. 2, the frame 210 is machine-printed.
Preprinted items are shown in the frame 220.

The items that are machine-printed are information that is unique to each patient, and are mainly information that is necessary for identifying the patient and delivering the chart.

Of these, "accounting / non-accounting" represents the result of the judgment as to whether or not the medical expenses on the day of the patient burden, which is a feature of the present invention.

The items to be printed in advance are printed in a format in which the initial medical examination fee, overtime addition, guidance fee, etc., which are the basic items of medical expenses, can be handwritten in a selective manner.

Next, referring to FIG. 3, "accounting basic slip" 20
The flow of the outpatient clinic office work using 0 will be explained.

First, when the patient PT comes to the hospital, he / she presents a medical examination ticket or the like at the reception desk and applies for the medical examination. The window attendant E inputs the identification number of the patient and the code of the department to be examined from the input device 101, and the re-entry registration system 10
Register to 0.

When the input is completed, the recurrence registration system 10
The accounting basic slip 200 is output from 0.

Next, the basic accounting slip 200 is put together with the chart and sent to the examination room. In the examination room, the basic items of the medical expenses, such as first visit, whether to return, and whether to add after-hours, are entered in the basic accounting slip 200.

After the medical treatment is completed, the basic accounting slip 200 is sent to the accounting window by the patient's own possession.

The accounting clerk A refers to the item "accounting / non-accounting" printed on the basic accounting slip 200, and tells the patient PT whether or not waiting for accounting is necessary. Patients PT who do not need to wait for accounting can return home as they are, but patients PT who bear the medical expenses will wait in front of the accounting window until the calculation is completed and a bill is issued for the payment of medical expenses.

Next, a procedure for automatically determining the presence / absence of accounting will be described.

The determination procedure is built in the control device 104 of FIG. 1 and is executed with reference to the patient information and insurance information stored in the storage device 103.

FIG. 4 shows the structure of patient information and insurance information stored in the storage device 103.

In this system, one patient can register up to five types of insurance.

As shown in FIG. 4, the contents of the patient information are patient identification information 411, name 412, date of birth 413, and gender 4.
14, the medical record number 415, the partial contribution calculation date 416, and the like, and is mainly information for patient identification.

Here, the partial payment calculation date 416 means the date when the patient pays the fixed amount when the patient's burden is limited to a fixed amount each month by the insurance used. In other words, at the time of re-registration on May X, if the partial payment calculation date is May, the patient has already paid the partial payment for May. There will be no burden. On this partial contribution calculation date 416,
The accounting system 110 updates.

Next, the insurance information has information on five types of insurance.

Each insurance information includes insured person number 421, insurance type 422, insured person number 423, person / family 424,
It is composed of information such as applicable limited department 425, outpatient burden ratio 426, hospitalization burden ratio 427, partial burden amount 428, start date 429, and expiration date 430.

Of these, the insurance type 422 is a code indicating the type of insurance, and is insurance that can be used alone (referred to as main insurance) or insurance that is used in combination with other insurance (referred to as combined insurance). It is used to determine that.

The application-limited department 425 represents a medical department that uses the insurance. For example, if the internal medicine is a limited application department, the insurance can be used only when the internal medicine is examined, and cannot be used when the other medical examination is conducted. The outpatient burden ratio 426 represents the ratio of the patient burden when using the insurance.

The partial burden amount 428 represents a fixed amount in insurance such as medical insurance for the elderly, which can be paid up to a fixed amount every month. Start date 429 is the date when you started using the insurance,
The expiration date 430 represents the expiration date of the insurance.

Next, the procedure for determining the presence or absence of accounting will be described with reference to these pieces of information. This judgment is made based on the judgment tables shown in Tables 1 and 2.

[0053]

[Table 1]

[0054]

[Table 2]

In Table 1, system 1
Of the insurances registered in 00, the insurance applicable to the medical examination department and within the valid period is the target of the determination condition as the valid insurance. Depending on the type of effective insurance, etc., determine whether or not there is a patient burden when using that insurance. There are insurances that can be judged independently and insurances that can be judged in combination with other insurances.

0% of patient's burden of national insurance, company insurance, retirement insurance,
In addition, in the case of life insurance, work-related accident, public accident, and own expense, it is possible to make a single judgment, so if these insurances are registered, it is immediately judged whether or not there is a patient burden.

When using national insurance, company insurance, or retirement insurance with patient burden, it may be used in combination with public expense insurance such as medical care for the elderly, so whether the patient is burdened or not in combination with other conditions of public expense insurance. judge.

In Table 2, after determining whether or not there is a patient burden for each insurance, the presence or absence of today's accounting is determined. In other words, if it is only the judgment of "patient burden", today's accounting will be "present", and if the judgment of no patient burden is all,
Today's accounting is "none".

If the "patient burdened" judgment and the "no patient" judgment are mixed, the judgment by the system is impossible.

FIG. 5 is a flow chart showing the determination processing procedure. First, it is checked whether or not the examination fee is registered as an applicable department for all of the five types of registered insurance and is within the expiration date. If yes (YES), the insurance type is checked (steps 501 and 502).

If the insurance type is national insurance, company insurance, or retirement insurance (step 503), the self-pay ratio is 0%.
Is checked (step 504), and if it is 0%, a "patient burden is not applied" determination is made (step 505).
However, if it is not 0%, it is judged that "patient has a burden" (step 506).

Further, when the insurance type corresponds to public expense insurance (step 503), it is further checked whether it is a life insurance, old-age insurance, or other public expenses (step 507). If it is the insurance for the elderly, it is checked whether or not the partial contribution for the elderly has been collected this month, and if it has been collected, a judgment to that effect is made (steps 508 to 511).
If it corresponds to other public expenses (step 503),
Make a judgment of "other public expenses are available" (Step 51)
2).

On the other hand, when the insurance type corresponds to industrial accident or public accident insurance (step 503), it is determined that "patient is not burdened" (step 513).

Further, if it corresponds to own expense, it is judged that "patient has a burden" (step 514).

Next, the combination of insurances is examined according to Table 3, and it is judged whether or not the patient has a burden (step 51).
5-521).

[0066]

[Table 3]

Finally, based on the results of each of the above judgments, it is checked whether or not accounting processing is necessary (step 522). If there is only the judgment result that the patient has a burden, "accounting", only the judgment result that the patient has no burden In the case of, make a judgment of "no accounting",
If both the patient burden and the patient burden are mixed, it is left to the judgment of the staff at the counter (steps 523 to 525).

Therefore, for a patient without patient burden,
It is possible to improve the service because the waiting time for accounting is eliminated, and the waiting time for accounting is shortened even for a patient with a burden on the patient, so that the service can be improved.

Further, since the patient burden judgment is automated, human error in the judgment can be prevented.

The judgment result is printed on the basic accounting slip,
Since the judgment result can be easily referred to at the accounting counter, the counter operation can be simplified.

[0071]

As described above, according to the present invention, since the determination of the burden on the patient is automated, there is an effect that human error in the determination can be prevented.

Further, the judgment result is printed on the basic accounting slip,
Since the judgment result can be easily referred to at the accounting counter, there is an effect that the counter operation can be simplified, the response time with the patient can be shortened, and the service can be improved.

[Brief description of drawings]

FIG. 1 is a block diagram of a re-entry registration system to which the present invention is applied.

FIG. 2 is a diagram showing an example of a format of an accounting basic slip output from the revisit registration system.

FIG. 3 is an explanatory diagram showing an operation example of a re-entry registration system.

FIG. 4 is a diagram showing a structure of patient information and insurance information stored in a re-entry registration system.

FIG. 5 is a flowchart showing a procedure for determining whether or not a patient has a burden.

[Explanation of symbols]

100 ... Returning registration system, 101 ... Returning registration input device, 102 ... Output device, 103 ... Storage device, 104 ... Returning registration control unit, 105 ... Accounting input device, 106 ... Accounting control unit, 200 ... Accounting basic slip.

Claims (1)

[Claims] 1. The patient information registered in the storage device at the time of the first examination, the insurance information used by the patient, and the patient burden judgment table registered in advance in the storage device are read at the time of re-acceptance, and the A method of determining whether or not a medical expense is borne by a patient, which is determined by a process of collating read information.