JPH09282360A - Managing method for insurance information in computer for medical expense calculation work - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an insurance information managing method which improves the efficiency of medical expense calculation work relating to the insurance information and reduces miscalculation accompanying the calculation processing by holding application periods of insurance for every patient and insurance kind. SOLUTION: The computer for medical expense calculation work has a magnetic storage device 5, in which there are a patient headstone file 8 containing the insurance information for every patient and a patient clinical consultation file 9 containing medical treatments for the patients together with date and time data. When there is alteration of the insurance information, the patient headstone file 8 has two pieces of insurance information before and after the alteration period. To issue a medical return detailed statement, data and time data on each treatment are read out, it is judged whether the data and time are before and after the alteration, and one adequate insurance information between two pieces is selected and used.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a method for managing insurance information in a medical office computer. The present invention is applied to, for example, a medical office computer that performs medical insurance claim work.

[0002]

2. Description of the Related Art Conventionally, medical office computers have been used in various medical institutions to support or automate the preparation of medical treatment remuneration bills and medical bills for patients. The medical treatment remuneration statement is a statement of the cost of the medical treatment performed by a medical institution for a patient, the medical institution billing a payment fund such as social insurance for the burden.

[0003] Normally, a medical fee statement is issued at the end of the month by aggregating the amount for that month. The medical office computer stores the medical treatment performed on the patient and the insurance information of the patient for each patient. As for medical treatment, medical treatment such as medication, injection, and examination is held in a file by a code representing the medical treatment such as internal medicine and surgery. On the other hand, insurance information includes the name, gender, date of birth, insurer number that identifies the patient, and the insurance type such as social insurance, national health insurance, old-age insurance, work accident insurance, etc. applicable to the patient. / It is composed by family, patient's copayment rate, etc. In this specification, a file that records medical care activities for each patient is called a "patient medical care file", and a file that records patient-specific information and insurance information for each patient is called a "patient initial file". The medical office computer calculates the amount of medical treatment fee billed from these two files and issues the medical treatment fee statement.

Japanese Examined Patent Publication (Kokoku) No. 3-70276 discloses a window accounting machine which improves the workability of calculating the medical bill for a patient. This accounting machine takes into account the fact that there are two types of copayment calculation methods for patients, a fixed rate calculation method and an irregular fixed amount calculation method, and has separate calculation tables for copayment payments based on these two methods. . The fixed-rate calculation method is a method that is applied to each insurance, and for example, the “self-payment ratio of medical expenses is 10%”. On the other hand, the irregular flat-rate method is a method that is applied only to the person who is responsible for social insurance.
If it is ~ 1500 yen, the person pays 100 yen, 1501-25
If it is 00 yen, it will be 200 yen ... ”. The accounting machine selects one from these tables according to the key operation of the operator and automatically calculates the medical expenses.

[0005]

According to this accounting machine,
The operator does not have to calculate the patient's copayment cost each time. However, this accounting machine does not have the concept of the insurance application period, and therefore does not have the concept of performing automatic calculation based on this.

[0006] The term "application period of insurance" refers to a period in which each application content is valid even if the same insurance has different application contents. For example, a certain social insurance policy may have changed from a burden rate of 10% to March 1996 to a burden rate of 20% after April 1996. In such a case, for example, when the operator inputs the medical care contents in April and calculates the medical expenses, the item “personal burden ratio” in the patient initials file is set to “10%” for the medical care action that occurred in March. For the incidents that occurred in April, "20%" had to be rewritten for each medical treatment. Particularly, at the beginning of the month when the amount of work is large, it is very inconvenient to repeat this work for each patient, which lowers the efficiency of the whole work and causes work mistakes.

[Object of the present invention] The present invention has been made in view of this problem, and an object of the present invention is to hold an application period of insurance for each patient and for each insurance type, so that office work related to insurance information can be performed. It is to provide an insurance information management method that improves processing efficiency and reduces calculation errors associated with clerical processing.

[0008]

[Means for Solving the Problems]

(1) The present invention is a method for managing insurance information in a medical office computer, which performs predetermined medical-related office processing based on patient insurance information. In this method, when the application content of insurance is changed depending on the period, the insurance information regarding the insurance is divided for each application period, and the information is held together.

According to this aspect, even when the content of insurance application changes, it is held for each application period. For this reason, for example, even when the medical care action occurs over a plurality of application periods, it is not necessary to rewrite the insurance application content each time according to the time when the medical treatment action occurs.

(2) In another aspect of the insurance information management method according to the present invention, for the insurance whose application content is changed depending on the period, it is currently applied at any timing after the input of the content of the change and the time of the change. Appending end-of-life period information to the new insurance information, adding new start-up information to the insurance information that is currently being applied, and reflecting the changes made to another new insurance information. And hold these two new insurance information side-by-side.

[0011] Examples of "change" include a change in the personal burden rate and a change in the public expense rate (the rate of medical expenses borne by the country for specific diseases etc.). Since such a change occurs for each patient, when it is known that the change will be made, for example, the operator inputs the change into the medical office computer. At any timing after this input, this computer first adds the end-of-application information to the insurance information currently applied (hereinafter referred to as "basic insurance information") to generate new insurance information. For example, 96
If the content of application is changed from April, 2016, the end of application will be "9.
The end of March 2006 ”.

Subsequently, this computer, for example, copies the basic insurance information, adds the application start date information to this, and reflects the change contents to generate another new insurance information. In the case of the above example, the application start date is the beginning of April 1996.
The changes are reflected by, for example, updating the personal burden rate from 10% to 20%.

In this way, two new insurance information items are generated from the basic insurance information, the insurance information having the application end period and the insurance information having the application start period. These are held in a coexisting state.

(3) In another aspect of the insurance information management method according to the present invention, when the change content and the change time of the insurance whose application content is changed according to the period are input, the change content and the change time are indicated. It is stored in a storage area related to the basic insurance information, and a change flag is set in the storage area. Thereafter, the flag is referenced at any timing. When the flag is set, the end-of-application information is added to the basic insurance information. To generate new insurance information, add application start date information to the basic insurance information, and generate another new insurance information by reflecting the change contents, and these two new insurance information coexist. Hold these in a ready state.

In this mode, it is premised that the contents of change and the time of change are first input as in (2). Subsequently, the storage area in which the contents of the change and the change time are related to the basic insurance information is stored, and the change flag is set in the storage area. The “storage area related to basic insurance information” may be a storage area in which the basic insurance information is stored (a storage area for a patient initials file described later as an example) or a storage area in which the basic insurance information is stored. It may be a storage area (for example, a storage area of an insurance information table, which will be described later) in which information that manages is stored in some sense.

The medical office computer refers to the flag at an arbitrary timing, and when the flag is set, adds the end-of-application information to the basic insurance information to generate new insurance information. Further, the application start date information is added to the basic insurance information, and the new contents of the change are reflected to generate another new insurance information. These two new insurance information items are retained in a coexisting state.

(4) In one aspect of the present invention, a table is provided for storing the change content and the change time of the insurance whose application content has been changed. Then, by referring to this table, the end-of-application information is added to the currently applied insurance information as new insurance information, the start-of-application information is added to the currently applied insurance information, and Is reflected as another new insurance information, and the new insurance information is held for each patient.

(5) In case of (4) In one aspect of the present invention, the table is further provided with a change flag. Then, the change processing for the insurance information is performed after confirming whether or not there is a change regarding the application content with reference to the change flag.

In the cases of (6), (4) and (5), according to an aspect of the present invention, when the patient first comes to the hospital every month, the insurance information is changed with reference to the table.

(7) Another aspect of the insurance information management method according to the present invention is to use the insurance information held by the aspects (1) to (6). That is, when insurance information should be taken into consideration in relation to medical treatment performed on a patient, if there are multiple insurance information according to the applicable period,
Insurance information that should be taken into consideration is specified based on the time of occurrence of the medical treatment.

For example, in the case of issuing a statement of medical fees to the social insurance payment fund or issuing a medical contribution bill to a patient every certain period of time, the medical treatment provided to the patient is You must take into account insurance information in connection. When the application content of this insurance is changed for each application period, a plurality of insurance information is stored in the modes (1) to (3). Therefore, in this aspect, the insurance information to be taken into consideration is specified based on the time of occurrence of the medical care action. As a result, for example, an operator can freely calculate and prepare a medical treatment remuneration statement without inputting insurance information one by one according to the time when medical treatment occurs.

[0022]

BEST MODE FOR CARRYING OUT THE INVENTION A preferred embodiment of the present invention will be described with reference to the drawings.

[Configuration] FIG. 1 is an overall configuration diagram of a medical office computer that realizes the insurance information management method of this embodiment. As shown in the figure, this computer includes a processing unit 1 including a CPU for controlling the entire computer, a display unit 2 including a display for displaying to an operator and its control unit, and a keyboard for receiving a key input to the processing unit 1. 3 and
The processing unit 1 includes a printer device 4 for printing a medical treatment fee statement and the like, and a magnetic storage device 5 for storing various files. The magnetic storage device 5 holds a master file 6, an insurance information table 7, a patient initials file 8, and a patient medical care file 9.

The master file 5 stores data relating to overall medical treatment activities such as medical treatment remuneration points and medical treatment-specific names. The insurance information table 7 is a table for managing the insurance information of various medical insurance such as national health insurance and social insurance. In the present embodiment, it is assumed that the change content and the change time of the insurance information are also written in the insurance information table 7. The patient initials file 8 holds patient-specific information such as patient name, sex, date of birth, insurer number, insurance type, person / family, self-payment rate, and other related information for each patient. On the other hand, the patient medical care file 9
The contents of medical treatment and the time when it was performed are recorded for each patient.

FIG. 2 is a diagram showing a file structure of a patient among the patient initial files 8. From the insurance information block shown in FIG. 8A, the insurer number of this patient is “06
It can be seen that the insurance applied to medical treatment is “10092”, “social insurance”, and since this patient is the patient himself, the burden rate is “10%” and the related information is “abc”. This is the basic insurance information, and the concept of the applicable period is not included in the figure. In this example, the insurance information describes social insurance, but one patient may use two or more insurances. In that case, the insurance information is written in the patient initial file of the patient for each insurance. A block is formed.

FIG. 3 is a diagram showing the structure of the insurance information table 7. In the figure, the insurer numbers of various insurances are first used as headings, then the insured person's burden rate corresponding to the insurer number,
The family burden rate is described. When a new patient comes to the hospital, this table is referenced by the operator inputting the insurer number of the insurance used by the patient into the medical office computer, and the burden rate is introduced according to the distinction between the person and the family. Then, a patient initial file for the patient is newly generated. This table is associated with each patient initial file 8 by insurer number.

A feature of the present embodiment is that when a change occurs in insurance information, a new column is provided for entering a start period indicating the start time when the change becomes effective and an end period indicating the end of the effective period. This is because a change flag indicated by "change" has been newly established so that the presence / absence can be easily searched. The change flag is 0 in the initial state, and when it is 1, that is, when the flag is set, the existence of the change is indicated.
The change flag may be directly rewritten by the operator,
When the operator attempts to register by entering "starting period" or "ending period", 1 may be automatically set in the medical office computer.

On the other hand, FIG. 4 is a diagram showing an example of the structure of a patient medical care file 9 for a patient having the patient initials file shown in FIG. Here, March 10, 1996 and April 5,
On each day, it is shown that revisit and dose of oral medication were calculated respectively. On the right side of the content of the medical treatment, the medical treatment remuneration score for the medical treatment is described.

[Operation] First, when there is a change in the insurance information, the procedure for registering the change in the insurance information table will be described. Then, using the patient initials file 8, an automatic calculation method of medical treatment remuneration statements for a plurality of medical treatment actions over a plurality of application periods will be described.

(1) Update of insurance information table FIG. 5 shows a procedure in which when the insurance information of a certain insurance is changed, the operator inputs it into the medical office computer and first updates the insurance information table 7. It is a flowchart. Since the insurance information changes individually and irregularly for each insurance, this input work is appropriately performed. As shown in the figure, first, the insurance information table of FIG. 3 is loaded into the computer (S10). Next, the insurer number of the insurance for which the change occurs is input (S12). Then, the computer searches the table by this number and displays a screen including the insurance information on the display unit 2.

Subsequently, the operator rewrites the insurance information (S14). Here, for example, the insurer number "061
Assume that the insurance burden rate of "00192" is changed from 10% to 20%. FIG. 6 is a diagram showing a display state when the change content is input. Here, the end of "March 1996" is input for the insurance information before the change, and the start of "April 96" is input for the insurance information after the change. After this input, the change flag is changed to 1 (S16). After confirming the changed contents, the operator saves the insurance information table 7 (S18) and finishes the updating work. As a result, in the insurance information table 7 shown in FIG. 3, the records after the insurer number “05900010” are rolled down one by one, and the record with the insurer number “06100192” becomes two records as shown in FIG. Split,
It will be registered.

(2) Introduction of new insurance information into the patient initials file FIG. 7 is a diagram showing a procedure of introducing new insurance information into the patient initials file according to the above change. Although the input work of FIG. 5 was appropriately performed by the operator, the work of FIG.
Executed when an operator calls the patient's data when the patient first visits the month. Therefore, this process will not be performed on the second and subsequent visits, and
For patients who did not visit the current month, this process will not be performed until the next visit. That is, when the month changes, this process is first performed to check whether the insurance information is changed.

At the start of processing as shown in the figure, the computer first waits for the patient to visit the hospital (S20). When a patient comes to the hospital, the operator calls the data of the patient (S22), and it is determined whether or not it is the first visit of the month (S24). Here, if it is found that the visit is the second or later visit (N in S24), the process for the patient ends. On the other hand, if it is the first visit (Y in S24), the insurer number “0610” of the insurance used by the patient.
Based on "0192", the insurance information table 7 is searched (S26). Subsequently, it is determined whether the change flag for this insurance is 1, that is, whether the insurance information of this insurance has been changed (S28). If the change flag is not 1 (N of S28), there is no change in the insurance information, and the process for the patient ends. On the other hand, if the change flag is 1 (Y of S28), the insurance information block included in the patient initials file 8 (see FIG. 2) of the patient is once copied (S30), and the basic insurance information as the copy source is set. On the other hand, write the end of the applicable period (S3
Along with 2), the start of the applicable period is written in the insurance information of the copy destination (S34). Similarly, the contents of the change concerning the burden rate are read and reflected in the copy of the patient initials file 8 (S36), and the insurance information change process for this patient is completed. Each step of S32, 34, and 36 is automatically performed by the computer reading the change contents relating to the timing data and the burden rate from the relevant portion of the insurance information table 7.

When the series of processing shown in FIG. 7 is completed for a certain patient by the above steps, this computer shifts to an arbitrary subsequent processing program in order to perform another processing for this patient. When the subsequent processing is also completed, the process returns to the first step in FIG. 7 and waits for the next patient's visit.

FIG. 8 is a diagram showing a state where two insurance information blocks are generated for the patient initials file shown in FIG. 2 by the above-mentioned processing. As shown in the figure, here, two pieces of insurance information 8b and 8c are held in a coexisting state before and after the change. Here, in the above insurance information 8b, “application period” is provided in the uppermost column with respect to the basic insurance information that originally existed, and the application end period is given here. On the other hand, with respect to the insurance information 8c generated by copying from the basic insurance information, the application end period is similarly given and the personal burden rate is changed to 20%.

(3) Calculation of patient contribution Since it is necessary to request the patient contribution according to the burden rate to the patient who received the medical treatment, usually, the medical care contents are input to the computer immediately after the medical treatment, and the patient is charged. Calculate the amount to be charged to.

FIG. 9 is a diagram showing the procedure. When the patient is specified by the operator, the computer loads the patient initials file 8 of the patient (S40). Subsequently, since the operator inputs the date when the medical examination was performed, usually the date of the day when the input work is being performed (S42), the computer compares the date with the applicable period read from the patient initial file 8 (S44). , And a suitable burden rate is set (S46). After that, the points are read from the master file 6 according to the medical care contents input by the operator, and the patient burden rate is calculated by multiplying the set burden rate (S48).

Therefore, in the case of the patient of the patient initial file 8 shown in FIG.
20% will be charged for medical treatments received after April 1996, after being charged a 10% contribution.

(4) Automatic Calculation of Medical Care Fee Statement FIG. 10 is a flowchart showing a procedure for automatically calculating a medical treatment fee statement for a plurality of medical treatment actions over a plurality of application periods. This calculation itself is carried out collectively at the beginning of the following month for the medical treatment for one month in the previous month.
It should be noted that it is carried out separately from (2).

First, the medical office computer loads the patient medical care file 9 of the patient for whom the statement is to be prepared (S50),
The patient initials file 8 of the patient is loaded (S5
2). Subsequently, the medical fee points are automatically calculated in consideration of the application period of the insurance information (S54). When the patient medical care file 9 is as shown in FIG. 4 and the patient initial file 8 is as shown in FIG.
That is, the burden rate of the social insurance payment fund is 90%, the burden rate of medical treatment that occurred on April 5 is 20%, and the burden rate of the social insurance payment fund is 80%, so it is calculated from the patient medical care file shown in FIG. The March medical fee statement
It becomes (60 + 30) × 0.9. Similarly, from the figure, the score for April is calculated as (60 + 20) × 0.8.

The same processing is performed for the medical treatment act for the billing period of one month, and the medical treatment statement is finally created and printed (S56). This completes the process for that patient.

The above is the insurance information management method according to the present embodiment. In addition, regarding the present embodiment, the following improvements,
Deformation etc. are possible.

1. Here, the example in which the principal burden rate is changed has been described, but this may be any other change of insurance information. For example, if the patient is an insurer number “061001
In the case of a family member of “92”, the present embodiment can be applied even if the family burden rate is changed.

2. When a patient uses a plurality of insurances, standard insurance information exists for each insurance. At this time, since a plurality of insurance information is already stored in the state of FIG. 2,
Be careful. The present embodiment can be applied to such a case. That is, it is only necessary to create new insurance information as shown in FIG. 8 only for the insurance that is changed out of the plurality of insurances. The operator may input which insurance is used for medical treatment.

3. In the present embodiment, the automatic calculation of the medical treatment remuneration statement has been described, but this may be any processing as long as the processing uses insurance information. For example, the present embodiment can be applied to a case where patients are classified according to a burden rate.

4. In the present embodiment, a column of applicable period is newly provided only for the insurance information that has changed (that is, the transition from FIG. 2 to FIG. 8). However, you may have this field beforehand in the state of the initial basic insurance information.

5. If there is a burden from public expenses other than normal insurance, information on this public expense should be included in the basic insurance information in advance.
The present embodiment can be applied by holding the information in the insurance information table 7.

6 In the present embodiment, the burden rate has been described as an example, but this may naturally be the burden amount.

[0049]

According to the method of managing insurance information in the medical office computer of the present invention, the insurance information is held in parallel for each application period, so that, for example, medical care actions may occur over a plurality of application periods. Even in such a case, it is not necessary to rewrite the insurance application content each time according to the time when the medical treatment is performed. As a result, it is possible to improve office work efficiency and reduce processing mistakes.

Further, with respect to the insurance whose application contents are changed, the above effect can be obtained even when the insurance information before and after the change is generated at any timing after the input of the change contents and the change time. At this time, the generation of new insurance information itself can be performed, for example, during a time period when the computer for medical office is not used by the operator, so that the utilization efficiency of the computer is improved.

When the contents of change and the time of the change are stored in the storage area related to the basic insurance information and a change flag is set in the storage area, it is possible to scan only this flag to confirm the presence or absence of the change, so that the processing efficiency is improved. Be improved. Since the flag can be referred to at any timing, the efficiency of use of the medical office computer can be improved as described above.

When insurance information should be taken into consideration in relation to medical practice, when insurance information to be taken into consideration is specified on the basis of the time of occurrence of medical care, for example, the insurance information is input according to the time of occurrence of medical care. It is not necessary and can be convenient for users of the computer for medical office.

[Brief description of drawings]

FIG. 1 is an overall configuration diagram of a medical office computer that realizes an insurance information management method of the present embodiment.

FIG. 2 is a diagram showing a configuration of a file of a patient among patient initial files.

FIG. 3 is a diagram showing a configuration of an insurance information table.

FIG. 4 is a diagram showing a configuration example of a patient medical care file of a patient having the patient initial file shown in FIG. 2.

[Fig. 5] When the insurance information of a certain insurance changes,
It is a flowchart which shows the procedure which an operator inputs this into a medical office computer and updates an insurance information table first.

FIG. 6 is a diagram showing a display state of the medical office computer when the content of change is input.

FIG. 7 is a diagram showing a procedure for introducing new insurance information into a patient initials file according to an input change.

8 is a diagram showing a state in which two insurance information blocks are generated for the patient initial file shown in FIG. 2. FIG.

FIG. 9 is a diagram showing a procedure for calculating the amount of a patient's burden according to the burden rate when the patient receives medical treatment.

FIG. 10 is a flowchart showing a procedure for automatically calculating a medical treatment remuneration statement for a plurality of medical treatment actions over a plurality of application periods.

[Explanation of symbols]

1 processing unit, 2 display unit, 3 keyboard, 4 printer device, 5 magnetic storage device, 6 master file, 7
Insurance information table, 8 patient initial files, 9 patient medical care files.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Hirofumi Yoshitsuru 2-5-5 Keihan Hondori, Moriguchi City, Osaka Prefecture Sanyo Electric Co., Ltd.

Claims (7)

[Claims] 1. A medical office computer that performs predetermined medical-related clerical processing based on patient insurance information, and if the content of insurance is changed depending on the period, the insurance information related to that insurance is applied for each period of application. A method of managing insurance information in a medical office computer, characterized by holding them in a coexisting state. 2. A medical office computer that performs predetermined medical-related business processing based on patient insurance information, for insurance whose application contents are changed depending on the period, any information after the input of the changed contents and the time of change At the timing, new end insurance information is added to the current end insurance information to generate new insurance information, and start start information is added to the current end insurance information, and the changes are reflected. A method for managing insurance information in a medical office computer, characterized in that another new insurance information is generated and held in a state where these two new insurance information coexist. 3. A medical office computer that performs predetermined medical-related administrative processing based on patient insurance information, when the content of the change and the time of change are entered for the insurance whose content is changed depending on the period. The contents of the change and the time of the change are stored in a storage area related to the insurance information currently applied, and a change flag is set in the storage area.Then, this flag is referred to at any timing thereafter, and when this flag is set, Appending end-of-application information to the insurance information being applied to generate new insurance information, adding start-of-application information to the insurance information currently being applied, and adding another new information reflecting the above-mentioned changes. A method for managing insurance information in a medical office computer, characterized by generating insurance information and holding these two pieces of new insurance information in a coexisting state. 4. The method according to any one of claims 1 to 3, wherein a table is provided for storing the change content and the change time of the insurance for which the application content has been changed, and the table is referred to. By adding the end-of-application information to the insurance information currently applied as new insurance information, the start-of-application information is added to the insurance information currently applied, and the changes are reflected to create another new insurance information. A method for managing insurance information in a medical office computer, which is characterized by holding new insurance information for each patient as insurance information. 5. The change flag is further provided in the table, and the change processing for the insurance information is performed after confirming whether or not there is a change regarding the application content by referring to the change flag. The method of managing insurance information in the medical office computer described in 4. 6. The method according to claim 4, wherein the process of changing the insurance information by referring to the table is performed every month when the patient first visits the hospital. How to manage insurance information on a medical office computer. 7. The method according to any one of claims 1 to 6, wherein when insurance information should be taken into consideration in relation to medical treatment performed for a patient, there are a plurality of insurance information according to an application period. In this case, a method for managing insurance information in a medical office computer is characterized in that insurance information to be taken into consideration is specified based on the time of occurrence of the medical treatment.