WO2001071584A1

WO2001071584A1 - Apparatus and method for issuing medical fee specifications

Info

Publication number: WO2001071584A1
Application number: PCT/JP2000/006636
Authority: WO
Inventors: Yoichi Takada; Chikayoshi Yuzawa; Yuuji Maniwa
Original assignee: Kabushiki Kaisha Toshiba
Priority date: 2000-03-21
Filing date: 2000-09-27
Publication date: 2001-09-27

Abstract

For example, a clinic B (13) transmits basic information including medical treatment data to a service center (11) and requests the center (11) to issue a receipt and make an examination (D1). The requested center (11) receives the basic information, makes and issues a receipt according to the received basic information, and applies for payment to examination payment institution (16) on the basis of the issued receipt (D2). The examination payment institution (16) examines the receipt for which payment is requested and sends the receipt to the medical insurance institution described in the receipt if the receipt is a proper one (D3).

Description

Specification

Apparatus and method for issuing medical fee statement

Technical field

The present invention relates to an apparatus and a method for issuing an electronic medical fee statement via a communication network at the request of a medical institution such as a clinic or a hospital.

Background art

The fee paid to medical institutions such as clinics and hospitals when patients receive treatment and medication is called medical fees. Medical payments can be broadly divided into two types: fee-based payment and fixed-rate payment. The fee-for-pay system is a system in which, for example, in Japan, points are displayed for each type of medical treatment of insurance medical treatment, the sum of the points is multiplied by a unit price to calculate the medical treatment fee, and the amount is paid by the insurer. Say. In other countries, there may be limits on the total amount of medical expenses paid, different unit prices, or a combination of flat-rate payments.

Medical institutions such as hospitals, which are relatively large, have introduced an order ring system and a medical accounting system to manage medical fees and billing. Recently, some hospitals have built more sophisticated hospital information systems, such as incorporating an electronic medical record system into these systems. In such hospitals, when a doctor performs medical treatment, information on medical treatment is input from each terminal of the electronic medical record system / ordering system. The entered medical information is stored in the information department database. The medical accountant in the accounting department searches for medical information and other necessary information stored in the database for each patient using the medical accounting system, and refers to the search results to obtain a medical remuneration statement. Create on paper. Then, the accounting department sends the medical reimbursement statement prepared for each patient to the insurance reviewing agency, for example, on a monthly basis, and requests a review and payment of the medical reimbursement. The accounting department will also charge the patient for an amount that is proportional to the patient's burden.

At the same time, there is a call for various medical institutions to streamline their management resources and promote efficiency, just like general companies in other industries. For example, a large medical institution must secure a large number of personnel involved in medical accounting, and personnel expenses and other expenses will have a significant effect on management. In small hospitals and clinics, securing specialized human resources for medical accounting can be difficult in some cases. At the end of the month and at the beginning of the month, when clerical work related to the preparation of medical remuneration statements is concentrated, a temporary increase in staff is required. Shortage of staff during busy periods can lead to delays in billing and omission of billing.

In addition, if a medical institution introduces its own equipment for preparing a medical fee statement, a small medical institution such as a clinic will have a relatively small number of patients, so the cost-effectiveness of capital investment will be high. I can't expect it. In addition, enormous effort and cost are required to change the system in the case where the procedure for calculating medical fees has been changed due to the revision of the law on healthcare.

In addition, the efficient issuance of medical fee reimbursement statements enhances the administrative processing capacity, and promptly responds to patients at accounting desks. It is also necessary to realize one service.

On the other hand, an insurance reviewing institution must manually process the paper medical remuneration statement sent from each medical institution, which is cumbersome, inefficient and time-consuming. In addition, unless there is a digitization of the matters described in the paper medical remuneration statement, there is no other means of automatically checking other than human scrutiny. For this reason, it took a huge amount of time to check for excessive medical treatment by checking with past information.

As described above, in the past, each medical institution such as a hospital or clinic installed a dedicated device, and the accounting department independently created and issued a paper medical remuneration statement, which was inefficient. There was a problem that it was not possible to issue a medical statement in a reasonable and prompt manner.

Disclosure of the invention

An object of the present invention is to provide an apparatus and a method for issuing a medical remuneration statement rationally and efficiently.

An apparatus for preparing a medical fee statement according to the present invention is a communication workstation for receiving at least medical information of a patient and medical data including identification information of the patient from a medical institution via a network. Yon, a first database storing medical data received by the communication workstation, a part of medical data read out from the first database, and based on the read medical data. A plurality of creating workstations for creating a medical remuneration statement for each of the patient identification information and the medical information; and a plurality of creating workstations respectively. And a management workstation for monitoring a status of preparing the medical fee statement, and displaying a list of the status for each patient identification information.

In addition, the method of issuing a medical fee statement according to the present invention is a method for connecting a plurality of facilities for storing and managing medical data including at least medical information of a patient and identification information of the patient via a network. A method for issuing a medical fee statement by a computer system, comprising: a medical data receiving step for receiving the medical data from the facility via the network; and a medical fee based on the received medical data. It consists of a medical fee statement preparation step for preparing or supporting the preparation of the statement.

Further, the method for issuing a medical fee statement according to the present invention is provided at each of a plurality of facilities having a database for storing and managing at least medical information of patients and medical data including identification information of the patients. A method for issuing a medical remuneration statement by a combi-user system connected to a terminal via a network, comprising: transmitting the medical data stored and managed in the database to the terminal of the facility. A step of prompting, a step of receiving the medical data and providing or supporting the preparation of the medical fee statement, and a step of validating the created medical fee statement with the validity of the medical fee statement. Transmitting to the reviewing agency through the network.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a diagram showing a relationship between a plurality of hospitals, a claim issuing agent, and an insurance reviewing agency in one embodiment of the present invention. Figure 2 shows the flow of the issuance and review of the receipt

Figure 3A shows the order information input screen

Figure ¾B shows the screen at the end of the consultation

Figure 3C shows the screen when sending medical data

Figure 3D shows the screen for receiving notification of medical data

Fig. 3E shows a screen for prompting retransmission of medical data. Fig. 4 is a block diagram showing the schematic configuration of a system for creating a receptor.

Fig. 5 is a block diagram showing the schematic configuration of a workstation for creating a reception.

Figure 6A shows the application reception

Fig. 6B shows the patient's reception '' 'Fig. 7 shows the reception processing information screen on the management workstation

Figure 8A shows the screen when submitting a claim application

Fig. 8B shows a screen for receiving a receipt request with a receipt number.

Fig. 8C shows the screen of the receipt notification of the receipt application without the reception number

Figure 9 shows a list of insurance points and payment amounts for each patient notified to medical institutions on a monthly basis.

Figure 10 shows a screen listing the status of examinations by the insurance reviewing organization.

Fig. 11 is a flow chart showing the flow of the examination by the insurance examination organization Figure 12 shows the monthly payment amount list screen for each medical institution at the service center.

FIG. 13 is a diagram for explaining another embodiment of the present invention. FIG. 14 is a flow chart showing a flow of creating a receptor in a medical accounting system of a medical institution.

Fig. 15A shows the screen when connecting from the medical accounting system to the database of the service center. Fig. 15B shows the screen at the end of the reception creation in the medical accounting system.

Fig. 15C shows the screen when logging the connection from the medical accounting system to the database of the service center. Fig. 16 shows the case where the medical accounting system takes in the database of the service center. Flow chart

Figure 17 shows the screen when the medical accounting system takes in the database of the service center

BEST MODE FOR CARRYING OUT THE INVENTION

Hereinafter, an embodiment of the present invention will be described.

Figure 1 is a conceptual diagram showing the relationship between clinics and hospitals, agents who issue medical reimbursement statements (hereinafter referred to as “rezept”), and insurance review organizations. Figure 2 is a diagram showing the general procedure for creating a receptor by the agent.

The receptor issuing agent 11 shown in Fig. 1 belongs to a service center (center of a business or hospital group), and its terminal 11a is connected via a network to, for example, the A clinic 12 , B clinic 13, C clinic 14, and D clinic 15 (12 a Etc.) and the terminal 16a of the insurance reviewing agency 16 and the terminal 12b of the patient. The Recipient Issuing Agent 11 receives electronic medical record information on patients and order information such as medicines necessary for diagnosis and treatment from the clinics 12, 13, 15 and the hospital 14, and Create a receipt on behalf of the applicant and submit an application to insurance review agency 16.

The electronic medical record information of a patient is the electronic version of the information written on the patient's paper medical record. In general, medical records include information for recognizing the patient, such as the patient's name, the insurance union in which the patient is enrolled, the number of the insured person's card, age, address, telephone number, etc. Consists of In some cases, the medical record and the inspection form (order) are separated from each other. In this case, the electronic medical record information does not include the order information. Information on all orders, such as diagnosis, injection, etc. Patient identification information is the patient's personal information, such as the insurance union that the patient has joined, the insured person's card number, age, address, and telephone number. The medical care information consists of order information, the patient's chief complaint, an objective diagnosis (a finding) from the doctor's point of view, and the next medical care plan.

For the payment of medical fees from the insurance reviewing institution 16 to the clinics 12, 13, 15 and the hospital 14, a contract for remittance to the designated account shall be concluded in advance. .

Here, referring to FIG. 2, for example, the Requests the preparation and issuance of the claim from the agency that issues the claim 11, and the agency that issues the claim applies for an assessment to the insurance review agency 16. The case will be described.

As shown in step S1, the physician in the clinic A 12 activates the terminal 12a in the clinic A 12 in FIG. 1 and displays order information on the treated patient on a predetermined screen (not shown). And input electronic medical record information (hereinafter collectively referred to as medical treatment data).

For order information, enter information such as patient injections, medications, and tests. For example, in the screen shown in Fig. 3A, the blood test is performed for the (test) item, the Xml of the drug is injected for the (injection) item, and the MRI test is performed for the (image) item. The item is entered. Based on this display, the physician checks whether there are any errors in the entry or whether there are any missing or deficient items. Once the input of the electronic medical record information and the order information is completed, the data is temporarily stored in a database (not shown). Further, a screen as shown in FIG. 3B is displayed on the terminal 12a. On this screen, the name of the patient who will end the consultation will be displayed, such as "Taro Toshiba will end consultation.", And "Do you want to exit patient care?" Is required? "Is displayed, and the user is prompted to enter an answer to this message.

When a settlement contract, such as a direct debit, has not been concluded between the patient and the medical institution, and between the patient and the agent issuing the receipt Requires payment on the same day. In this case, patients and hospitals will need to receive a claim on the same day. In this case, the physician checks with the patient whether or not a same-day reception is required, and then clicks the Yes button on the same-day / no-request selection screen on terminal 12a. If the doctor does not end the medical treatment, the doctor's click on the No button on the screen in Fig. 3B will display the electronic medical record and order input screen.

As shown in step S2 in Fig. 2, terminal 12a of the clinic A sends the medical treatment data consisting of the electronic medical record information and order information stored in the database to the reception issuing agent. Send to terminal 1 1 a of 1 1. The transmission timing is determined as appropriate, such as each time one patient is completed, at regular intervals, or once a day of medical treatment is completed. Of course, the request may be transmitted at any time when the medical data is generated.

At the terminal 12a of the clinic A, when the medical data is transmitted, a screen as shown in FIG. 3C is displayed. This screen prompts the operator (doctor) to confirm whether the medical data can be transmitted. When the doctor clicks the 0K button on this screen, the medical data is actually transmitted. ·

The transmitted medical data is stored in the database of the receptor issuing agent 11. In step S3, the terminal 11a of the receptor issuing agent 11 retrieves the medical data from the clinic A from the database in step S3 and receives it (step S3). It should be noted that the request issuing agent 11 can directly access the database of Clinic A to retrieve medical data. You can also.

If the A clinic 12 wants to confirm whether the sent medical data has reached the receptor issuing agent 11 reliably, a screen as shown in Fig. 3D is displayed in step S4. According to this screen, it is confirmed by the A clinic 12 that the reception issuing agent 11 has successfully received the medical data of the patient “Toshiba Toshiba”. In the unlikely event that the reception issuing agent 11 did not receive the medical care data normally, as shown in Figure 3E, for example, "Please resend the medical care data of Taro Toshiba." A screen for prompting retransmission is displayed on terminal 12a of clinic A12. When the Yes button is clicked on this screen, the medical care data is sent again to the receptor issuing agent 11.

The reception issuing agent 11 receives the medical data of each patient not only from the clinic A, but also from the terminals of the clinic B 13, the C hospital 14, and the D clinic 1.5. It is necessary to resolve the certification of each of these medical institutions before providing services. By performing authentication, it is possible to suppress an unauthorized application from being intentionally applied.

Then, as shown in step S5 in FIG. 2, the receptor issuing agent 11 creates a receptor based on the medical data sent from each clinic or hospital. Here, the claim issuing agent 11 confirms whether or not the prepared claim is an appropriate one or not. In addition, it checks whether or not each clinic has already created it, and whether or not it is true (Step S6). The generated claims are: A clinic, patients, and 送信 Sent to each insurance review organization (step S7). When the application for examination is made based on the transmission of the receipt, the claim issuing agent 11 confirms the receipt of the receipt by the insurance review agency 16 (step S8).

In the following, a system for creating a claim applied to the service center and services provided in the system will be described.

Fig. 4 is a block diagram showing the configuration of the system for creating a receipt applied to the service center. This system is composed of a local area network (LAN) 70 as a basic element. This network 70 is connected to an external network 80 for communication with medical institutions such as clinics and hospitals and insurance review organizations.

The network 70 includes a plurality of receptacle creation workstations (hereinafter referred to as WS) 20 a, 20 b, 20 c,..., And a management WS 30. The communication WS 40 and the databases 50 and 60 are connected.

First, the communication WS 40 receives a request for creating a receptor and basic information required for creating a receptor from a medical institution via the network 80. The basic information is the medical data described above, and at least information identifying the date and time of the medical treatment, the clinic, and the patient, and the specific contents of the medical treatment, i.e., the diagnosis, treatment, and medication. It consists of information. Note that the WS 40 for communication may receive a request created by a medical institution. Processing based on the received receipt will be described later. Communication W The basic information received by S40 is sent to the database 50 and stored therein (fl).

Here, the management WS 30 distributes the tasks based on the plurality of request creation requests received by the communication WS 40 to the plurality of receptor creation WSs 20. For example, the WS 20 b for creating a request, which is requested from the management WS 30, reads the corresponding basic information based on the tasks distributed from the database 50 (f 2), and reads the read basic information. Create a receptor based on the. Further, the WS 20 b for creating a receptor outputs the created receptor to the database 60 (f 3).

Similar to the WS 20b for creating a receptor, the WS 20a for creating a receptor, 20c… creates a receptor based on a request from the management WS 30 and stores the result in a database 60b. There are a plurality of WS20 for creating a receptacle, which are output to the client, and each of the WS20 for creating a receptacle is configured to create a receptacle based on a request from the management WS30. As a result, the processing related to the receipt creation can be appropriately distributed, and the throughput of the entire system can be improved.

By accessing the database 60, the management WS 30 displays the status of the creation of the receptor and creates a report (f4). At this time, the ability to create a receptor per human or WS is displayed. This information is extremely useful when creating vast numbers of receptors. Based on the progress of receptor creation, if necessary, add a new WS for receptor creation to the system to improve processing capacity or stop unnecessary WS In addition, it is easy to increase the occupancy rate by reducing it. It is also effective to send a report on the status of progress to a medical institution or an insurance review institution at regular or arbitrary times. The ability to judge the load status of the system based on the report, and enable the requester to adjust the request for creating a receipt.

FIG. 5 is a block diagram showing the configuration of the WS for creating a receptor. As shown in the figure, the WS for creating a receptor includes a communication interface 21, a basic information acquisition unit 22, a reception creation unit 23, a user interface 24, and a database (low power / )

2 and a processing unit 26. The communication interface 21 is connected to the network 70. The basic information acquisition unit 22 receives the request for creating a request distributed from the management WS 30, and obtains the basic information stored in the database 50 via the communication interface 21. U.S. management WS

It reads the basic information required to create the request requested from 30 and temporarily stores it in the local database 25. Further, the basic information acquisition unit 22 causes the receptor creation unit 23 to start creating a receptor based on the basic information.

A user interface 24 is connected to the receptor creation section 23. The user interface 24 is composed of an input unit 241 composed of a keyboard, a mouse and the like, and a display unit 242 composed of a display and the like. The database 25 temporarily stores the data of the receptor created by the receptor creator 23. The processing unit 26 is responsible for the created It performs various information processing such as data transmission processing and error data handling processing.

Figure 6A shows the format of a claim for application to insurance review agency 16. Figure 6B shows the format of the patient / hospital reception. The claim consists of the information required for examination and payment, such as the name of the hospital where the application was made, the name of the agency issuing the claim, the name of the patient and the number of the insured person's card.

Reception for an application to an insurance reviewing agency is important to understand how much you can claim a medical fee from the reviewing agency. Patient and hospital receptions are also important to understand which patients need to pay and how much medical care they need to pay. The contents of the claim consist of the contents of the medical treatment consisting of consultation, medication, injection, examination, and diagnostic imaging, and information such as the insurance score for each. In the case of an application for application to an insurance reviewing organization, the lower part is calculated by multiplying the total insurance points, the percentage paid by the paying organization (the fund of the insurer's union, etc.) and the total insurance points by the percentage. The payment amount to be obtained is displayed. In the case of a patient / hospital claim, the payer is the patient, and the payment amount according to the burden rate of the patient is displayed.

Such a receipt is created based on the basic information acquisition unit 22 by the calculation unit 23 for calculating the payment amount based on the number of insurance points. In addition, the receptor is created as record data registered in the database 25. The created record of the receptor is displayed on the display section 242 and is confirmed by the operator. When confirming this, the operator makes an error in the If you look at, record code of receptions bets correction of data rows that cormorants _t check is made through the input unit 2 4 1 is temporarily held in the database 2 5.

'The above process is repeated for all medical data contained in the basic information.

The processing unit 26 is a communication interface 21 and a network 70, which stores all records of the receptor created by the receptor creating unit 23 and stored in the database 25. Then, the data is transferred to the database 60 (f3 in FIG. 4).

In the database 60, the records of the receptor can be arbitrarily extracted and sorted (sorted) using at least the fields of the medical institution and the patient name as keys.

The management WS 30 shown in FIG. 4 accesses the database 60 and displays the processing information of the receptor as shown in FIG. In other words, a list of hospital names, patient names, insurance coverage, receipt preparation status, claim application status, and payment status is displayed for each case. Recepts that are required to be issued on the same day in advance are indicated with an identifier 100 so that they can be distinguished from other claims. ■

Such a list display may be performed not only in the management WS 30 but also in the WS 20 a, b, c,. In this case, for example, the operator inputs the first list item (Shibaura Hospital, Taro Toshiba) in the list of Fig. 4 in order to process the top ten items on the list display. When selected by Part 2 41, etc., the patient's medical data (electronic medical record information and order information) is displayed.

Application for claim examination>

When an application is made to the insurance reviewing agency 16 using the created application receipt, in a preferred embodiment, an electronic file in a predetermined format is created and the data of the receipt is written, and the relevant data is written. Send the electronic file to the insurance review agency 16 via the network 80 (online application). As another embodiment, there is a case where the data of the receipt is printed out on paper and transmitted to the insurance reviewing agency 16 (offline application). Also, as will be described later, if the service center acts only for the issuance of the claim and does not act for the application, it sends the created claim data to the requesting medical institution and ends the service.

At the time of the above-mentioned online application, as shown in FIG. 8A, a message such as “Send a request for application” is displayed on the display of the management WS 30. When the user clicks the OK button on this screen, an electronic file for applying for a claim is transmitted to the insurance review organization 16.

Upon receipt of the claim application from the claim issuing agent 11, the insurance review agency 16 sends a response notice to the claim issuing agent 11. Upon receipt of the response notification, the message issuance agent 11 displays a message, for example, as shown in FIG. 8B, indicating that "Taro Toshiba has received a request for a request." A receipt number is added to the reception response notification of this request. Have been. This receipt number is the reference number in the order of receipt of the claim application submitted to the insurance review agency 16. After the receipt number is assigned, the claim issuing agent 11 can make an inquiry about the claim application to the insurance review agency 16 based on the receipt number.

When responding to the status of a large number of applications over a relatively long period, such as one month, it is preferable that a receipt number be assigned.However, during a short period such as one day, the number of applications is small. The reception number may be omitted as shown in Figure 8C.

In addition, for the claims that need to be issued on the same day, the claim issuing agent 11 will process them with the highest priority. After that, the created request is sent to the requesting medical institution. When the medical institution receives the reception data, a message is displayed to confirm the receipt. If the patient is to receive the receipt at a later date, send it to the terminal 12b at the patient's home.

Information on such a claim application is sent to the medical institution in batches, for example, on a monthly basis from the claim issuer. For example, FIG. 9 shows an example of a screen display on a terminal of a medical institution such as a clinic or a hospital. This screen displays, for each patient who visited in a certain month (for example, January), a list of insurance points and payment amounts for that month.

Insurance screening agencies)

A claim application is sent to insurance reviewing agencies 16 from a number of claim issuers and a number of hospitals. Terminals at Insurance Review Agency 16 keep track of all received application statuses To be able to do so, a list of receptors as shown in Figure 10 is displayed.

In this list, the item of “Receipt that passed the screening” is displayed as “Completed”. Recipes that need to be reviewed again will be labeled “Needs investigation”. Unprocessed receipts will be marked as “unreviewed”. According to such a list, it is possible to easily grasp the review status of each of the claims.

At the time of the receipt review, if a desired item line is selected from among the item lines distinguished for each hospital name (and patient name) in the list, the reception for the selected hospital is selected. Data is displayed. Based on the displayed data of the claim, the reviewer of the insurance review agency 16 conducts the review.

Figure 11 is a flow chart showing the flow of the review performed by the insurance review agency. First, as shown in step S91, the terminal 16a of the insurance review agency 16 receives the reception. Next, in step S92, the received receipt is examined. As a result of this examination, if the receipt is appropriate (step S93 = Yes), a medical fee is remitted (remittance) (step S94).

On the other hand, as a result of the examination in step S92, if the receptor is judged to be inappropriate (step S93 = No), the examined receptor is returned to the claim issuing agent 11. The receipt issuing agent 11 conducts a re-examination of the returned claim (step S95). The claim, which has been reviewed by the claim issuer 11 and the deficiencies and inappropriate matters have been resolved, will be re-examined by the insurance review agency 16. In step S93, the receptionist is again checked whether or not the reception is appropriate. If the reception is appropriate, the medical fee is transferred. If it is not appropriate, the process returns to step S95, and the examination, the claim application by the claim agent 11 and the claim examination by the insurance reviewing agency are repeated.

Information on the claim that passed the examination will be notified to the claim issuer 11 and the medical institution concerned. In addition, when payment is completed several weeks after the receipt screening or on the specified date, the <Payment> item is displayed as “Complete” on the list display screen in Figure 10. Items for which payment has been completed may be deleted from the list.

The terminal 16a of the insurance reviewing agency 16 displays not only a list of the screening status as shown in Fig. 10 but also a list of monthly payments as shown in Fig. 12 for example. In this display, the hospital name, number of medical treatments, payment amount, account number, and payment status are listed. Therefore, the insurance review agency 16 can check at a glance how much the medical fee has been paid to each clinic or hospital, and can also pay the medical fee to each clinic or hospital. Upon payment, a confirmation will be displayed. In addition, when the receptor issuing agent 11 also performs the payment procedure, the same display is performed on the terminal 11 a of the receptor issuing agent 11.

The claim issuing agent 11 who applied for the claim will submit application data indicating which claim was applied, Of the applicants passed the review, and status data indicating which claims were reexamined, such as the receipt number issued by the insurance reviewing agency 16. The information is stored in the database 60 in association with the unique data of the database. This information is useful for efficient and rational processing of the receptor, similar to the information on the preparation status of the receptor described above. According to the above-described embodiment, the information is applied to the service center. The system for creating a reception receives medical data (basic information) of each patient from multiple medical institutions such as clinics and hospitals via a network, and creates a reception based on the data. Apply to an insurance reviewing agency. In this way, by providing a system for intensive receipt and application of medical treatment that goes beyond the distance between medical institutions, each medical institution has its own accounting department, etc. Receptacles will be issued more reasonably and efficiently than if humans create them manually. As a result, each medical institution can greatly reduce the burden on the accounting department and other organizations. In addition, each medical institution can avoid introducing expensive dedicated equipment and systems for issuing issuance of claims, etc., and can achieve significant cost reductions including labor costs. In addition, even if the procedure for calculating medical fees may change due to the revision of the insurance medical care system, only the service center needs to respond. One of the advantageous effects is that the receipt of documents will be digitized and issued promptly, which will greatly speed up accounting work and counter service operations.

Here, another embodiment of the present invention will be described. In the above embodiment, the system of the service center (recipient issuing agent 11) issues a receptor based on basic information such as medical care data transmitted from a medical institution via a network. And made an application. In another embodiment, the service center performs only part of the work in the flow from the issuance of the receipt to the application. In addition, the service center will provide a database that is useful for preparing the receipt.

FIG. 13 is a diagram for explaining another embodiment of the present invention.

First, in the above-described embodiment, for example, the clinic B 13 transmits basic information such as medical data to the service center (recipient issuing agent) 11 and requests the issuance and examination of the receptor (D 1), The center 11 receiving the request receives the basic information, and prepares and issues a receptor based on the received basic information. Then, the center 11 submits an application based on the issued claim to the examination and payment machine (insurance examination organization) 16 (D2). The screening payment institution 16 reviews the applied claim and, if the claim is appropriate, the insurance institution (fund for the union of insurers, etc.) described in the receipt, for example, A insurance union (D 3). The medical insurance fee stated in the receipt will be paid by Insurance Association A.

Next, in another embodiment, the service center 11 is solely responsible for creating the receptor. This means that, for example, the clinic A 12 sends basic information such as medical data to the service center 11 and requests the creation of a receptor based on the basic information (D 4), the service center 11 that has received the request prepares a receptor based on the basic information, and transmits the prepared receptor to the A clinic 12 (D5). A clinic A2, which received the request created by the service center 11, sends the same request directly to the examination and payment institution 16 without going through the service center 11, and applies for the examination. (D6).

Further, in another embodiment, a medical institution prepares a reception, and at that time, necessary information provision is received from the service center 11.

For example, C Hospital 14 creates a receipt in the hospital's medical accounting system. The prepared claim is sent directly to the screening payment institution 16 (D7). Here, if the receipt prepared at C Hospital 14 contains an error, etc., the examination and payment institution 16 returns this to C Hospital 14 (D8).

In such a case, C Hospital 14 sends the returned receptor to service center 11 (D 9). The service center 11 adjusts, corrects errors, etc., and provides useful add-on information to the hospital 14 received from the hospital 14 (D10). It goes without saying that such information service may be received before applying to the examination and payment agency 16.

Here, the creation of a receptor at a medical institution will be described with reference to FIGS. 14 to 17.

First, as shown in step S111, the medical care data is transmitted to the medical accounting system on the network inside the medical institution. You.

Next, the medical accounting system of the medical institution is set up in the service center 11 and prepares a receipt. The database 60 used for the application is accessed via an external network. (Step S 1 1 2). At this time, the message displayed in the medical accounting system is shown in Figure 15A.

Next, in step S113, relevant data for creating a receptor is received.

During the preparation of the reception in step S114, the database 60 of the service center 11 is always accessed via the network to exchange data. Copy and import the data required to create the receptor in real time.

Figure 15B shows the confirmation screen when the reception creation is completed. When the Yes button is clicked on this screen, the connection between the medical accounting system and the database 60 for preparing a receipt provided in the service center 11 is disconnected. The message shown in Figure 15C is displayed, and the medical accounting system ends.

In step S115, an application is made by sending the prepared receipt to the institution / payment agency 16.

Fig. 13 shows a case where the medical accounting system takes in the database 60 from the service center 11 and creates a receipt. If the internal database of the medical accounting system has not been updated for a certain period of time, a message as shown in Fig. 17 is displayed and the service center 11-cara database 60 is retrieved. To get the latest information.

According to the other embodiment described above, it is possible to receive effective support from the service center 11 for creating a receipt. Therefore, errors included in the prepared claim can be reduced, and sufficient screening can be performed by the screening and payment organization.

The above-described embodiment is merely an example, and the present invention is not limited to the above-described embodiment and can be implemented with various modifications. For example, a medical accounting system may be incorporated in a service center acting on behalf of issuing and applying for a claim, and the present invention may be implemented as a system acting on behalf of a medical accounting business. Industrial applicability

INDUSTRIAL APPLICABILITY The present invention is useful in a system technology field that uses a computer and a network to streamline and improve the efficiency of medical accounting operations in insurance medical treatment.

Claims

The scope of the claims

1. a communication workstation for receiving at least a patient's medical information and medical data including the patient's identification information from a medical institution via a network;

A first database for storing medical data received by the communication workstation;

A plurality of preparation stations for reading a part of the medical data from the first database, and for generating a medical remuneration statement for each of the patient identification information and the medical information based on the read medical data,

A management work station comprising: a management work station that monitors a creation status of the medical fee statement in each of the plurality of creation workstations and displays a list of the created status for each patient identification information. Statement creation device.

2. It further comprises a second database for storing data of the medical fee statement created by the plurality of creating workstations,

The communication workstation reads out the data of the medical remuneration statement from the second database and sends the data to an examination organization that examines the validity of the medical reimbursement statement. The apparatus according to claim 1, wherein the transmission is performed via a device.

3. Issue a medical remuneration statement through a computer system that is connected via a network to a plurality of facilities that store and manage medical data, including at least the patient's medical information and the patient's identification information. A way to A medical data receiving step for receiving the medical data from the facility via the network;

A method for issuing a medical remuneration statement, comprising: a medical remuneration statement creation step for creating or supporting the creation of a medical remuneration statement from the received medical data.

4. The facility has a database for storing and managing medical data including at least the medical information of the patient and the identification information of the patient, and in the medical data receiving step, the medical data is obtained from the database. The method for issuing a medical fee statement according to claim 3 to be received.

5. The medical remuneration according to claim 3, including an application step for applying the created medical reimbursement statement to an examination agency that examines the validity of the medical reimbursement statement via the network. How the statement is issued.

6. The method of issuing a medical fee statement according to claim 3, wherein the data on the medical fee statement is transmitted to the facility and the patient who performed the medical treatment via the network.

7. Receiving notification from the reviewing institution that the applied medical reimbursement statement does not meet the prescribed criteria, and again preparing a medical reimbursement statement by the medical reimbursement statement preparing step 6. The medical remuneration statement issuance method according to claim 5, wherein the medical remuneration statement application step applies to the examination institution via a network.

8. In the medical treatment data receiving step, a request to receive medical treatment data for each medical treatment for which a medical fee statement needs to be prepared. How to issue the medical fee statement described in item 3.

9. The method of issuing a medical fee statement according to claim 3, wherein in the medical data receiving step, the medical fee data relating to the medical treatment for which the medical fee statement has been required is received at regular intervals.

10. In the medical fee statement preparation step, whether at least the medical fee statement including the medical data received in the past has been completed or the application has been completed. 6. The method for issuing a medical fee statement according to claim 5, wherein one of the medical fees is displayed in a list for each medical care.

11 1. A network that is connected via a network to terminals provided at a plurality of facilities each having a database that stores and manages at least patient medical information and medical data including this patient's identification information. A method for issuing a medical fee statement by a computer system, comprising:

Prompting the terminal of the facility to transmit the medical care data stored and managed in the database;

Receiving the medical treatment data and performing or assisting in the preparation of the medical remuneration statement;

A step of transmitting the created medical fee statement to an examination organization that examines the validity of the medical fee statement via the network.

12. The method for issuing a medical remuneration statement according to claim 11, further comprising a step of prompting the terminal of the facility to input a request when distributing the medical remuneration statement.

1 3. The received medical data are examined in the order of distribution The method for issuing a medical remuneration statement according to claim 12, which is displayed in a list by treatment.

14. At least a database that stores and manages medical information including the patient's medical information and the patient's identification information is used to generate a medical fee statement by a computer system connected to multiple facilities via a network. Issuance method,

Reading the medical data by accessing the database;

Reading the medical care data and performing or supporting the preparation of the medical remuneration statement;

A step of transmitting the created medical fee statement to a reviewing organization that examines the validity of the medical fee statement via the network.

15. The method for issuing a medical statement according to claim 14, wherein the database is accessed at a predetermined time interval, and the medical database updated from the previous access is read.

16. The method for issuing a medical remuneration statement according to claim 14, wherein a request for reading updated medical data from the database is received upon receiving a data update notification from the database.