WO2020119175A1 - Procédé de contrôle d'anomalies de frais médicaux, serveur de contrôle et support d'enregistrement - Google Patents

Procédé de contrôle d'anomalies de frais médicaux, serveur de contrôle et support d'enregistrement Download PDF

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Publication number
WO2020119175A1
WO2020119175A1 PCT/CN2019/102431 CN2019102431W WO2020119175A1 WO 2020119175 A1 WO2020119175 A1 WO 2020119175A1 CN 2019102431 W CN2019102431 W CN 2019102431W WO 2020119175 A1 WO2020119175 A1 WO 2020119175A1
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WIPO (PCT)
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medical
item code
price
unit
unit price
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PCT/CN2019/102431
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English (en)
Chinese (zh)
Inventor
陈明东
黄越
胥畅
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平安医疗健康管理股份有限公司
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Publication of WO2020119175A1 publication Critical patent/WO2020119175A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Definitions

  • This application relates to the technical field of medical behavior monitoring, in particular to a method for monitoring abnormal medical expenses, a monitoring server, and a computer-readable storage medium.
  • the main purpose of this application is to provide a method for monitoring abnormal medical expenses, a monitoring server, and a computer-readable storage medium, aiming to solve the work of analyzing and identifying the behavior of medical institutions exceeding the maximum price due to the huge medical data of various medical institutions The technical problem of large quantity and low accuracy.
  • the present application provides a method for monitoring abnormal medical expenses, including the steps of:
  • the preset maximum price limit table includes a plurality of standard item codes and respective corresponding restricted unit prices
  • an abnormal flag is set to associate with the medical institution identification
  • the text to be checked is generated according to the interpretation document paragraph corresponding to the semantic recognition text.
  • the present application also provides a monitoring server, including:
  • a receiving module the receiving module is used to receive medical data sent by a server of a medical institution, wherein the medical data includes an identification of the medical institution and an actual unit price corresponding to the medical item code;
  • a query module the query module is used to match the medical item code in the medical data with the standard item code of the preset maximum price list;
  • the query module is further configured to, if the medical item code matches the standard item code, confirm the limit unit price corresponding to the standard item code matching the medical item code according to the preset maximum price limit table;
  • a judgment module the judgment module is used to judge whether the actual unit price is greater than the restricted unit price
  • An identification module configured to set an abnormal flag to associate with the medical institution identification if the actual unit price is greater than the restricted unit price.
  • the present application also provides a monitoring server.
  • the monitoring server includes: a communication module, a memory, a processor, and a computer stored on the memory and capable of running on the processor. Read instructions, when the computer-readable instructions are executed by the processor, to implement the steps of the medical expense abnormality monitoring method as described above.
  • the present application also provides a computer-readable storage medium having computer-readable instructions stored on the computer-readable storage medium, the computer-readable instructions executed by the processor to achieve the above Steps of monitoring method for abnormal medical expenses.
  • the medical expense abnormality monitoring method, monitoring server and computer-readable storage medium proposed in this application enable the verification staff to quickly investigate the illegal charges of medical institutions, Maintain the interests of patients; by matching the medical project code with the standard project code of the preset maximum price list, so as to avoid the diversification of medical project names for medical projects, which leads to the failure of comparison with the preset maximum price list and improve the ratio Right rate.
  • FIG. 1 is a schematic structural diagram of a hardware operating environment involved in an embodiment of the present application
  • FIG. 2 is a schematic flowchart of a first embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 3 is a schematic flowchart of a second embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 4 is a schematic flowchart of a third embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 5 is a schematic flowchart of a fourth embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 6 is a schematic flowchart of a fifth embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 7 is a schematic flowchart of a sixth embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 8 is a schematic flowchart of a seventh embodiment of a method for monitoring abnormal medical expenses of an application
  • FIG. 9 is a schematic diagram of the functional modules of the monitoring server of the application.
  • FIG. 1 is a schematic diagram of a hardware structure of a monitoring server 100 in various embodiments of the present application.
  • the monitoring server 100 may be a server that is communicatively connected to a terminal for medical expenses reimbursement by an insured person or a medical institution. It can also be a monitoring service platform dedicated to data monitoring that is connected to the server and the terminal for medical expense reimbursement.
  • the monitoring server 100 provided by this application includes components such as a communication module 10, a memory 20, and a processor 30. Wherein, the processor 30 is respectively connected to the memory 20 and the communication module 10, and the memory 20 stores computer-readable instructions, and the computer-readable instructions are simultaneously executed by the processor 30.
  • the communication module 10 can be connected to external communication equipment through a network.
  • the communication module 10 can receive a request sent by an external communication device, and can also send broadcast events, instructions, and information to the external communication device.
  • the external communication device may be a server, a mobile phone, a computer, a charging terminal of a medical institution, a prescription terminal issued by a medical institution, or the like.
  • the memory 20 can be used to store software programs and various data.
  • the memory 20 may mainly include a storage program area and a storage data area, wherein the storage program area may store an operating system, at least one function required application program (such as a conversion rate calculation program), etc.; the storage data area may store data according to the monitoring server 100 The use of data or information created.
  • the memory 20 may include a high-speed random access memory, and may also include a non-volatile memory, such as at least one magnetic disk storage device, flash memory device, or other volatile solid-state storage device.
  • the processor 30 is a control center of the monitoring server 100, and uses various interfaces and lines to connect the various parts of the entire monitoring server 100, by running or executing software programs and/or modules stored in the memory 20, The data in the memory 20 executes various functions and processing data of the monitoring server 100, thereby performing overall monitoring on the monitoring server 100.
  • the processor 30 may include one or more processing units; preferably, the processor 30 may integrate an application processor and a modem processor, where the application processor mainly processes an operating system, a user interface, and application programs, etc.
  • the processor mainly handles wireless communication. It can be understood that the above-mentioned modem processor may not be integrated into the processor 30.
  • the above-mentioned monitoring server 100 may further include a circuit control module for connecting to a power source to ensure the normal operation of other components.
  • the monitoring server 100 may also include a display module for displaying system interfaces, medical data, pre-stored maximum price lists, etc., to facilitate real-time operation and control by workers.
  • the structure of the monitoring server 100 shown in FIG. 1 does not constitute a limitation on the monitoring server 100, and may include more or fewer components than the illustration, or a combination of certain components, or different Parts arrangement.
  • Step S100 Receive medical data sent by a server of a medical institution, where the medical data includes a medical institution identification, a medical item code, and an actual unit price corresponding to the medical item code;
  • the medical institution may be a hospital, nursing home, outpatient department, clinic, health center, and first-aid station that performs disease diagnosis and treatment.
  • the medical institution may also be a pharmacy that legally sells medicines.
  • the medical data is specifically the medical detailed list issued for the patients visiting the medical institution or purchasing medicine, including the medical institution identification of the medical institution, the name of the medical item consumed, the medical item code, the actual unit price corresponding to the medical item code, the actual Pricing unit, etc.
  • Medical items are items that medical institutions can charge separately for medicines, diagnosis and treatment, medical service facilities, etc. provided to patients.
  • Application software is installed on the server of the medical institution, so that the server of the medical institution sends medical data to the monitoring server regularly or in real time.
  • the monitoring server can directly obtain medical data reported by the application software from its own memory; when the monitoring server is a dedicated monitoring service platform, it can send a request to the medical institution server to obtain medical data, or the medical institution server actively sends medical data To the monitoring service platform.
  • the medical institution server regularly sends medical data, which can be sent at regular intervals, for example, every day, every hour, etc. It may also be that medical staff send relevant data in real time to the monitoring server after entering relevant data.
  • the staff will easily use the medical item name as the outpatient consultation fee when you enter it.
  • set the medical item code AAAA0002 to correspond to the outpatient consultation fee of the deputy chief physician
  • set the medical item code AAAA0003 to correspond to the outpatient consultation fee of the chief physician.
  • Step S200 Match the medical item code in the medical data with the standard item code of the preset maximum price limit table, where the preset maximum price limit table includes multiple standard item codes and the corresponding corresponding limit unit prices;
  • the preset maximum price list is formulated by the price management department where the medical institution is located, and contains the maximum price charged for each medical item to limit the medical institutions to charge for each medical item within a reasonable range to prevent Monopoly, price increases, etc.
  • the preset maximum price limit table includes standard medical item codes, unit price limits, and pre-designed price units.
  • Step S300 if the medical item code matches the standard item code, confirm the limit unit price corresponding to the standard item code matching the medical item code according to the preset maximum price limit table;
  • the medical item code matches a plurality of the standard item codes, a prompt message is generated and sent to the medical institution server. Since each standard item code is uniquely present, when multiple matches are found, it is proved that when the medical institution staff enter the medical data, the number of medical item codes entered is missing.
  • the restricted unit price is the highest price set by the price setting department where the medical institution is located, that is, the medical institution cannot charge beyond the restricted unit price when charging a medical item.
  • Step S400 Determine whether the actual unit price is greater than the restricted unit price
  • Step S500 If the actual unit price is greater than the restricted unit price, an abnormal flag is set to associate the medical institution identifier.
  • the abnormal sign can be embodied as a prominent color display of the medical institution sign when monitoring the display data of the service end, so that the supervisory staff can distinguish the inconsistency between the pre-designed price unit and the actual pricing unit Medical institutions.
  • the medical institution 001 charges a general outpatient consultation fee of 20 yuan for patient A, and sends the medical data with the medical item name as the general outpatient consultation fee, and the medical data with the medical item code AAAA0001 to the monitoring server.
  • step S500 it may further include:
  • the explanation document is the explanation statement submitted by the medical institution server based on the medical data. Since the format and statement method of the explanation statement cannot be limited, the actual special circumstances are numerous, so it is necessary to perform semantic analysis on the interpretation document to determine whether it is a statement for the price. .
  • word vector is the vectorization of the phrase
  • position vector is the vectorization of the position of the phrase in the interpretation document to facilitate subsequent model calculation.
  • the semantic generation model is a model that can be performed in advance by a person skilled in the art to perform semantic recognition.
  • the BERT model in this embodiment specifically includes:
  • the semantic recognition model can summarize the central ideas of each paragraph. After matching with the preset price keyword, it can be judged Whether each paragraph is an explanation of price.
  • the text to be checked is generated according to the interpretation document paragraph corresponding to the semantic recognition text.
  • the staff concerned with price monitoring can directly read the text to be checked to determine whether the medical institution charges illegally and avoid reading the explanatory text manually.
  • the verification staff can quickly check the illegal charging behavior of medical institutions and protect the interests of patients; through the matching of the medical item code with the standard item code of the preset maximum price list, it can avoid Various medical institutions specify diversification of medical project names, which leads to the failure of comparison with the preset maximum price list, and improves the accuracy of comparison; by generating semantic recognition, whether this text matches the preset price keyword can be identified in the explanatory text
  • the paragraphs on price interpretation are subject to further verification by the staff involved in price monitoring to improve work efficiency.
  • the preset maximum price limit table includes limit unit prices of different institution levels corresponding to the plurality of standard item codes, respectively; step S300 includes :
  • Step S310 if the medical item code matches the standard item code, query the institution level corresponding to the medical institution ID according to the pre-stored medical institution level database;
  • the pre-stored medical institution level database contains the medical institution identification and their corresponding institution levels.
  • the institution level is determined as three levels according to the "Hospital Classification Management Standards", and each level is further divided into A, B, and C, etc., and the third-level hospitals have additional special levels.
  • medical institutions may also be classified according to specific conditions.
  • step S320 the corresponding unit price limit is determined according to the preset maximum price limit table, the institution level and the medical item code.
  • the price department sets different maximum price limits for medical institutions of different institutional levels for some medical projects.
  • the medical institution 001 charges a general outpatient consultation fee of 15 yuan for patient A, and sends the name of the medical project as a general outpatient consultation fee, and the medical item code AAAA0001 is sent to the monitoring server.
  • the institution level corresponding to the medical institution ID 001 is level two; match the medical item code AAAA0001 with the standard item code of the preset maximum price list to obtain the standard item in the preset maximum price list
  • the matching of the code AAAA0001 confirms that the standard unit code AAAA0001, the corresponding unit price of the second level of the institution is 10 yuan, then the actual unit price of 15 yuan is greater than 10 yuan, and an abnormal mark is set to associate with the medical institution ID 001.
  • the preset maximum price limit table includes a predesigned price unit corresponding to the limit unit price, and the medical data includes the actual The actual pricing unit corresponding to the unit price; before the step S400, including:
  • Step S600 Determine a pre-design price unit corresponding to the limit unit price according to the preset maximum price limit table
  • Step S700 confirm the actual pricing unit corresponding to the medical item code, and determine whether the pre-designed pricing unit and the actual pricing unit are consistent;
  • Step S800 when the pre-designed price unit and the actual pricing unit are inconsistent, the abnormal mark is set to be associated with the medical institution identification;
  • step S400 is executed.
  • the medical item name in the maximum price standard table is cupping therapy
  • the medical item code is 044000000400
  • the limit unit price of the medical item is 10 yuan
  • the pre-design price unit is 3 cans. If the medical data sent by the medical institution 001 charges cupping therapy 10 yuan/can for patient A, and judges that the pre-designed price unit is "3 cans" and the actual priced unit is "can", the pre-designed price unit is not consistent with the actual priced unit.
  • the setting of the pre-designed price unit is specifically set according to dimensions such as daily habits, convenient statistics, and an indivisible minimum unit.
  • the pre-designed price unit of bed fees can be "day", “week” and “hour”. In daily habits, "day” is more commonly used for statistical convenience. If a malicious medical institution uses "week” as the statistical unit, it will inevitably lead to the actual unit price being greater than the preset unit price, which can be identified by the monitoring method provided in the first embodiment. If a malicious medical institution uses "hours" as a statistical unit, it violates daily habits and is easily recognized by patients. Therefore, the monitoring method provided in this embodiment may only be used to monitor the charges of some medical items.
  • the method further includes:
  • Step S110 Determine whether the medical item code matches the non-repeatable charge item code in the preset non-repeatable charge item table
  • the preset non-repeatable charge item table is preset by a person skilled in the art according to the attributes of each medical item, wherein the preset non-repeatable charge item table includes multiple medical items that cannot charge the same patient multiple times, for example: bed Fee, hemodialysis, rescue fee, etc.
  • Step S120 if the medical item code matches the non-repeatable item code, the quantity corresponding to the medical item code is obtained, and if the quantity is greater than 1, the abnormal flag is set to be associated with the medical institution identification .
  • the repeatable charging unit may be "time”, “day”, “group”, etc., and the non-repeatable unit is "person-time”. For example, for each patient's daily medical data, the bed fee can only be charged once. When the bed fee charge amount is greater than 1, the abnormal mark is set to be associated with the medical institution ID.
  • the medical data includes a patient identification, and after the step S100, further includes:
  • step S130 according to the medical item code corresponding to the same patient identification, a preset conflict list is searched for whether there is a conflict item corresponding to the medical item code, wherein the preset conflict list includes multiple sublists, Each of the sub-lists includes at least two conflicting items and corresponding medical item codes;
  • multiple sub-lists are set according to different medical conditions, and at least two conflict items are set in each sub-list. For example, because the same patient cannot incur the medical examination fee, registration fee, and examination fee at the same time, in the sub-list of general outpatient care, you can set up conflict items for the medical examination fee, registration fee, and examination fee, respectively.
  • Step S140 If the conflicting item and the medical item code exist in the preset conflicting charge list, determine whether the conflicting item corresponding to the medical item code is set in the same sublist;
  • Step S150 If two or more conflicting items corresponding to the medical item codes are set in the same sublist, an abnormal mark is set to associate the medical institution identification.
  • secondary cesarean section and laparoscopic pelvic adhesion separation are contradictory items.
  • Set secondary cesarean section and laparoscopic pelvic adhesion separation in the same sublist in the preset conflict charge list when the medical data At the same time, the medical item code of the second cesarean section and the medical item code of the laparoscopic pelvic adhesion separation operation are judged, then two conflicting items matching the medical item code are judged to exist in the same sublist, and an abnormal mark is set to associate with the medical institution.
  • step S200 in the sixth embodiment of the method for monitoring abnormal medical expenses of the present application, after the step S200, it includes:
  • step S900 if the medical item code does not match the standard item code, a prompt message is generated and sent to the medical institution server.
  • the medical cost abnormality monitoring method Before the medical cost abnormality monitoring method provided by this application runs, it is necessary to learn the local medical project coding rules, specifically, in this embodiment, the current "Basic Medical Insurance Drug Catalog” and “Diagnosis and Treatment Project Catalog” , "Medical Service Facility Standards” and other medical item names and medical item codes are entered and stored in advance. If the medical item code does not match the standard item code, it proves that the medical item indicated by the medical item code may be an independent item of the medical institution, which is not recorded in the maximum price list; or the medical data sent by the medical institution , Input error. Sending prompt information to the server of the medical institution to remind and urge the medical institution to modify or explain the unmatched medical item code in the sent medical data.
  • the medical data further includes a medical item name corresponding to the medical item code
  • the preset maximum price limit table further includes The standard project name corresponding to the standard project code
  • Step S910 Determine the medical item name corresponding to the medical item code that does not match according to the medical data
  • Step S920 Calculate the matching degree between the name of the medical item and the name of each standard item in the preset maximum price medical table through a preset rule;
  • the medical data can be medical detailed lists, medical records, etc., when medical staff input, the text content is more complicated.
  • using recurrent neural network (RNN) to analyze text content such as disease information, disease types, Medical project name, etc.
  • RNN recurrent neural network
  • the two-way RNN model is used to encode the vector into a sentence vector matrix, so that the fields related to the disease information in the medical data are matched to the corresponding disease information standardized fields.
  • the preset rule is: perform keyword extraction on the name of the medical item according to a preset first keyword group, where the preset first keyword group includes medicine charges, medical treatment item charges, and medical facilities Material charges;
  • the keyword of the medical item is extracted according to a preset second keyword group, wherein the preset second keyword group includes a basic organic substance name, a basic inorganic substance name, Name of detection method, etc.;
  • keyword extraction is performed on the name of the medical item according to a preset third keyword group, where the preset third keyword group includes the name of the medical method, etc.;
  • keyword extraction is performed on the medical item name according to a preset fourth keyword group, where the preset fourth keyword group includes origin information;
  • Step S930 comparing the matching degree of the medical item name with each of the standard item names and a preset threshold
  • Step S940 If there is at least one match between the standard item name and the medical item name that is greater than or equal to the preset threshold, then generate to-be-confirmed information and send it to the medical institution server, the to-be-confirmed information Contains the name of a standard project that matches the name of the medical project greater than a preset threshold;
  • the information to be confirmed including the name of the standard project is generated and sent to the server of the medical institution, so that the staff of the medical institution can modify the name of the original medical project or the original medical project logo to comply with the audit according to the prompt of the information to be confirmed The name or logo of the rule.
  • Step S950 If the matching degree of the standard item name and the medical item name is less than the preset threshold, generate information to be modified and send it to the medical institution server.
  • the information to be modified differs from the information to be confirmed in that the information to be modified does not contain the standard project name used to remind the staff of the medical institution. Since the standard project name that is similar to the medical project name is not matched, after receiving the information to be modified, the staff of the medical institution will modify the uploaded medical project name or medical project logo according to the local audit rules. If it is a medical institution independent project, it needs Make further explanations.
  • this application also provides a monitoring server, including:
  • a receiving module 10 the receiving module 10 is configured to receive medical data sent by a server of a medical institution, wherein the medical data includes a medical institution identification, a medical item code, and an actual unit price corresponding to the medical item code;
  • the query module 20 is used to match the medical item code in the medical data with the standard item code of the preset maximum price limit table, the preset maximum price limit table includes multiple standard item codes and Corresponding limit unit price;
  • the query module 20 is further configured to, if the medical item code matches the standard item code, confirm the limit unit price corresponding to the standard item code matching the medical item code according to the preset maximum price limit table;
  • a judgment module 30, the judgment module 30 is used to judge whether the actual unit price is greater than the restricted unit price
  • An identification module 40 the identification module 40 is configured to set an abnormal flag to associate the medical institution identifier if the actual unit price is greater than the restricted unit price;
  • An obtaining module is used to obtain an explanation document corresponding to the medical institution identification and the medical item code;
  • Word segmentation module the word segmentation module is used for word segmentation processing of the interpreted document to generate a phrase
  • a vector module the vector module is used to vectorize the phrase to generate a word vector corresponding to the phrase and a position vector corresponding to the position of the phrase in the interpretation document;
  • a recognition module the recognition module is used to input the word vector and the position vector into a semantic generation model to generate semantic recognition text corresponding to each paragraph of the interpretation document;
  • the judgment module is also used to judge whether the semantic recognition text matches a preset price keyword
  • a generating module wherein the generating module is configured to generate a text to be checked according to the paragraph of the interpreted document corresponding to the semantic recognition text if the semantic recognition text matches a preset price keyword.
  • the verification staff can quickly check the illegal charging behavior of medical institutions and protect the interests of patients; through the matching of the medical item code with the standard item code of the preset maximum price list, it can avoid Various medical institutions specify diversification of medical project names, which leads to the failure of comparison with the preset maximum price list, and improves the accuracy of comparison.
  • the preset maximum price limit table includes limit unit prices of different institutional levels corresponding to a plurality of the standard item codes, respectively; the query module 20 is further used for the medical item If the code matches the standard item code, the institution level corresponding to the medical institution ID is queried according to the pre-stored medical institution level database; and the corresponding institution level and the medical item are confirmed according to the preset maximum price limit table Restricted unit price corresponding to the standard item code matching the code.
  • the preset maximum price limit table includes a pre-designed price unit corresponding to the limit unit price
  • the medical data includes an actual price unit corresponding to the actual unit price
  • the query The module 20 is further used to determine the pre-designed price unit corresponding to the restricted unit price according to the preset maximum price limit table; to obtain the actual pricing unit corresponding to the medical item code;
  • the judgment module 30 is also used to judge the Whether the design price unit and the actual pricing unit are consistent;
  • the identification module 40 is also used to set the abnormal flag to associate the medical institution identifier when the pre-design price unit and the actual pricing unit are inconsistent;
  • the judging module 30 is also used to judge whether the actual unit price is greater than the restricted unit price when the pre-designed price unit and the actual pricing unit are consistent.
  • the judgment module 30 is further used to judge whether the medical item code matches the non-repeatable charge item code in the preset non-repeatable charge item table; the identification module 40 is also used to If the medical item code matches the non-repetitive charging item code, the quantity corresponding to the medical item code is obtained, and if the quantity is greater than 1, the abnormality flag is set to be associated with the medical institution identification.
  • the query module 20 is further configured to match the medical item code corresponding to the same patient identifier with the conflict item in the preset conflict charge list, wherein the preset conflict charge list Includes a plurality of sub-lists, and each of the sub-lists includes at least two of the conflicting items and corresponding medical item codes; the judgment module 30 is also used to if the conflict exists in the preset conflicting charge list If the item corresponds to the medical item code, it is judged whether the conflicting item corresponding to the medical item code is set in the same sub-list; the identification module 40 is also used if more than two items correspond to the medical item code Is set in the same sub-list, then the abnormal mark is set to associate with the medical institution identification. .
  • the monitoring server further includes an information generation module 50, the information generation module 50 is configured to generate prompt information if the medical item code does not match the standard item code, and Send to the medical institution server.
  • the query module 20 is further configured to determine the medical item name corresponding to the medical item code that does not match according to the medical data; the medical item name and all The matching degree of each standard item name in the preset maximum price medical table; the judgment module 30 is also used to compare the matching degree of the medical item name with each of the standard item names and a preset threshold; the information is generated
  • the module 50 is configured to generate to-be-confirmed information and send to the server of the medical institution if at least one match between the standard item name and the medical item name is greater than or equal to the preset threshold, and the to-be-confirmed
  • the information includes a standard item name that matches the medical item name greater than a preset threshold; the information generation 50 is used if the matching degree of the standard item name and the medical item name are both less than the preset threshold, Then, the information to be modified is generated and sent to the medical institution server.
  • the monitoring server 100 includes a communication module 10, a memory 20, and a processor 30, wherein the processor 30 is connected to the memory 20 and the communication module 10, respectively, and the memory
  • the computer readable instructions are stored on the 20, and when the computer readable instructions are executed by the processor 20, the steps of the medical expense abnormality monitoring method described above are realized.
  • the present application also proposes a computer-readable storage medium on which computer-readable instructions are stored.
  • the computer-readable storage medium may be a non-volatile readable storage medium.
  • the methods in the above embodiments can be implemented by means of software plus a necessary general hardware platform, and of course, can also be implemented by hardware, but in many cases the former is better Implementation.
  • the technical solution of the present application can be embodied in the form of a software product in essence or part that contributes to the existing technology, and the computer software product is stored in a storage medium (such as ROM/RAM as described above) , Magnetic disk, optical disk), including several instructions to make a terminal device (which can be a mobile phone, computer, server, air conditioner, or network equipment, etc.) to perform the method described in each embodiment of the present application.

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Abstract

La présente invention concerne un procédé de contrôle d'anomalies de frais médicaux, un serveur de contrôle et un support d'enregistrement. Le procédé comprend les étapes consistant à : recevoir des données médicales envoyées par un serveur d'institution médicale, les données médicales comprenant un identifiant d'institution médicale, un code d'article médical, et un prix unitaire réel correspondant au code d'article médical ; faire correspondre le code d'article médical avec un code d'élément standard d'une liste de limites de prix maximales prédéfinie, la liste de limites de prix maximales prédéfinie comprenant une pluralité de codes d'élément standard et de prix unitaires limites correspondant respectivement à ceux-ci ; si le code d'article médical correspond au code d'article standard, confirmer un prix unitaire limite correspondant au code d'article standard qui correspond au code d'article médical selon la liste de limites de prix maximales prédéfinie ; déterminer si le prix unitaire réel est supérieur au prix unitaire limite ; et si le prix unitaire réel est supérieur au prix unitaire limite, régler un indicateur d'anomalie associé à l'identifiant d'institution médicale. La présente invention peut, sur la base de réseaux neuronaux, faciliter l'identification rapide du comportement d'institutions médicales facturant des frais qui dépassent la limite de prix maximale.
PCT/CN2019/102431 2018-12-13 2019-08-26 Procédé de contrôle d'anomalies de frais médicaux, serveur de contrôle et support d'enregistrement WO2020119175A1 (fr)

Applications Claiming Priority (2)

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CN201811531181.5 2018-12-13
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