JP3229849B2 - Warning method and warning device for high medical expenses - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a business processing apparatus for calculating the medical treatment cost of a patient in a medical institution, and more particularly to the same apparatus for retrieving a patient corresponding to a large medical expenses.

[0002]

2. Description of the Related Art When a patient receives medical treatment at a medical institution, the medical treatment cost is calculated according to the contents of the medical treatment, the examination received, and the prescribed medicine. The patient pays a part of the medical treatment cost to the accounting counter of the medical institution in accordance with a predetermined burden according to the type of insurance to be applied, the person, and the family. This is called a self-pay or patient-pay. On the other hand, medical institutions
Claim the remaining medical expenses, excluding the patient's copayment, to the insurance agency. At that time, issue a medical fee reimbursement statement called a claim that describes the individual treatments, tests, prescribed medicines, and their medical points given to the patient, and submit it to the insurance organization to claim the insurance money . Once a month, the medical institution issues a receipt describing the details of the patient's medical treatment and the number of medical treatments for the previous month for each patient, and submits it to the insurance institution.

[0003] Many medical institutions have introduced business processing devices for calculating such copayments, issuing invoices and issuing receipts, for example, to speed up window operations and prevent erroneous calculation of medical treatment costs. Useful for patient services.

[0004] By the way, medical treatment costs are increasing due to the use of the latest medical equipment and the use of expensive new drugs.
The patient's out-of-pocket expenses are proportionally higher. Therefore, if the amount of self-pay exceeds a certain limit specified by a Cabinet Order,
There is a system in which the excess amount is paid as a large medical expenses from health insurance.

[0005] Specifically, when a patient goes to the same medical institution and the co-payment paid for a month exceeds 63600 yen, the system is reimbursed by claiming the surplus to an insurance institution. is there. Or, if they are in the same household,
If you receive medical treatment at two or more medical institutions with the same insurance and you pay more than 30,000 yen per case, the total amount of the corresponding co-payment exceeds 63,600 yen, a large amount of medical treatment It is paid as an expense.

[0006]

In a medical institution, medical care data of a patient is sequentially input and stored in an installed office processing device, and a self-pay is calculated and charged to the patient. In the following month, a receipt that summarizes the medical data for one month is output.
Therefore, for a specific patient, it can be determined whether or not the copayment paid by the patient in one month exceeds the predetermined amount. But for some patients,
It was not possible to determine whether or not the sum of the copayments of the examinees (often a family) outside the same household as the patient exceeds a predetermined amount by using a conventional paperwork apparatus.

[0007]

According to the present invention, a patient's unique information including at least a telephone number and a total of one month's copayment paid by the patient are stored for each patient, A second patient having the same telephone number as the first patient's telephone number for the first patient who paid a co-payment of K or more.
Searching for a patient, determining whether the co-payment of the second patient searched for is equal to or greater than the predetermined amount K, and determining if the co-payment is equal to or greater than K in the first patient. Summing the co-payment of the patient and the co-payment of the second patient, and determining whether or not the co-payment added in the step exceeds a predetermined amount M (where M> K) The above-mentioned problem is solved by providing a step of performing the above and a step of displaying that the subject is subject to a large medical expenses when it is determined that the number exceeds M in the determination.

[0008]

FIG. 2 is a block diagram showing the configuration of this embodiment. Reference numeral 10 denotes a memory as storage means,
Inside, together with unique information such as the patient's name, patient data 11 that stores medical data that is the basis of self-payment and medical fee calculation, and personal data that temporarily stores unique information for one patient excluding medical data A memory A12 and a personal data memory B13, a contribution memory 14 for storing the total amount of the copayments, and a large medical expenses M (636 in the embodiment) specified by a Cabinet Order.
00 memory) and a K memory 16 for storing a predetermined amount K (in the embodiment, 30,000 yen) per case involving two or more medical institutions, also specified by a Cabinet Order. And a P memory 17 for storing a predetermined amount of money P, and a corresponding person memory 18 for storing a patient corresponding to a large amount of medical expenses. Note that M, K, and P can be set to arbitrary values. In particular, P is used to select patients who do not correspond to high medical expenses but have paid close co-payments. is there. In the embodiment, P is set to an amount not less than K and not more than M.

FIG. 3 shows an example of the patient data 11. At the top is a unique patient number 31, followed by the patient's unique information of name 32, age 33, gender 34, address 35, telephone number 36, and insurer number 37. In the second half, medical data 39 indicating the medical treatment received by the patient is stored with the date, and the monthly co-payment 38 calculated based on the data and calculated as a total of one month of the co-payment paid by the patient.
Is stored. Then, data from the patient number 31 to the monthly contribution 38 excluding the last medical data 39 is copied to the personal data memories A12 and B13.

Returning to FIG. 2, reference numeral 21 denotes a patient search means for searching for and extracting a patient meeting a specific condition from the patient data 11;
22 is a telephone number comparing means for comparing the telephone numbers stored in the personal data memory A12 and the personal data memory B13 and outputting a result of the match / mismatch, and 23 is stored in the personal data memory A12 and the personal data memory B13. The insurer number comparing means 24 for comparing the insurer numbers which are present and outputting the result of coincidence / mismatch, 24 is a monthly contribution 38 stored in the personal data memory A12 or B13,
A charge comparing means for comparing the contents with the contents of the M memory 15 or the K memory 16 or the P memory 17 to judge the size; an adding means 25 for summing the charges and storing the sum in the charge memory 14 in the memory 10; 26 is control means for controlling the entire operation, and 27 is C
Display means such as an RT are connected to each other by a bus 30.

Next, the operation of the embodiment will be described with reference to FIG. First, the control means 26 instructs the patient search means 21 to search for patients whose total co-payments during the month are equal to or greater than K (step S101). When the relevant person is searched, the unique information of the patient is stored in the personal data memory A12 from the patient data 11.
Copy to Then, the burden comparing means 24 determines whether or not the self-pay of the patient (referred to as patient A) is M or more (S102). If it is not less than M, since this patient A alone already corresponds to the large medical expenses, the patient A is stored in the corresponding person memory 18 and displayed on the display means 27 as the target patient of the large medical expenses (S111). .

On the other hand, if the co-payment of the individual A does not exceed M (S102; No), the co-payment 38 is copied to the co-payment memory 14, and then the patient's household becomes expensive. Move on to the examination to determine if the medical expenses are appropriate.

Then, the patient having the same telephone number 36 as the patient A is searched by the patient search means 21 (S103). Patients with the same telephone number are more likely to belong to the same household among their families. The patient search means 21 is a telephone number comparison means 22
Is used to check whether the telephone numbers 36 of the patients match or not, and the unique information of the matched patients is copied from the patient data 11 to the personal data memory B13 (this is referred to as patient B). Then, the insurer number comparing means 23 compares whether the insurer number 37 of the patient A and the patient B is the same (S102). If it is not the same, the process returns to step S103 to search for another family member. I do. Only when the monthly contribution 38 is equal to or greater than K (S106; Yes), the addition means 25 adds the monthly contribution 38 of the patient B to the monthly contribution 38 of the patient A. That is, the monthly contribution 38 of the patient B is added to the contents of the contribution memory 14 and stored. Then, the process returns to step S103.

Thus, having the same telephone number 36 as patient A,
In addition, the patient with the same insurer number 37 is searched one after another, and the copayment is added. And patient data 11
(S104; Yes), the contribution comparing means 24 determines whether the total of the co-payments stored in the contribution memory 14 exceeds M (S10).
8). If it exceeds M, the patient A is stored in the corresponding person memory 1
8 and is displayed on the display means 27 as a patient for whom high medical expenses are to be paid (S111). That is, it indicates that the patient A or the household of the patient A is subject to high medical expenses.

On the other hand, if the content of the contribution memory 14 does not exceed M, it is determined whether the content of the contribution memory 14 does not exceed P (S109). This is the M
This is done to identify households or patients who have not exceeded but are already paying close co-payments. If it is determined that the value exceeds P, the control means 26 displays a warning on the display means 27 that the co-payment has reached a considerable amount (S110). As a result, households or patients who are likely to exceed M by adding the copayment of the family members living outside the home who were not searched this time or the copayments paid by the outside medical institution are notified to that effect. Be alerted.

Although P and K have different values in the embodiment, P may have the same value as K and may be substituted by K. In other words, if one of the patients has paid the co-payment of K or more, the determination in step S109 necessarily results in step S110.
Therefore, the patient or his / her household can always be warned that the co-payment has reached a considerable amount. in this way,
Even patients and households that are not covered by high medical expenses can be used for patient services such as alerting them. In addition, since the value of P can be set arbitrarily, the classification level of the warning target can be flexibly changed.

[0017]

According to the present invention, it is possible to determine whether or not one month of self-pay corresponds to a large amount of medical expenses for one patient and the household of the patient. It becomes possible to notify the patient that he / she is eligible for high medical expenses. In addition, even if it does not correspond to high medical expenses, it is possible to extract patients or their households who paid a considerable amount of co-payment, so that they can be alerted to that fact and improve services for patients. Very useful.

[Brief description of the drawings]

FIG. 1 is a flowchart illustrating an operation procedure of an embodiment.

FIG. 2 is a block diagram illustrating a configuration of an embodiment.

FIG. 3 is a diagram showing an example of patient data in the embodiment.

[Explanation of symbols]

11 Patient data 12, 13 Personal data memory 14 Contribution memory 15 M memory
16 K memory 17 P memory 21 Patient search means 22 Telephone number comparison means 2
3 Insurer number comparing means 24 Contribution comparing means 25 Adding means

──────────────────────────────────────────────────続 き Continued on the front page (58) Field surveyed (Int.Cl. ⁷ , DB name) G06F 17/60 126

Claims (6)

(57) [Claims] 1. A patient's unique information including at least a telephone number and a total of one month's co-payment paid by the patient are stored for each patient, and a co-payment of a predetermined amount K or more is paid. Searching for a second patient having the same telephone number as the telephone number of the first patient, and determining whether the co-payment of the searched second patient is equal to or greater than the predetermined amount K. And, when it is determined that the value is equal to or larger than K in the determination,
Summing the co-payment of the first patient and the co-payment of the second patient; and determining whether or not the co-payment added in the step exceeds a predetermined amount M (where M> K) And a step of displaying that the subject is subject to a large reimbursement fee when it is determined that the number exceeds M in the determination. 2. An apparatus in which at least a predetermined amount K or more of co-payment is paid in a device storing for each patient at least patient-specific information including a telephone number and a total of one month's co-payment paid by the patient. Searching for a first patient, searching for a second patient having the same telephone number as the first patient, and searching for a second patient having the same telephone number as the first patient. A step c for determining whether or not the amount is equal to or more than K; and a step d for summing the co-payment of the first patient and the co-payment of the second patient when it is determined that the amount is K or more. And step e for repeating steps b to d for the remaining patients; and step f for determining whether or not the co-payments summed in said step exceed a predetermined amount M (where M> K). , The method of warning high medical costs, characterized in that when it is determined that more than M, having the steps g displaying indicating that a high-cost medical care subject Te. 3. A device which stores at least a predetermined amount K of co-payment in a device storing at least each patient's unique information including at least a telephone number and a total of one month's co-payment paid by the patient for each patient. Searching for a first patient, searching for a second patient having the same telephone number as the first patient, and searching for a second patient having the same telephone number as the first patient. A step c for determining whether or not the amount is equal to or more than K; and a step d for summing the co-payment of the first patient and the co-payment of the second patient when it is determined that the amount is K or more. And step e for repeating steps b to d for the remaining patients; and step f for determining whether or not the co-payments summed in said step exceed a predetermined amount M (where M> K). , Step f In step g, when it is determined that the amount exceeds M, it is indicated that the subject is subject to high medical expenses, and when it is determined in step f that it does not exceed M, the total co-payment is equal to a predetermined amount. A step h for determining whether or not P (however, M> P ≧ K) or more, and a step i for displaying that it is close to a large medical expenses when it is determined to be P or more in step h. A method for warning of high medical expenses. 4. An apparatus for storing, for each patient, patient-specific information including at least a telephone number and one month's total of the copayment paid by the patient, wherein the copayment is a predetermined amount K or more. First search means for searching for a first patient who has paid for, second search means for searching for a second patient having the same telephone number as the telephone number of the searched first patient, and second searched for First determining means for determining whether or not the patient's co-payment is equal to or greater than the predetermined amount K;
In response to the determination, the adding means for adding the co-payment of the first patient and the co-payment of the second patient, and adding the co-payment to the predetermined amount M ( However,
M> K), a second determining means for determining whether or not the value exceeds
In response to the determination unit determining that M has been exceeded, the first display unit for displaying that the subject is subject to high medical expenses, and the second determination unit determining that M has not been exceeded. Accordingly, a third determination is made as to whether or not the sum of the co-payments is equal to or greater than a predetermined amount P (where M> P ≧ K).
And a second means for displaying that it is close to a large medical expenses in response to the determination being made by the determination means to be P or more.
A warning device for large medical expenses comprising: 5. The first search means includes the second search means, the first comparison means includes the second and third comparison means, and the first search means includes the second and third comparison means. 1
The display unit be those which comprise the second display means, further claims, characterized in that a control means for controlling the display means and comparing means to these retrieval means 4
Warning device for large medical expenses described in . 6. The K and M are 30,000 yen and 6 respectively.
Is 3600 yen serial to any one of claims 1 to 3
The warning method for the high reimbursement expenses mentioned above.