JP3773207B2 - Receipt mutual assistance support device and receipt examination support system - Google Patents

Description

TECHNICAL FIELD The present invention relates to a receipt office assistance assistant and a receipt examination support system used for assistance in receipt office assistance and receipt examination sent from a medical institution or insurance pharmacy.

  The insured person of the health insurance can receive a partial contribution until he / she is cured at a medical institution such as a hospital or clinic, such as medical examination, treatment, medicine supply / hospitalization. In addition, even if you receive a doctor's prescription, you can have the insurance pharmacy dispense the drug by paying a partial contribution.

  A medical institution or insurance pharmacy is required to request a health insurance insurer to pay a contribution to be paid by the insurer (hereinafter referred to as an insurer contribution).

  Here, a request for payment of an insurer contribution to a health insurance insurer by a medical institution or insurance pharmacy is made via a bill called a receipt (hereinafter referred to as a receipt). The receipt describes in detail matters relating to the contents of the medical practice and the dispensing such as the number of treatments for the insured person and the type and number of the medications, and it is necessary to pay in accordance with the description.

  By the way, the payment of the insurer contribution through the receipt is made in response to a unilateral request from the medical institution or insurance pharmacy to the health insurance insurer, and there is no monitoring institution In some cases, it is possible to acquire the insurer contribution by an unfair claim including a mistake or by an illegal act. Therefore, it is necessary to eliminate such unfair charges or fraudulent acts, and a mechanism for confirming the authenticity of the receipt has been established.

  Here, such an unfair claim is, for example, a case where there is no description regarding medical practice (medicine, injection, etc.), or the medical practice and the receipt score do not match. This is a case of requesting payment of insurer contribution for non-medical practice.

  That is, between medical institutions and insurance pharmacies and health insurance insurers, the Social Insurance Medical Fee Payment Fund, the National Health Insurance Association Federation, etc. ( (Hereinafter referred to as examination and payment institution).

Therefore, the receipts created by medical institutions and insurance pharmacies are collected by the examination and payment institution, and those that are suspected by the co-administrator are first excluded, followed by sufficient technical and technical knowledge. It is attached to a detailed examination by a doctor who has (hereinafter referred to as a person in charge of examination). As a result, only receipts whose authenticity has been confirmed are sent to each insurer of the health insurance, but others are returned to medical institutions and insurance pharmacies.
JP 2001-344337 A JP 2002-41649 A JP 2002-109069 A

  However, in this kind of administrative assistance by administrative assistants, the assistant assistant inspects from all angles and stops the method of extracting a clearly suspicious receipt. The receipts that can not be said depend largely on the ability and skill level of the administrative assistant, so it is not only impossible to secure efficient administrative assistance, but it is also unscientific and it is difficult to detect mistakes in the first place. There is a situation.

  In addition, in such an examination by the examiner, although there is an entity that the degree of inaccuracy and the degree to be focused on correspondingly vary depending on each receipt, similar human resources are obtained. The reality is that we are turning around, and there are cases where there is insufficient extraction of the suspicious receipts by the assistant co-worker, and it is not possible to obtain a sufficient effect of reducing the burden of examination processing.

  Conventionally, there are Patent Document 1, Patent Document 2, and Patent Document 3 as systems and methods related to such receipts and insurance procedures.

  Here, Patent Document 1 is a settlement system in which when an insurer receives a receipt, the claim for the receipt is settled or returned to a medical institution. Further, Patent Document 2 stores insurance card data for each insured in a database of a medical information storage management company that stores medical information, and this is used to check the insurance card at the time of reception and to charge the insurer. This is done through a company to reduce the burden on insurance medical institutions. Furthermore, Patent Document 3 confirms whether or not an insured person has a qualification with a qualification certification organization, and attempts to prevent a loss of medical expenses for the insurer.

  All of these are trying to solve the problems of ensuring efficient office work and reducing processing burdens at health insurance insurers and insured persons, medical institutions and insurance pharmacies. It is not intended to solve the problems of securing secure office work and reducing the processing burden.

Therefore, the problem of the present invention is that it is possible to easily find an error for each receipt so that the effect of improving the efficiency of the office assistant work and the effect of reducing the examination processing burden can be sufficiently obtained. It is an object of the present invention to provide a reception assistant support device and a receipt examination support system that can appropriately allocate human resources in accordance with the level of accuracy and the level to be focused.

That is, the present invention is configured to include the first invention and the second invention. The first invention relates to a reception assistant support device, and the second invention relates to a receipt examination support system . The third invention described later relates to a method for supporting receipt of paperwork, and the fourth invention relates to a method for supporting examination of a receipt.

The receipt office assistance support apparatus according to the first invention described in the claims includes an input unit for performing examination of receipt information included in a receipt for which payment of an insurer contribution to be borne by the insurer has been requested, and a display This is intended for administrative assistants including departments.

  This includes an item-specific inaccuracy information storage unit, an automatic input execution unit, an image character conversion unit, a receipt information display execution unit, a reception focus degree information display execution unit, and a correct examination information input execution unit. ing.

  Here, the item-specific inaccuracy information storage unit is the item-specific inaccuracy indicating the degree of inaccuracy of the receipt information for each item with respect to the item specifying information for specifying the medical treatment pattern, medical institution, and other items. Information is stored in association with each other. The automatic input execution unit is an input unit that automatically inputs receipt information that is image information included in the claimed receipt, including item identification information and insurer contribution information regarding the insurer contribution. Perform the function to be performed. The image character conversion unit performs a function of converting the receipt information that is input image information into the receipt information that is character information. The receipt information display execution unit performs a function of executing display of the converted reception information through the display unit. The receipt emphasis degree information display execution unit calculates and calculates the receipt emphasis degree information indicating the degree to which the administrative assistance for the receipt requested based on the item-specific inaccuracy information storage unit should be focused. The function of executing the display of the received information on the degree of focus through the display unit together with the display of the receipt information. The correct examination information input executing unit has a function of executing input of correct check information for performing an appropriate check of the requested claim through the input unit.

  According to such a receipt co-help assistance device according to the first invention, such item-specific inaccuracy information storage unit, automatic input execution unit, image character conversion unit, receipt information display execution unit, receipt focus degree information display Since it is configured to include an execution unit and a correct examination information input execution unit, it is possible to easily find mistakes for each receipt, and to cope with the level of inaccuracy and the level of focus that each receptor has. Thus, it is possible to accurately allocate human resources.

  Therefore, according to this, it is possible to sufficiently obtain the effect of improving the efficiency of the assistant office work and the effect of reducing the examination processing burden.

  In such a receptionist co-assistance support apparatus according to the first invention, the item-specific inaccuracy information is obtained statistically from item-specific inaccuracy information such as medical treatment patterns, medical institutions, and other items. Yes, from the standpoint that receiving focus level information becomes appropriate by setting it to the latest information one after another and discovery of mistakes in highly important receipts becomes high, the item-specific inaccuracy information update execution unit It is preferable to contain.

  Here, the item-specific inaccuracy information update execution unit is obtained through a new statistical examination of the item-specific inaccuracy information storage unit stored in the item-specific inaccuracy information storage unit. The update to the item-specific inaccuracy information is performed through the input unit.

In addition, the receipt examination support system according to the second invention described in the claims includes an input unit that examines receipt information included in a receipt for which an insurer is required to pay an insurer contribution, and including the display portion, which is also of the.

This is a receipt examination support system having a configuration corresponding to the system of FIG. 1 described later .

According to such a receipt review support system according to the second invention, such item-specific inaccuracy information storage unit, automatic input execution unit, image character conversion unit, receipt information display execution unit, receipt focus degree information display execution And the correct examination information display execution unit, it is easy to find mistakes about each receipt, and it corresponds to the degree of inaccuracy and the degree of focus that each receipt has. It is possible to accurately allocate human resources.

  Therefore, according to this, it is possible to sufficiently obtain the effect of improving the efficiency of the assistant office work and the effect of reducing the examination processing burden.

In such a receipt examination support system according to the second invention, the item-specific inaccuracy information is obtained statistically from item-specific inaccuracy information such as medical treatment patterns, medical institutions, and other items. From the viewpoint that the receipt emphasis information becomes appropriate by sequentially setting the latest information, and the discovery of mistakes in high-importance receipts becomes high, the item-specific inaccuracy information update execution unit is It is preferable to include.

  Here, the item-specific inaccuracy information update execution unit is obtained through a new statistical examination of the item-specific inaccuracy information storage unit stored in the item-specific inaccuracy information storage unit. The update to the item-specific inaccuracy information is performed through the input unit.

  On the other hand, the receipt office co-help support method according to the third invention includes an item-specific inaccuracy information storage unit, an automatic input execution unit, an image character conversion unit, a receipt information display execution unit, a receipt focus degree information display execution unit, and accurate examination information. Co-assistant receipt of the receipt information included in the receipt for which the insurer is required to pay the insurer's contribution, which is performed using a reception co-help support device including an input execution unit, an input unit, and a display unit. This is a method for the office assistant assistant in charge.

  This is configured as a method including the following steps.

  That is, the item-specific inaccuracy information storage unit indicates item-specific inaccuracy information indicating the degree of inaccuracy of the receipt information for each item with respect to the item specifying information for specifying the medical treatment pattern, medical institution and other items. The step of storing in correspondence.

  The automatic input execution unit automatically inputs receipt information that is image information included in the claimed receipt, including item identification information and insurer contribution information regarding the insurer contribution. Steps to perform through.

  A step in which the image character conversion unit converts the received receipt information, which is image information, into receipt information, which is character information.

  A step in which the receipt information display execution unit displays the converted reception information through the display unit.

The receipt emphasis degree information display execution unit calculates the receipt emphasis degree information indicating the degree to be focused on the administrative assistance for the receipt requested based on the item-specific inaccuracy information storage unit. The step of executing the display of the received strength information through the display unit together with the display of the receipt information.
Here, “displaying the reception focus information together with the display of the receipt information” is not limited to the case where the display of the reception focus information and the display of the receipt information are executed simultaneously. This is a concept that includes the case where the display of information and the display of receipt information are executed around time.

  Then, the accurate examination information input execution unit executes the input of accurate examination information for performing an accurate examination of the requested receipt through the input unit.

  According to such a method of supporting receipt of administrative assistance relating to the third invention, it is configured to include calculation of such receipt focus information, display of the calculated receipt focus information, and input of appropriate examination information. As a result, it is possible to easily find an error for each receipt, and it is possible to accurately allocate human resources in accordance with the degree of inaccuracy and the degree to which each receipt should be focused.

  Therefore, according to this, it is possible to sufficiently obtain the effect of improving the efficiency of the assistant office work and the effect of reducing the examination processing burden.

  In such a receptionist support assistance method according to the third invention, the item-specific inaccuracy information is obtained statistically from item-specific inaccuracy information such as medical treatment patterns, medical institutions, and other items. Yes, from the viewpoint that receiving focus level information becomes appropriate by setting the information to the latest information one after another, and the discovery of mistakes in highly important receipts becomes high. In the case of further including an accuracy information update execution unit, the method is preferably configured as a method including the following steps.

  That is, the item-specific inaccuracy information update execution unit is acquired through a new statistical examination of the item-specific inaccuracy information stored in the item-specific inaccuracy information storage unit. The update to the item-specific inaccuracy information is executed through the input unit.

  In addition, the receipt examination support method according to the fourth invention includes an item-specific inaccuracy information storage unit, an automatic input execution unit, an image character conversion unit, a receipt information display execution unit, a receipt focus degree information display execution unit, and an accurate examination information display. An examination that uses a receipt examination support device including an execution unit, an input unit, and a display unit, and examines the receipt information included in the receipt for which the insurer is required to pay the insurer contribution. This is a method for the person in charge.

  This is configured as a method including the following steps.

  That is, the item-specific inaccuracy information storage unit indicates item-specific inaccuracy information indicating the degree of inaccuracy of the receipt information for each item with respect to the item specifying information for specifying the medical treatment pattern, medical institution and other items. The step of storing in correspondence.

  The automatic input execution unit executes the automatic input of the receipt information that is image information included in the claimed receipt including the item identification information and the insurer contribution information on the insurer contribution through the input unit. Step.

  A step in which the image character conversion unit converts the received receipt information, which is image information, into receipt information, which is character information.

  A step in which the receipt information display execution unit displays the converted reception information through the display unit.

The receipt emphasis degree information display execution unit calculates and calculates the receptive emphasis degree information indicating the degree to which the claim should be focused on the examination for the requested claim based on the item-specific inaccuracy information storage unit. The step of executing the display of the reception focus degree information through the display unit together with the display of the receipt information.
Here, “displaying the reception focus information together with the display of the receipt information” is not limited to the case where the display of the reception focus information and the display of the receipt information are executed simultaneously. This is a concept that includes the case where the display of information and the display of receipt information are executed around time.

Then, the correct examination information display execution unit displays the correct examination information for performing the accurate examination of the request which is transmitted from the apparatus other than the receipt examination support apparatus or inputted through the input unit. And the step of executing through the display unit together with the display of the reception focus information.
Here, “execution of accurate examination information display together with display of receipt information and reception focus information” is not limited to the case where all of these displays are executed simultaneously. Although the two are executed at the same time, the display of the remaining is a concept including the case where it is executed before and after the time, and the case where all of these are executed separately before and after the time.

  According to such a receipt examination support method according to the fourth aspect of the present invention, it is configured to include calculation of such receipt focus degree information, display of calculated receipt focus degree information, and indication of appropriate examination information. In addition, it is possible to easily find an error about each receipt, and to appropriately allocate human resources according to the degree of inaccuracy and the degree to which each reception should be focused.

  Therefore, according to this, it is possible to sufficiently obtain the effect of improving the efficiency of the assistant office work and the effect of reducing the examination processing burden.

  In such a receipt review support method according to the fourth invention, the item-specific inaccuracy information is obtained statistically from item-specific inaccuracy information such as medical treatment patterns, medical institutions, and other items. From the point of view that the receipt focus information becomes appropriate by setting the latest information sequentially and the detection of mistakes in a highly important receipt becomes high, the method includes the following steps. It is preferable.

  That is, when the receipt examination support apparatus further includes an item-specific inaccuracy information update execution unit, the item-specific inaccuracy information update execution unit stores the item-specific inaccuracy information stored in the item-specific inaccuracy information storage unit This is a step of performing an update to the item-specific inaccuracy information acquired through the new statistical examination of the item-specific inaccuracy information in the storage unit through the input unit.

According to the receipt office assistance support apparatus and the receipt examination support system according to the present invention, the effect of improving the efficiency of the office assistance work and the effect of reducing the examination processing burden can be sufficiently obtained.

  The best mode for carrying out the present invention will be described below in detail with reference to the accompanying drawings.

[Receipt Examination Support System]
FIG. 1 is a block diagram of a receipt examination relaxation system according to an embodiment of the present invention. The receipt examination support system 1 includes a partial composition of the receipt office assistance support apparatus 2 and the receipt examination assistance apparatus 3 (the case shown in FIG. 1), or a partial configuration of the receipt office assistance support apparatus 2 and the receipt examination assistance apparatus 3 ( Not shown). Note that the receipt examination support system 1 in FIG. 1 uses an appropriate examination information display execution unit 31 as a partial configuration of the receipt examination support apparatus 3.

[Receive clerical assistance equipment]
FIG. 2 is a block diagram of the receipt office co-assistance support apparatus 2.

In the present embodiment, the receipt co-help assistance device 2 performs the co-help of the co-worker in order to examine the receipt information included in the receipt for which the insurer has been requested to pay the insurer contribution. Is to support.
The receipt information is made up of information such as the name of the recipient, the insurance card symbol number, the name of the wound, the date of medical treatment, the reexamination that is the content of the medical treatment, the home, and medication.

As shown in FIG. 2, specifically, the receipt office co-assistance support apparatus 2 includes a display unit for displaying receipt information and information for co-operation assistance, a control unit for controlling the display unit, input of a receipt, and the like. And an input unit that receives the data and a storage unit that can store various data.
As the display unit, a monitor using a liquid crystal display or a CRT (Cathode-Ray Tube) can be used. The control unit includes a central processing unit, a storage device, and the like, and various processes can be realized by developing and starting a predetermined program. The input unit is composed of a keyboard, a mouse, a pen tablet and the like. As the receipt input, 99.5% is a paper receipt, which is laid by an optical reader or the like. The storage unit includes an HDD (Hard Disk Drive) device or the like.

  As shown in FIG. 2, the storage unit, input unit and control unit of the receipt office co-assistance support apparatus 2 further include an item-specific inaccuracy information storage unit 21, an automatic input execution unit 23 a, an image character conversion unit 23 b, A receipt information display execution unit 24, a reception focus information display execution unit 25, a correct examination information input execution unit 26, and an item-specific inaccuracy information update execution unit 27 are provided.

  Hereinafter, each of these components will be described in more detail.

(1) Item-specific inaccuracy information storage unit The item-specific inaccuracy information storage unit 21 stores receipt information that is grasped for each item with respect to item specification information for specifying medical treatment patterns, medical institutions, and other items. It functions to store the item-specific inaccuracy information table 22 corresponding to the item-specific inaccuracy information indicating the degree of inaccuracy, which is acquired in advance through a statistical examination of the receipt information. .

FIG. 4 shows the item-specific inaccuracy information table 22.
The item-specific inaccuracy information table 22 is different from each item in the item specifying information 221 (medical pattern, medical institution, etc.) that is the item-specific inaccuracy information 220 stored in advance in the item-specific inaccuracy information storage unit 21. Made at a rate of 222.
The item-specific inaccuracy information table 22 is used in advance in order to obtain a ranking point to be described later for the review of the receipt information (first examination, reexamination, guidance, home, medication, injection, treatment, surgery, examination, The presence / absence of description regarding image, hospitalization, etc.) is obtained from the receipt score column, and the error rate for each medical pattern is obtained statistically and stored in the item-specific inaccuracy information storage unit 21.
In addition to medical treatment patterns, information on medical institutions (hospitals, clinics), gender, generations (children, adults, elderly people), illnesses (disease classification codes), number of treatment days, hospitalization / outpatient, billing points, etc. By memorizing, it is possible to provide a reference for extracting a receptor pattern that is more multifaceted and low-risk.

(2) Automatic Input Execution Unit The automatic input execution unit 23a automatically receives receipt information that is image information included in the claimed receipt and includes insurer contribution information regarding item identification information and insurer contribution. It performs the function of executing simple input through the input unit.

Specifically, the automatic input execution unit 23a can optically read the receipt information written on the paper receipt, and the read receipt information is stored in the storage unit and used for reception assistance and examination. Is done. The optical reading means may be, for example, a commonly used optical reading device.
The automatic input execution unit 23a also has a function of inputting a magnetic receipt even in the case of a magnetic receipt in which the receipt information is digitized. The magnetic receipt is sent by a storage medium such as a floppy (R) disk or a magnetic tape. Alternatively, online input such as file transfer may be used.

(3) Image Character Conversion Unit The image character conversion unit 23b functions to convert the received information, which is image information, into the receipt information, which is character information.
A portion that can be recognized by the optical reading means performs character recognition (character conversion) at the time of image acquisition.

(4) Receipt Information Display Execution Unit The receipt information display execution unit 24 performs a function of executing display of the converted receipt information through the display unit.
FIG. 5 is a diagram showing a screen for co-helper according to an embodiment of the present invention. A part of the receipt information 51 is displayed.

(5) Receipt Focus Level Information Display Execution Unit Receipt Focus Level Information Display Execution Unit 25 searches the item-specific inaccuracy level information table 22 based on the item identification information 221 included in the converted receipt information, and corresponds items The degree to which the inaccuracies information 220 is extracted, and the degree of focus should be given to the administrative assistance for the receipt requested based on the inaccuracy information 220 on the extracted item and the insurer contribution information included in the receipt information. It performs the function of calculating the received receptacle intensity information to be displayed and executing the display of the calculated receptor intensity information together with the display of the receipt information through the display unit.

Based on the item-specific inaccuracy information 220 in the item-specific inaccuracy information table 22, the receipt focus degree information display execution unit 25 receives a ranking point of a receipt, which is one of the receipt focus information 53 shown in FIG. 52 so that the importance of the receipt can be closely watched through the mutual assistance and examination.
The receipt emphasis degree information display execution unit 25 calculates the ranking points 52 based on the item-specific inaccuracy information 220. For example, the error rate weighted for each item such as the medical treatment pattern and the medical institution of FIG. 4 is obtained, and for example, (error rate) × (claimed point) is obtained as the ranking point 52. As a result, the ranking point 52 has a high claim claim point, and at the same time, if the medical pattern has a high error rate or a medical institution with a high error rate, the ranking point 52 is high and needs to be sufficiently examined. . On the other hand, if the medical care pattern has a low receipt claim point and a low error rate, or a medical institution with a low error rate, the ranking point 52 becomes low, and it can be examined in a form close to non-examination.
In actual business, the reception of points below a certain level at this ranking point 52 is not focused, and only the receptions at points above a certain level are examined. This ranking point 52 can be adjusted according to the amount of work of the receipt examination for the month, and the increase or decrease of the human resources of the assistant coordinator and the examiner.

In addition, the receipt emphasis degree information display execution unit 25 can extract and display a keyword requiring attention by extracting a specific keyword included in the receipt, and can pay attention to the clerical assistance and examination.
Furthermore, even when chemicals that require attention at low-cost receipts, item names with many inspection mistakes, etc. are detected and used, they can be displayed at the reception focus information display execution unit 25 and can be closely watched by co-operation and examination. It is like that.
It should be noted that these cautionary keywords, medicines to be noted, items with many inspection errors, etc. are stored in advance in the item-specific inaccuracy information storage unit 21 and used in the reception focus degree information display execution unit 25. it can.

(6) Appropriate Examination Information Input Execution Unit The Appropriate Examination Information Input Execution Unit 26 is precise examination information for conducting an accurate examination of the requested claim and may affect the calculation of the insurer contribution. It fulfills the function of executing the input of something through the input unit.

Specifically, in FIG. 5, the co-helper determines the importance of the receipt from the receipt information 51 and the reception focus information 53 such as the ranking points 52, and determines the number of reexaminations, which is a medical pattern, If there is any doubt about treatment or medication, information such as home visits and the number of times of medication can be checked, and co-help tag information, which will be detailed examination information described later, can be entered in the co-help tag information field 55.
In addition, the display part of this screen may be a normal computer terminal or PC.

(7) Inaccuracy Information Update Execution Unit by Item The inaccuracy information update execution unit by item 27 is inaccurate by item in the inaccuracy information table by item 22 stored in the inaccuracy information storage unit by item 21. The update to the item-specific inaccuracy information 220 obtained through the new statistical examination of the degree information 220 is performed through the input unit.

  The item-specific inaccuracy information update execution unit 27 collects the error rate for each medical treatment pattern and each medical institution as statistical information in advance and periodically reflects it in the item-specific inaccuracy information table 22 to make the item-inaccurate information incorrect. The degree information 220 can be reflected as the latest information on the ranking points.

[Receipt Examination Support Device]
FIG. 3 is a block diagram of the receipt examination support apparatus 3.

  In the present embodiment, the receipt examination support device 3 assists the examiner in examining the receipt information included in the receipt for which the insurer is required to pay the insurer contribution. Is.

As shown in FIG. 3, specifically, the receipt examination support apparatus 3 receives a display unit that displays receipt information and information for examination, a control unit that controls the display unit, and a receipt input. It is comprised including the input part and the memory | storage part which can memorize | store various data.
As the display unit, a monitor using a liquid crystal display, a CRT (Cathode-Ray Tube) or the like can be used. The control unit includes a central processing unit, a storage device, and the like, and various processes can be realized by developing and starting a predetermined program. The input unit includes a keyboard, a mouse, a pen tablet, and the like. Further, 99.5% of the receipt input is a paper receipt, which is constituted by an optical reader or the like. The storage unit is laid out by an HDD (Hard Disk Drive) device or the like.

  As shown in FIG. 3, the storage unit, input unit, and control unit of the receipt examination support apparatus 3 further include an item-specific inaccuracy information storage unit 21, an automatic input execution unit 23 a, an image character conversion unit 23 b, and a receipt. The information display execution unit 24, the reception focus information display execution unit 25, the correct examination information display execution unit 31, and the item-specific inaccuracy information update execution unit 27 are arranged horizontally.

  Hereinafter, each of these components will be described in more detail. In addition, the description which overlaps with the said receipt office co-help assistance apparatus 2 is abbreviate | omitted.

(1) Appropriate examination information display execution part The accurate examination information display execution part 31 is transmitted from an apparatus other than the receipt examination support apparatus 3 related to the person in charge of examination, or an accurate examination of the received claim made through the input part. It performs the function of executing through the display section the display of the receipt information and the reception focus information together with the display of the receipt of the receipt information and the receipt focus degree information that may affect the calculation of the insurer contribution.

FIG. 6 is a view showing an examination screen according to an embodiment of the present invention.
As shown in FIG. 6, the appropriate examination information display execution unit 31 displays the receipt information 51, the ranking point 52 that is the receipt focus degree information 53, the reason thereof, and the co-help tag information that is the appropriate examination information 54. Can be done.
The person in charge of the examination can input the examination result to the corresponding part of the receipt information 51 on the screen (the item pointed out in the mutual assistance tag information) with reference to the mutual assistance tag information on the examination screen.

[Office Assistant Screen]
FIG. 5 is a diagram showing the office assistant screen 5.
The office work assistant screen 5 is a display screen of the receipt focus degree information display execution unit 25.
The office co-help screen 5 displays the name of the medical institution, the insurer name, the patient's name, gender, and age of the patient, which is the receipt information 51. In addition, the patient's injury name 56 (in this example, upper respiratory tract inflammation and femoral fracture), the medical treatment start date, and the actual medical treatment days are displayed.
Further, the receipt information 51 displays receipts such as the number of re-examinations, the number of home visits, the number of nights, the content and number of medications, the content and number of injections, and the number of treatments.
In addition, the reception focus degree information 53 displays information on the ranking points 52 and the reasons (for example, the score, characteristics of the name of the disease, specific character strings in the summary column).
In the example of FIG. 5, the ranking point 52 indicating the importance of the receptor is 11050 pt, and the main reason is that the claim point of the receipt is XX points, treatment and injection, and insulin is used. .
The person in charge of clerical work inputs the content of the doubt in the co-help tag information column 55 in which the appropriate examination information 54 is entered by looking at the ranking point 52 and the reason.

[Review Screen]
FIG. 6 shows the examination screen 6.
The examination screen 6 is a display screen of the accurate examination information display execution unit 31. The examination screen 6 displays the receipt information 51, the ranking points 52 as the receipt focus information 53, the reason and the co-help tag information as the appropriate examination information 54. In the co-help tag information column 55, the co-help tag information input by the appropriate examination information input execution unit 26, which is the previous process, is displayed.
In the present embodiment, “1. Celestamine is prescribed for upper respiratory tract inflammation” input as co-help tag information. “2. Home-use self-injection instruction management fee is calculated and then the specific disease prescription management addition is calculated. And enter the result such as “No problem” or “Not accepted”.
The co-help tag information is in a hyperlink format, and the corresponding part of the receipt can be displayed by clicking.
The operation button 58 can operate the screen by “return” or “forward”, and by clicking the operation button 59, it is possible to detect past receipts and dispensing receipts of related receipts. The button 60 is a button for switching to the next reception. Further, enlarged display and reduced display are possible.
The person in charge of examination can see the screen and input the result of examination to the relevant part of the receipt information 51 on the screen (the item pointed out in the co-help tag information) by using a keyboard or a pen tablet.

  As described above, in such a receipt office assistance support device 2 and a receipt examination support device 3, such item-specific inaccuracy information storage unit 21, automatic input execution unit 23a, image character conversion unit 23b, receipt information display Execution unit 24, receipt focus information display execution unit 25, item-specific inaccuracy information update execution unit 27, and correct examination information input execution unit 26 in the reception assistant assistance device 2, and accurate examination in the receipt examination support device 3 Since it is configured to include the information display execution unit 31, it is possible to easily find an error about each receipt, and human resources corresponding to the degree of inaccuracy and the degree to which each receipt should be focused. Can be directed accurately.

  Therefore, according to this, it is possible to sufficiently obtain the effect of improving the efficiency of the assistant office work and the effect of reducing the examination processing burden.

[Receive clerical assistance support method]
FIG. 7 is a flowchart for explaining the overall configuration of a method according to an embodiment of the present invention.

  In the present embodiment, the receipt office co-assistance support method is performed using the above-described receipt office co-assistance support apparatus 2, and as shown in the flowchart in FIG. 7, each step from step 1 to step 7 is performed. It is configured. Hereinafter, each step will be described with reference to FIG.

(1) Step 1
This is an item that indicates the degree of inaccuracy of the receipt information that is grasped for each item by the item inaccuracy information storage unit 21 with respect to the item specifying information for specifying the medical treatment pattern, the medical institution, and other items. This is an item-specific inaccuracy information storage step for storing the item-specific inaccuracy information table 22 that is associated with the inaccuracy information that is acquired in advance through a statistical investigation of the receipt information.

(2) Step 2
The automatic input execution unit 23a inputs automatic input of receipt information, which is image information included in the requested receipt, including item identification information and insurer contribution information regarding the insurer contribution. It is an automatic input execution step executed through the section.

(3) Step 3
This is an image character conversion step in which the image character conversion unit 23b converts the input receipt information, which is image information, into receipt information, which is character information.

(4) Step 4
This is a reception information display execution step in which the reception information display execution unit 24 displays the converted reception information through the display unit.

(5) Step 5
This is because the receipt emphasis information display execution unit 25 searches the item-specific inaccuracy information table 22 based on the item identification information included in the converted receipt information and extracts corresponding item-specific inaccuracy information. In addition to calculating the degree of receipt focus information that indicates the degree to which the administrative assistance for the receipt requested based on the inaccuracy information by item and the insurer contribution information included in the receipt information should be focused This is a step of executing the reception focus degree information display for displaying the display of the calculated reception focus degree information together with the display of the receipt information.

(6) Step 6
This is the input to the correct examination information input execution section 26 that is input for accurate examination information for performing an accurate examination of the requested claim, which may affect the calculation of the insurer contribution. This is a step of executing the correct examination information input to be executed.

(7) Step 7
This is because the item-specific inaccuracy information update execution unit 27 performs a new statistical examination of the item-specific inaccuracy information in the item-specific inaccuracy information table 22 stored in the item-specific inaccuracy information storage unit 21. Updating the item-specific inaccuracy information acquired through the input unit through the input unit.

[Receipt Examination Support Method]
FIG. 7 is a flowchart for explaining the overall configuration of a method according to an embodiment of the present invention.

  In the present embodiment, the receipt examination support method is performed using the receipt examination support apparatus 3 as described above. As shown in the flowchart of FIG. 7, each step from Step 1 to Step 5 and Step 7 are performed. , Step 8. In addition, the description which overlaps with the said receipt office assistance assistance method is abbreviate | omitted.

(1) Step 8
This is because the accurate examination information display execution unit 31 performs the accurate examination of the received claim sent from an apparatus other than the receipt examination support apparatus related to the examiner or input through the input unit. In this case, the accurate examination information display execution step is executed, through which the display of the receipt information and the reception emphasis degree information is displayed through the display unit, which may affect the calculation of the insurer contribution.

  Thereby, the receipt office co-assistance support apparatus, the receipt examination support apparatus, their methods, and the program according to the present embodiment are completed.

  That is, according to such a receptionist co-help support device, a receipt examination support device, and their method and program, calculation of such receipt focus degree information, display of the calculated receipt focus degree information, and input of appropriate examination information As a result, it is easy to find mistakes for each receptor, and accurately allocate human resources according to the level of inaccuracy and the level of focus that each receptor should have. It is possible to

  Therefore, according to this, it is possible to sufficiently obtain the effect of improving the efficiency of the assistant office work and the effect of reducing the examination processing burden.

It is a receipt examination support system block diagram concerning one embodiment of the present invention. It is a block diagram of the receipt office work assistance assistance apparatus which concerns on one embodiment of this invention. It is a block diagram of the receipt examination assistance apparatus which concerns on one embodiment of this invention. It is a figure of the inaccuracy information table according to item concerning one embodiment of the present invention. It is a figure which shows the office work assistance screen which concerns on one embodiment of this invention. It is a figure which shows the examination screen which concerns on one embodiment of this invention. It is a flowchart explaining the method which concerns on one embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Receipt examination assistance system 2 ... Receipt co-help assistance device 21 ... Item-specific inaccuracy information storage unit 22 Item-specific inaccuracy information table 220 ... Item-specific inaccuracy information 221 ... Item specific information (medical treatment pattern, medical institution)
23a ··· Automatic input execution unit 23b · Image character conversion unit 24 · Receipt information display execution unit 25 · Receipt focus information display execution unit 26 · Relevant examination information input execution unit 27 · · Inaccuracy information by item Update execution unit 3 · Receipt review support device 31 · Correct screening information display execution unit 5 · Administrative assistance screen 51 · Receipt information 53 · Receipt focus level information 54 · Correct screening information (co-help note information)
55 .. Mutual assistant tag information column 6 ... Screen

Claims (4)

An input unit and a display unit carry out a review of receipt information that the insurer claims payment of insurance's contributions to be paid is included in the receipt was made in a free herd concept office assistance support device,
Item-specific inaccuracy information for storing item-specific inaccuracy information indicating the degree of inaccuracy of the receipt information for each item with respect to item specifying information for specifying medical treatment patterns, medical institutions, and other items An information storage unit;
The input for receipt information including insurer contributions information relating to the item specifying information and the insurer contributions a receipt information is image information included in the request has been made receipt, input to run through the input unit A force execution unit;
Extract item-specific inaccuracy information corresponding to the item identification information from the item-specific inaccuracy information storage unit based on item identification information included in the receipt information converted from the receipt information, which is image information, into character information. In addition , based on the extracted item-specific inaccuracy information , the receipt focus degree information indicating the degree to which the receipt of the requested claim should be focused on the administrative assistance is calculated, and the calculated receipt focus degree information A reception focus information display execution unit that executes the display of the receipt information together with the display of the reception information;
An accurate examination information input execution unit for executing input of accurate examination information for performing an accurate examination of the requested claim through the input unit ;
The receipt emphasis degree information display execution unit displays the column for inputting the appropriate examination information on the office work assistant screen through the display unit, the receipt information, and the receipt emphasis degree information side by side.
A reception assistant support device characterized by Updating the item-specific inaccuracy information stored in the item-specific inaccuracy information storage unit to the item-specific inaccuracy information acquired through a new statistical survey of the item-specific inaccuracy information storage unit characterized in that it comprises a itemized inaccuracy information update execution unit that executes the input unit, receipt office assistance support device according to 請 Motomeko 1. Including an input unit and a display unit for reviewing the receipt information included in the receipt for which the insurer is required to pay the insurer contribution,
Item-specific inaccuracy information for storing item-specific inaccuracy information indicating the degree of inaccuracy of the receipt information for each item with respect to item specifying information for specifying medical treatment patterns, medical institutions, and other items An information storage unit;
An input execution unit that executes, through the input unit, receipt information that is image information included in the requested receipt and includes receipt information including the item specifying information and insurer contribution information regarding the insurer contribution. When,
Extract item-specific inaccuracy information corresponding to the item identification information from the item-specific inaccuracy information storage unit based on item identification information included in the receipt information converted from the receipt information, which is image information, into character information. In addition, based on the extracted item-specific inaccuracy information, the receipt focus degree information indicating the degree to which the receipt of the requested claim should be focused on the administrative assistance is calculated, and the calculated receipt focus degree information A reception focus information display execution unit that executes the display of the receipt information together with the display of the reception information;
A receipt office co-assistance support device, including: an accurate examination information input execution unit for executing input of accurate examination information for performing an accurate examination of the requested claim through the input unit;
Including an input unit and a display unit for reviewing the receipt information included in the receipt for which the insurer is required to pay the insurer contribution,
The receipt the manner probability assessment information sent from office assistance support device, the display of the receipt information Ho及 beauty the receipt promotion degree information, receipt examination support including precise examination information display execution unit that executes through the display unit of the own apparatus,
A receipt examination support system characterized by comprising: Updating the item-specific inaccuracy information stored in the item-specific inaccuracy information storage unit to the item-specific inaccuracy information acquired through a new statistical survey of the item-specific inaccuracy information storage unit characterized in that it comprises a itemized inaccuracy information update execution unit that executes the input unit, receipt examination support system according to 請 Motomeko 3.

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