JP4072103B2 - Examination support method for medical remuneration statement, examination support device for medical remuneration statement, and program for examination support device for medical remuneration statement - Google Patents

Description

  The present invention relates to a screening support method for a medical fee description, a screening support device for a medical fee specification, and a program for a screening support device for a medical fee specification.

  By paying a partial contribution, health insurance insured persons can receive medical examinations, treatments, etc. at medical institutions such as hospitals and clinics, obtain drugs, and be hospitalized. In addition, even if you receive a doctor's prescription, you can have the insurance pharmacy dispense the drug by paying a partial contribution. Therefore, a medical institution or insurance pharmacy needs to request payment of a contribution that the insurer should bear (hereinafter referred to as an insurer contribution) to a health insurance insurer.

  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 medical fee remuneration statement (hereinafter referred to as a receipt). The receipt contains information on the content of the preparation, such as the number of treatments for the insured, the type and number of medications, and the health insurance insurer pays the insurer's contribution according to the description. I do.

By the way, the payment of the insurer contribution made through the receipt is made in response to a unilateral request from the medical institution or insurance pharmacy to the health insurance. Therefore, if the reception is not monitored at all, a medical institution or insurance pharmacy may acquire an insurer contribution by an unfair claim including a mistake or an illegal act. Therefore, in order to eliminate unfair claims and fraudulent activities, a social insurance medical fee payment fund (hereinafter referred to as a payment processing mechanism), which is a reviewing body for receipts, is interposed between medical institutions and insurance pharmacies and insurers. Yes.
Here, an unfair claim is, for example, a case where there is no description about a medical treatment period in a receipt, or a case where an unnecessary medical action (medicine, injection, etc.) is being performed. This is a case of requesting payment of the insurer's contribution for a medical practice that has nothing.
In the present invention, such a receipt having an unfair claim or an illegal act is referred to as a receipt in which an erroneous medical treatment fee (wrong medical fee) is described.

  Receipts created by medical institutions and insurance pharmacies are collected by the payment processing mechanism, and prior to the detailed review by the reviewer, there is a receipt that is clearly missed by the co-worker, and there is a mistreatment fee. Receipts with strong suspicion of being listed are eliminated. Then, a highly suspicious receipt in which a mistreatment fee is described is subjected to a detailed examination by a reviewer (such as a doctor) having sufficient technical and technical knowledge. In the present invention, this is called actual examination. As a result of the actual examination, only the receipts confirmed to be appropriate are sent to each insurer, and other receipts are returned to medical institutions and insurance pharmacies.

However, there is a suspicion that in the case of such mutual administrative assistance by the administrative assistant, the administrative assistant will inspect all the receipts requested by the medical institution from all angles and the wrong medical treatment fee is described. It is necessary to extract a certain receipt. The task of discovering a receipt with a false medical treatment fee by visual inspection from a huge amount of receipts depends largely on the intuition and skill level of the co-worker, so efficient co-working work In addition to being unable to ensure, it may be difficult to detect mistakes themselves.
In addition, in such an examination by the person in charge of examination, although there is a fact that the degree of inaccuracy and the degree to be focused on corresponding to each receipt vary considerably, The actual situation is turning around. In addition, there are cases where the receipt of suspected wrong medical treatment fees is clearly described by the co-administrator, and the examination processing burden on the examiner has not been sufficiently reduced. It has become.

  Conventionally, as a system and a method related to such a receipt and insurance procedure, there is a system or method for paying the receipt or returning it to a medical institution when the insurer receives the receipt (see Patent Document 1). . In addition, insurance card data for each insured is stored in the database of a medical information storage management company that stores medical information, and the insurance medical institution checks the insurance card and bills the insurer. To reduce the burden on insurance medical institutions (see Patent Document 2). Furthermore, there is one that confirms whether or not an insured person is qualified by a qualification authority and prevents loss of medical expenses of the insurer (see Patent Document 3).

JP 2001-344337 A ([0012], FIG. 1) JP 2002-41649 A ([0034], FIG. 7) Japanese Patent Laid-Open No. 2002-109069 ([0020] to [0028], FIG. 1)

Any of the inventions described in the patent documents described above is intended to solve the problems of ensuring the efficiency of office work and reducing the processing load in health insurance insurers, insured persons, medical institutions and insurance pharmacies. However, it does not attempt to solve problems such as ensuring efficient office work in the payment processing mechanism and reducing the burden of examination processing.
The present invention has been made in view of the above circumstances, so that it is possible to easily find an error in each receipt so as to sufficiently improve the efficiency of the office assistant work and reduce the burden of examination processing. Examination support method for medical fee description, examination support device for medical fee specification, which makes it possible to accurately allocate human resources in accordance with the degree of inaccuracy and the degree to which the receipt should be focused It is another object of the present invention to provide an examination support apparatus program for a medical remuneration statement.

In order to solve the above problems, the present invention provides:
(1) Obtained from past review results so that reviewers can preferentially review receipt data that is likely to contain incorrect medical fees and reduce the burden of review processing. Based on the rules, the electronic data (receipt data) of the subject to be reviewed is sorted in the descending order of the possibility that there is an erroneous medical fee (suspicion).
(2) In addition, in order to improve the efficiency of office work assistant work, so that the person in charge of review can concentrate on receipt data that may contain incorrect medical fees when conducting an actual review, Based on the rules obtained from past examination results, etc., the receipt data that is unlikely to contain wrong medical fees from the receipt data is sorted.
(3) Further, in order to increase the probability that the examiner in (1) will find the receipt data containing the wrong medical fee from the subject receipt data, after the sorting in (2), (1) Sorting was done.

  According to the present invention, it is possible to easily find an error in each medical remuneration statement so that the efficiency of the assistant office work can be improved and the examination processing burden can be sufficiently reduced. It is possible to accurately allocate human resources according to the level of accuracy and the level of focus.

  FIG. 1 shows a model for realizing a medical fee specification examination support method, a medical fee specification examination support device, and a medical fee specification examination support device program in each embodiment of the present invention, and its user It is a figure for demonstrating a relationship.

  The medical institution 1 such as a hospital or a pharmacy charges the medical treatment fee to the payment processing mechanism 2 such as a payment fund that is a public institution, and the payment processing mechanism 2 is charged by the medical institution 1. After paying the medical fee, the medical fee is paid to each medical institution, and the medical fee is paid to the insurer 3 (health insurance association, local government, etc.) where the patient is insured. To charge. After paying the medical treatment fee to the payment processing mechanism 2, the insurer 3 reviews the payment processing mechanism 2 and makes a reexamination request to the payment processing mechanism 2 only for those suspected.

The medical institution 1 charges the medical treatment fee to the payment processing mechanism 2 based on a medical fee remuneration statement (receipt), which is a medical fee claim application created for each patient and for each medical treatment. Since most of the receipts provided by the medical institution 1 are based on papers handwritten or printed by a personal computer or the like, the payment processing mechanism 2 first receives the receipt, reads it with a scanner, etc. Make an image. Then, the image data and the receipt data obtained by converting the image data into electronic data by OCR (Optical Character Reader) or punching are stored in the receipt DB 210 of the receipt management unit 200.
If the receipt has already been converted into electronic data, that is, if it is a magnetic receipt, this receipt is stored in the receipt DB 210 as it is.
Therefore, it is assumed that the receipt data stored in the receipt DB 210 includes image data (receipt image data) in addition to the receipt data (medical fee description data) stored as text information.

On the other hand, the payment processing mechanism 2 uses the examination support device (examination support device for medical fee remuneration statement) after performing the administrative check of the receipt data of the aforementioned receipt management unit 200 by a computer (not shown). Receipt data for actual examination is extracted (S02).
The examination support apparatus has a function of extracting and sorting out receipt data that is likely to have an erroneous medical fee based on past examination results. Details of the function of this examination support apparatus will be described later. It will be described in the first embodiment.

Then, the examiner displays the extracted receipt data as the receipt image data on the computer screen, examines the received data one by one visually, and inputs the examination result to the examination support apparatus (S03).
Here, the examiner finds the receipt data in which the wrong medical fee is described, and excludes the receipt data in which the wrong medical fee is described from the receipt data to be examined. Then, the payment processing mechanism 2 transmits to the insurer 3 only the receipt data in which the wrong medical fee is described, ie, the receipt data in which the appropriate medical fee is described, from the receipt data to be examined. Then, the medical institution 1 is paid for the medical fee, and the insurer 3 is charged for the medical fee (S04).

(First embodiment)
FIG. 2 is a block diagram showing an expanded function of the examination support apparatus in the first embodiment.
As described above, the examination support apparatus 100 acquires the receipt data to be examined from the receipt DB 210 of the receipt management unit 200 storing the receipt data, and based on the rules obtained from the past examination results, They are arranged (sorted) in descending order of the possibility that incorrect medical fees are listed, and assist the examiner in making the actual examination easier.
The receipt data includes information such as the name of the examinee, insurance card number, injury and illness name, medical treatment start date, medical treatment details such as medication, injection, examination, surgery, etc. The

As shown in FIG. 2, the examination support apparatus 100 includes a data acquisition unit 110 that acquires receipt data from the receipt DB 210 of the receipt management unit 200, a processing unit 120 that rearranges the receipt data, and an arrangement of the receipt data. A rule storage unit 101 for storing various rules for performing a change, a display unit 170 for displaying receipt data, image data of a receipt, etc., addition of various rules, rearrangement and selection of reception data, selection results, examination results, etc. And an input unit 180 that receives input.
As the display unit 170, a liquid crystal display or a monitor using a CRT (Cathode Ray Tube) can be used. The input unit 180 includes a keyboard, a mouse, a pen tablet, and the like.

  Hereinafter, these components will be described in detail.

(Rule memory)
As described above, the rule storage unit 101 stores various rules that are a reference for the processing unit 120 to rearrange and display the receipt data, and there is a possibility that an incorrect medical fee is described in the receipt data. A screening-required determination rule storage unit 140 that stores a screening-required determination rule, which is a criterion for determining that the data is high, and a display rule for rearranging and displaying the receipt data so that the user can easily perform actual screening. And a display rule storage unit 150.

(Examination decision rule)
The review judgment rule is based on the keywords (injuries and illnesses) described in the receipt based on the criteria for judging that there is a high possibility that the wrong medical treatment fee is described based on the past review results and the experience of the examiner. Name, examination, medication, etc.).

FIG. 3 is a diagram illustrating an operation screen of the display unit 170 of the examination support apparatus 100. As illustrated in the area 1202 of FIG. 3, the examination-required determination rule is composed of one or more items (conditions).
For example, the “required injection” ∧ “hospital” in the screening decision rule “A1” is composed of a condition “with injection” and a condition “hospital”, and includes a receipt (receipt) that includes both of these two conditions. Data) indicates that there is a high possibility that erroneous medical fees are described based on past examination results (high possibility that an actual examination is necessary). In addition, the “required examination” ∧ “hospital” ∧ “sickness and sickness name 6 or more” of the judgment rule “A2” requires the conditions “with examination”, the condition “hospital”, and “sickness and sickness name 6”. The above is composed of the above-mentioned conditions, and this means “a receipt issued by a hospital with 6 or more description of names of injuries and inspected as a medical practice”. Here, a receipt (receipt data) that satisfies all three conditions is likely to contain an erroneous medical fee based on past examination results, that is, it can be judged that there is a high possibility that an actual examination is required. Is shown.

  This examination-needed determination rule includes “usage frequency”, “reliability”, and “support”. “Usage frequency” is data indicating how many times the rule has been used to sort the receipt data in the past. “Reliability” is data indicating the possibility that it is determined from the receipt data that has been reviewed in the past that the receipt data that conforms to this rule includes an incorrect medical fee in the review. The “support level” is data indicating how much the receipt data conforming to the rule is included in the entire receipt data.

For example, the screening requirement determination rule “A1” has been used “222 times” in the screening support apparatus 100 in the past, and the possibility that an incorrect medical fee is described in the receipt data that conforms to this rule is “10.0. The number of receipt data that conforms to this rule is “2%” of the total number of receipt data.
The receipt data sorting unit 121 sorts the receipt data in descending order of the number of applicable examination determination rules.

(Display rules)
The display rule indicates a condition for rearranging the receipt data so that the user can easily perform the actual examination. For example, the receipt data as shown in the area 1203 of FIG. Is the rule. By applying this display rule, for example, when the user wants to review all the issued records issued by the same medical institution, it is possible to narrow down to the medical institution and check the receipt data.

(Processing part)
As described above, the processing unit 120 sorts and sorts the receipt data based on the various rules stored in the rule storage unit 101, displays the receipt data (image data), and examines the receipt data input by the user. It has a function of accepting results, and includes a receipt data sorting unit (medical fee description data sorting unit) 121 and a rule updating unit 122.

  The receipt data sorting unit 121 matches the receipt data extracted from the receipt DB 210 based on the rule selected by the user out of the screening determination rules stored in the screening determination rule storage unit 140 described above. It has a function of arranging (rearranging) in order of increasing judgment rule. In other words, since the receipt data that conforms to more judgment rules requiring examination is more likely to be the receipt data in which an erroneous medical fee is described, it becomes easier for the user to select the receipt data for the actual examination with priority. .

  The rule update unit 122 receives an input from the input unit 180, selects a predetermined rule from various rules stored in the rule storage unit 101, rearranges, updates the content of the rule, It has a function to create rules.

FIG. 4 is a diagram exemplifying a screen of the display unit 170 when setting a screening requirement determination rule in the screening support apparatus. As illustrated in FIG. 4, the “required examination determination rule” (required examination determination rule list) stores the required examination stored in the necessary examination judgment rule storage unit 140 so that the user can easily select the examination required rule. A list of judgment rules is displayed. In addition, a check box for allowing the user to select “acceptance / rejection” of each rule is also displayed in the list of determination-needed determination rules.
In addition, in this determination rule list, “usage frequency”, “reliability”, “support”, and the like that are used as a guide when the user selects a determination-needed determination rule are also displayed. The displayed rules may be rearranged and searched according to the usage frequency, reliability, and support.

Then, the user selects a screening requirement determination rule by checking a check box of “rejection” of the screening requirement determination rule. When the setting button is clicked, the rule update unit 122 selects a check-needed determination rule from the check-needed determination rule storage unit 140.
It should be noted that all the acceptance / rejection check boxes may be adopted in advance so that only the examination-required determination rule that the user has determined to be unnecessary needs to be unchecked. In addition, all the checks may be non-adopted so that the user can check each one and assemble the rules for examination determination.

  In addition, an “independent determination rule addition field” is also displayed so that a user-needed determination determination rule can be added. When the user inputs a screening requirement determination rule created independently in this field and clicks the add button, the rule update unit 122 adds the determination rule to the screening requirement determination rule storage unit 140. The added examination-required determination rule is displayed in the “required examination-determination rule”.

  FIG. 5 is a diagram illustrating a screen for setting display rules in the examination support apparatus 100. As in the case of the screening determination rule setting screen, a list of display rules stored in the display rule storage unit 150 is displayed on the display rule setting screen so that the user can easily select a display rule. Then, a check box for allowing the user to select whether or not to adopt each rule is displayed. The user selects a display rule by checking a check box of the display rule.

In the above, the component of the 1st Embodiment of this invention was demonstrated.
Next, the processing procedure of the examination support apparatus 100 will be described using the flowchart of FIG. 6 with reference to FIGS.

(Step S101)
In step S101, the data acquisition unit 110 of the examination support apparatus 100 receives selection of receipt data to be examined (processed) of the examination support apparatus 100 input from an input screen (not shown) by the user, and the selected receipt data is received. Obtained from the receipt data DB 210.
When the receipt data to be examined (processed) by the examination support apparatus 100 is selected, the file name of the receipt data is displayed in the area 1201 of FIG. 3 so that the user can confirm the received receipt data. The

(Step S102)
In step S <b> 102, the rule update unit 122 of the examination support apparatus 100 receives selection of the examination requirement determination rule input by the user, and acquires this rule from the examination requirement determination rule storage unit 140.

  In the area 1202 of FIG. 3, a list of the examination requirement determination rules stored in the examination requirement determination rule storage unit 140 is displayed so that the user can confirm the examination requirement determination rules. This list also displays the usage frequency, reliability, support level, and the like that are used as a guide when the user selects a screening-needed determination rule.

Then, the user confirms the list of examination requirement determination rules in the area 1202 of FIG. 3 and clicks the rule application execution button in the area 1204 when applying the examination requirement determination rules displayed in the area 1202 as they are.
If it is desired to make some setting without applying the examination-required determination rule as it is, an area 1204 is displayed after the rule is set on the examination-requirement determination rule setting screen shown in FIG. Click the Apply Rule Application button.
Here, for example, it is assumed that the examination-needed determination rule numbers “A1”, “A2”, and “A3” are selected.

(Step S103)
In step S103, the receipt data selection unit 121 allows the user to extract the receipt data that should be preferentially subjected to the actual examination, based on the examination determination rule selected in step S102. Receipt data that conforms to the judgment rule requiring examination is extracted from the data, and is rearranged in the order of the number of the judgment rules requiring examination.

For example, as illustrated in the area 1201 in FIG. 3, the file name of the receipt data having many examination judgment rules that are suitable is easy to understand for the receipt data that is likely to contain an erroneous medical fee. 3 is displayed in the upper part (upper part) of the area 1201. The number of matched rules (number of hit rules) and rule No (number) are also displayed.
For example, in the example of the area 1201, the file name “XXXX” indicates that the number of matched rules is “3” and the matched rule numbers are “A1, A2, A3”.

(Step S104)
In step S104, when the user confirms the receipt data and the like rearranged in step S103 and immediately starts the actual examination (Yes), the process proceeds to step S105. If it is desired to rearrange and select (search) the receipt data (No), the process proceeds to S106.

(Step S105)
In step S <b> 105, the processing unit 120 of the examination support apparatus 100 receives an instruction input for displaying receipt data (image data) from the user, and displays the image data on the display unit 170. Then, a user examination result is received from the input unit 180.

  Here, the selection of the receipt data to be displayed (to perform actual examination) is performed by the user in the receipt data file displayed at the top in the area 1201 of FIG. Refer to the name, etc., the user may select manually while watching the screen on the spot, or select the number of receipt data according to the user's actual examination work amount based on the user's examination work plan on the day It is good to do.

FIG. 7 is a diagram exemplifying an examination work plan screen for a user to input an instruction to acquire actual examination target receipt data in accordance with his / her examination work plan.
“Previous results” in FIG. 7 indicates the results of the previous actual examination work stored in the receipt DB 210, “Scheduled work amount” indicates the scheduled work amount of the actual examination on this day (that day), and “Work amount” “Input” is a column for inputting the actual examination work amount of the day.

When the user inputs the actual examination work amount for the day and clicks the calculation button in FIG. 7, the number of actual examinations corresponding to the inputted work amount is displayed in “Number of examinations” of “Scheduled work amount”. Then, when extracting (selecting) the receipt data for the number of actual examinations from the receipt DB 210, the extraction execution button is clicked. Then, the data acquisition unit 110 receives the above-described selection of the user's receipt data, and the number corresponding to the actual examination work amount of the user's day from the receipt DB 210 (for example, one person's day is 200 cases, and two people work. In this case, for example, the top 400 cases are extracted in descending order of the number of conforming judgment judgment rules.
The file name and the like of the extracted receipt data are displayed in the area 1201 in FIG. The user selects a receipt data file to be displayed from the file name displayed in this area 1201 and clicks it. When the screen display button in the area 1205 in FIG. 3 is clicked, the data acquisition unit 110 extracts the receipt data (image data) from the receipt DB 210 and causes the display unit 170 to display the image data of the receipt data (FIG. 3). (See area 1207 in the screen example).
Then, the user conducts an actual examination of the receipt data while looking at the receipt data (image data) in a state similar to that in which the user visually confirms the contents described in the actual receipt (paper receipt). , Enter the result of the examination.

  The received data (image data) to be displayed is a condition (keywords, etc.) included in the judgment-required judgment rule so that the user can easily understand which part of the receipt data should be carefully examined. A portion that conforms to may be displayed with colored characters or underlines.

(Step S106)
On the other hand, in step S <b> 106, the rule update unit 122 receives selection of a display rule input by the user, and acquires this rule from the display rule storage unit 150.

Then, the user confirms the display rule in the area 1203 in FIG. 3 and clicks the rule application execution button in the area 1204 when applying the display rule displayed in the area 1203 as it is.
If you want to make some settings without applying the display rules as they are, click the rule setting button in the area 1204, set the rules on the display rule setting screen shown in FIG. 5, and then apply the rules in the area 1204. Click the execute button.
In addition, although the display rule of the area | region 1203 of FIG. 3 has selected only "Arrange by medical institution", you may select two or more display rules.

(Step S107)
In step S107, the receipt data sorting unit 121 arranges the receipt data narrowed down in step S106 based on the display rule selected in step S106 so that the user can extract the receipt data to be subjected to actual examination with priority. Make a replacement. The file names of the receipt data sorted by medical institution for easy viewing by the user are displayed in an area 1201 in FIG.

(Step S108)
In step S108, as in step S105, the processing unit 120 receives display input of receipt data (image data) from the user, and displays this image data on the display unit 170. And a user's examination result is received.

  The first embodiment of the present invention has been described above. According to this embodiment, the user can extract the receipt data that is likely to include an erroneous description of the medical fee. In other words, the person in charge of review can prioritize the actual review from the receipt data that is likely to include the wrong medical treatment fee, and can reduce the burden of the review process and improve the efficiency of the assistant work. . In addition, since the determination rule and the display rule can be set by the user himself / herself, the user can perform a detailed examination such as rearranging the receipt data in a form that the user can easily examine.

(Second Embodiment)
Next, a second embodiment of the present invention will be described.
FIG. 8 is a block diagram showing an expanded function of the examination support apparatus according to the second embodiment of the present invention. Components having functions similar to those of the first embodiment are denoted by the same reference numerals, and description thereof is omitted.
Based on the rules obtained from the past examination results, the examination support apparatus 300 includes the receipt data obtained from the receipt DB 210 of the receipt management unit 200 based on the rules obtained from the past examination results. It is characterized in that by sorting out items that are “low”, data that is likely to contain incorrect medical fees is extracted.

  As shown in FIG. 8, the examination support apparatus 300 includes a processing unit 320 that sorts, sorts, and retrieves receipt data, and a rule storage unit 301 that stores various rules for sorting receipt data. It is comprised including.

(Rule memory)
As described above, the rule storage unit 301 sorts the receipt data that is unlikely to contain an erroneous medical fee from the receipt data received by the processing unit 320, and receives the receipt data that conforms to a predetermined condition and fits Stores various rules for displaying.
Therefore, a screening unnecessary determination rule that is a criterion for determining that there is a low possibility that an erroneous medical fee is described, that is, a criterion for determining that there is a high possibility that a detailed actual screening is unnecessary is stored. A screening unnecessary determination rule storage unit 130 is included.

(Examination decision rule)
The review unnecessary judgment rule is based on the keywords (injuries and illnesses) described in the receipt, based on the past receipt review results and the experience of the examiner. Name, examination, medication, etc.). In the present invention, criteria that can be judged as “low” that the possibility of erroneous medical fees being described are called “unreviewed determination rules” for the sake of convenience, but there is no necessity for a review that meets these criteria. Not really. Since these receipts have a low possibility of error, it is possible to conduct an efficient examination with reduced human resources, and to put the remaining power into the examination of the receipt that describes the wrong medical fee. Therefore, it is possible to make more appropriate personnel allocation.

  As illustrated in the area 1206 of FIG. 3, the examination unnecessary determination rule is composed of one or more items (conditions). For example, the determination rule “No Prescription” ∧ “No Medication” of the judgment unnecessary judgment rule “B1” is composed of a condition “Prescription” and a condition “No Medication”. A receipt satisfying both (receipt data) indicates that there is a low possibility that an erroneous medical fee is described based on past examination results, that is, a high possibility that an actual examination is unnecessary.

Further, this examination unnecessary determination rule is also configured to include the “usage frequency”, “reliability”, and “support”.
Therefore, the examination unnecessary determination rule “B1” has been used “111111 times” in the examination support apparatus 300 until now, and there is a possibility that an incorrect medical fee is not described in the receipt data that conforms to this rule “99.0% The number of receipt data that conforms to this rule is “2%” of the total number of receipt data.
The receipt data sorting unit 321 sorts the receipt data that meets (applies) at least one of the examination unnecessary determination rules as the receipt data that is highly likely to require no actual examination.

The receipt data sorting unit 321 of the processing unit 320 may include an erroneous medical fee description based on a rule selected by the user among the screening unnecessary determination rules stored in the screening unnecessary determination rule storage unit 130 described above. A function that sorts out poorly received receipt data and extracts the receipt data that may include incorrect medical treatment fees, displays the receipt data (image data), and reviews the receipt data input by the user Has a function to accept results.
Here, as a condition for the receipt data sorting unit 321 to sort into the receipt data that is unlikely to include the description of the misdiagnosis fee, it conforms to any one of the plurality of examination unnecessary determination rules selected by the user. However, it may be set so that two or more rules are met.

The components of the second embodiment of the present invention have been described above.
Next, the processing procedure of the examination support apparatus 300 will be described with reference to FIGS. 3 and 8 and the flowchart of FIG.

  The operation in step S201 is the same as the operation in step S101 in FIG. 6 according to the first embodiment, and thus the description thereof will be omitted.

(Step S202)
In step S202, the rule update unit 122 of the examination support apparatus 300 accepts selection of the examination unnecessary determination rule input by the user as in the case of the first embodiment, and this rule is stored as the examination unnecessary judgment rule storage unit. From 130.

  In a region 1206 of FIG. 3, a list of examination unnecessary determination rules stored in the examination unnecessary determination rule storage unit 130 is displayed so that the user can check the examination unnecessary determination rules. This list also displays the usage frequency, reliability, support level, and the like, which serve as a guide when the user selects the examination unnecessary determination rule.

Then, the user checks the list of examination unnecessary judgment rules in the area 1206 in FIG. 3 and, if the user does not apply the examination unnecessary judgment rules as they are and wants to make some settings, click the rule setting button on the screen to conduct examination. A rule is set on an unnecessary determination rule setting screen (not shown), and then a rule application execution button in the area 1204 is clicked. Then, the receipt data sort part 121 performs a rule. As in the case of the screening unnecessary determination rule setting screen, the screening unnecessary determination rule setting screen can be used to select a screening unnecessary determination rule and to add a rule created by the user.
Here, for example, it is assumed that the examination unnecessary determination rule Nos. “B1”, “B2”, and “B3” are selected.

(Step S203)
In step S203, the receipt data sorting unit 321 uses the receipt data selected in step S201 from the receipt data selected in step S201 so that the user can extract the receipt data to be subjected to the actual examination with priority. Based on the receipt data that matches at least one of the examination unnecessary determination rules selected in step S202, that is, the receipt data that is unlikely to include an incorrect medical fee description, Extract.

  For example, the file name of the receipt data for which none of the screening unnecessary determination rules is matched is displayed in the area 1201 in FIG. In other words, if the selected screening unnecessary determination rule No is “B1”, “B2”, and “B3”, the file name of the receipt data that matches at least one of “B1”, “B2”, and “B3” Is not displayed in the area 1201.

(Step S204)
In step S204, when the user confirms the number of receipt data extracted in step S202 and immediately starts the actual examination (Yes), the process proceeds to step S205. If it is desired to rearrange and select (search) the receipt data (No), the process proceeds to S206.

(Step S205)
In step S <b> 205, the processing unit 320 of the examination support apparatus 300 receives an instruction input for displaying receipt data (image data) from the user, and displays the image data on the display unit 170. Then, a user examination result is received from the input unit 180. Here, the receipt data to be displayed (actual examination) may be selected manually while the user looks at the screen, or the user performs the actual examination work for the day based on his / her own examination work plan. It is good also as selecting the number of receipt data according to quantity.

  Since the operation from step S206 to step S208 is the same as the operation from step S105 to step S108 of FIG. 6 according to the first embodiment, the description thereof is omitted.

  Heretofore, the second embodiment of the present invention has been described. According to this embodiment, the user sorts out the receipt data that is unlikely to include the wrong medical fee, thereby extracting the data that may contain the wrong medical fee and receiving the receipt. The efficiency of data review can be improved. In addition, it is possible to improve the efficiency of the office assistant work and reduce the examination processing burden when the person in charge of the examination performs the actual examination.

(Third embodiment)
Next, a third embodiment of the present invention will be described.
FIG. 10 is a block diagram showing an expanded function of the examination support apparatus according to the third embodiment of the present invention. Components having the same functions as those in the first embodiment and the second embodiment are denoted by the same reference numerals and description thereof is omitted.

  The examination support apparatus 400 is a combination of the components in the first embodiment and the components in the second embodiment. That is, the processing unit 420 includes a receipt data sorting unit (medical fee detailed statement data sorting unit) 321, a receipt data sorting unit 121, and a rule updating unit 122. The rule storage unit 401 includes an examination-required determination rule storage unit 130, an examination-necessary determination rule storage unit 140, and a display rule storage unit 150.

The function of each component is the same as the function described in the first embodiment and the second embodiment, so that the description thereof will be omitted and the processing procedure of the examination support apparatus 400 will be described.
In the third embodiment, (1) first, the receipt data described in the second embodiment, which is less likely to contain erroneous medical fees, is sorted from the receipt data to be examined; 2) Next, the received data is rearranged in the descending order of the possibility that an erroneous medical fee is described in the first embodiment.

  FIG. 11 is a diagram schematically showing the processing procedure of the examination support apparatus 400. As shown in FIG. 11, first, in step S301, the receipt data sorting unit 321 of the examination support apparatus 400 describes an incorrect medical fee for the receipt data 510 to be examined using an examination unnecessary determination rule. A group 520 having a low possibility is classified into a group 530 having a high possibility that an erroneous medical fee is described.

  In step S <b> 302, the receipt data sorting unit 321 excludes the group 520 with a low possibility that an incorrect medical fee is described from the receipt data 510 to be examined, and describes an incorrect medical fee. Extract the group 530 with a high probability.

  In step S <b> 303, the receipt data sorting unit 121 sorts the receipt data group 540 that has been sorted from the group 530 in which an erroneous medical fee may be described in descending order of the possibility that the erroneous medical fee is described. create.

In step S304, the receipt data sorting unit 121 extracts a “particularly high” group 550 from the receipt data group 540 that is likely to contain an erroneous medical fee, and receives the receipt data that the user should review in the actual examination. Extract.
Here, the extraction of the group 550 that has a particularly high possibility that an erroneous medical fee is described may be manually selected on the spot by the user as in step S105 of the first embodiment described above. Based on the examination work plan of the user, the number of receipt data corresponding to the actual examination work amount of the user for the day may be selected in descending order of the possibility that the wrong medical fee is described. Good.

  Next, the operation of the examination support apparatus 400 in the third embodiment will be described using the flowchart of FIG. 12 with reference to FIG.

  The operation from step S401 to step S403 is the same as the operation from step S201 to step S203 of FIG. 9 according to the second embodiment, and the operation of step S404 is also similar to that of FIG. 6 according to the first embodiment. Since the operation is the same as that in step S102, description thereof will be omitted, and description will be given from step S405.

  In step S405, the receipt data sorting unit 121 selects the error extracted in step S403 based on the examination requirement rule selected in step S404 so that the user can extract the receipt data to be subjected to the actual examination with priority. Receipt data in which there is a possibility that medical fees are listed (highly likely) are rearranged in descending order of matching (hit) examination-required determination rules. That is, the receipt data excluding the receipt data that is unlikely to contain the description of the mistreatment fee is arranged in the order of the high possibility of describing the mistreatment fee.

  Since the operation from step S406 to step S410 is the same as the operation from step S104 to step S108 in FIG. 6 according to the first embodiment, the description thereof is omitted.

  The third embodiment has been described above. According to this embodiment, the screening support apparatus first excludes the receipt data that is unlikely to contain erroneous medical fees, and then in order from the highest possibility that erroneous medical fees are described. Since the receipt data is arranged, there is a high possibility of finding the receipt data in which an erroneous medical fee is described, and the examination processing burden when the examiner conducts the actual examination can be reduced. It is also possible to improve the efficiency of assistant office work.

  As mentioned above, although the example of suitable embodiment was shown about this invention, this invention is not limited to above-described embodiment, In the range which does not deviate from the meaning of this invention, it can change suitably. For example, although the examination support device is supposed to support the examination of receipt data (data of medical remuneration statement), it can be applied to various examinations such as credit card admission examination, criminal investigation and scoring of various qualification tests. It is.

Explained is the relationship between the examination support method for the medical remuneration specification, the examination support device for the medical remuneration specification, the program for the examination support device for the medical remuneration specification, and the use subject thereof in each embodiment of the present invention. FIG. It is the block diagram which expanded and showed the examination assistance apparatus in the 1st Embodiment of this invention. It is the figure which illustrated the operation screen of the examination assistance apparatus in each embodiment of this invention It is the figure which illustrated the screen for performing the setting of an examination required determination rule with the examination assistance device in the 1st embodiment of the present invention and the 3rd embodiment. In each embodiment of this invention, it is the figure which illustrated the screen for setting a display rule. It is the flowchart explaining operation | movement of the screening assistance apparatus 100 in the 1st Embodiment of this invention. In each embodiment of this invention, it is the figure which illustrated the examination work plan screen for a user to extract (select) examination object receipt data according to his own examination work plan. It is the block diagram which expanded and showed the examination assistance apparatus in the 2nd Embodiment of this invention. It is the flowchart explaining the process sequence of the examination assistance apparatus in the 1st Embodiment of this invention. It is the block diagram which expanded and showed the examination assistance apparatus in the 3rd Embodiment of this invention. It is the figure which showed typically the process sequence of the examination assistance apparatus in the 3rd Embodiment of this invention. It is a flowchart explaining the process sequence of the examination assistance apparatus in the 3rd Embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 100 Examination support apparatus 101 Rule storage part 110 Data acquisition part 120 Processing part 121 Receipt data sort part 122 Rule update part 130 Examination unnecessary judgment rule storage part 140 Examination required judgment rule storage part 300 Examination support apparatus 321 Receipt data classification part 400 Examination support apparatus

Claims (4)

A data acquisition unit that acquires medical fee description data from a receipt DB that stores the data of the medical fee specification, a processing unit, a display unit, and a storage unit, and supports examination of the medical fee specification An examination support device for a medical remuneration statement,
The storage unit
The criteria for determining the medical fee description data as the data of the medical fee specification that is unlikely to include a description of the erroneous medical fee description is indicated by a combination of the keyword conditions used in the medical fee statement. An examination unnecessary judgment rule storage unit for storing a plurality of judgment rules;
The criteria for determining the data of the medical fee description as data of the medical fee specification that is likely to include the description of the erroneous medical fee is indicated by a combination of keyword conditions used in the medical fee statement. A screening-required determination rule storage unit that stores a plurality of determination rules;
With
The processor is
Medical treatment fee including a combination of keyword conditions indicated in any of the examination unnecessary judgment rules stored in the examination unnecessary judgment rule storage unit among the data of the plurality of medical treatment fee specifications obtained by the data obtaining unit The condition of the keyword indicated in the examination requirement determination rule stored in the examination requirement determination rule storage unit out of the extracted medical fee statement data is extracted from the medical fee statement data excluding the statement data The medical remuneration statement examination support apparatus, wherein data of the medical remuneration statement including a combination of the above are displayed on the display unit in descending order of the number of combinations of the keyword conditions included . A medical support fee examination support program for supporting a medical fee statement review using a computer including an input unit, a display unit, and a processing unit,
Obtaining medical fee description data from a receipt DB storing the medical fee specification data; and
The criteria for determining the medical fee description data as the data of the medical fee specification that is unlikely to include a description of the erroneous medical fee description is indicated by a combination of the keyword conditions used in the medical fee statement. A step of displaying the examination unnecessary judgment rule of the examination unnecessary judgment rule storage unit for storing a plurality of judgment rules on the display unit;
Receiving a selection input of the examination unnecessary determination rule from the user via the input unit;
Obtaining the selected examination unnecessary judgment rule from the examination unnecessary judgment rule storage unit;
The medical fee details excluding the data of the medical fee statement including the combination of the keyword conditions indicated in any of the selected examination unnecessary determination rules among the medical fee details data acquired from the receipt DB Extracting document data; and
The criteria for determining the data of the medical fee description as data of the medical fee specification that is likely to include the description of the erroneous medical fee is indicated by a combination of keyword conditions used in the medical fee statement. A step of displaying on the display unit the examination-required judgment rule of the examination-required rule storage unit for storing a plurality of judgment rules;
Receiving a selection input of the examination requirement determination rule from the user via the input unit;
Obtaining the selected examination-required determination rule from the examination-required determination rule storage unit;
Among the data of the medical fee description data excluding the data of the medical fee specification statement including the combination of the keyword conditions indicated in any of the selected review unnecessary determination rules, the selected screening requirement determination rule Displaying the data of the medical remuneration statement including the combination of the keyword conditions shown on the display unit in the descending order of the number of combinations of the keyword conditions included ;
A program for examination support apparatus for medical remuneration statement, characterized in that said processing unit is executed. A data acquisition unit that acquires data of a medical fee description, and a criterion for determining the data of the medical fee specification as data of a medical fee statement that is unlikely to include erroneous medical fee descriptions. A screening unnecessary determination rule storage unit that stores a plurality of screening unnecessary determination rules indicated by a combination of keyword conditions used in a certificate, and a medical fee detailed description that is likely to include a description of a false medical fee in the medical fee description data A screening-required determination rule storage unit that stores a plurality of screening-required determination rules indicating the criteria for determining the data of the certificate as a combination of the keyword conditions used in the medical remuneration statement, a processing unit, and a display unit . An examination support method for a medical fee statement using a medical examination fee examination support device provided,
The data acquisition unit acquiring data of the medical fee description from a receipt DB storing data of the medical fee specification;
A combination of keyword conditions indicated in any of the examination unnecessary determination rules stored in the examination unnecessary determination rule storage unit among the plurality of medical fee detailed statement data acquired by the data acquisition unit by the processing unit Extracting medical fee statement data excluding the medical fee statement data including:
The processing unit includes the extracted medical fee description data, the medical fee specification data including a combination of keyword conditions indicated in the screening requirement rule stored in the screening requirement rule storage unit, Displaying on the display unit in descending order of the number of combinations of the keyword conditions included ;
A method for supporting examination of medical fee remuneration statements, characterized in that An examination support method for a medical fee statement that supports examination of a medical fee statement using a computer including a data acquisition unit, an input unit, a display unit, and a processing unit,
The data acquisition unit acquiring the data of the medical fee description from a reception DB storing the data of the medical fee specification;
A combination of keyword conditions used in the medical fee description as a criterion for determining the data of the medical fee specification as data of the medical fee specification that is unlikely to include the description of the erroneous medical fee. A step of displaying, on the display unit, the examination unnecessary judgment rule of the examination unnecessary judgment rule storage unit for storing a plurality of examination unnecessary judgment rules shown in FIG.
Receiving a selection input of the examination unnecessary determination rule from the user via the input unit;
The processing unit acquires the selected examination unnecessary determination rule from the examination unnecessary determination rule storage unit;
The processing unit includes data on a medical fee description including a combination of keyword conditions indicated in any of the selected examination unnecessary determination rules among the medical fee specification data acquired from the receipt DB. Extracting the data of the excluded medical fee statement;
A combination of keyword conditions used in the medical fee description as a criterion for the processing unit to determine the data of the medical fee specification as data of the medical fee specification that is likely to include a description of an erroneous medical fee A step of displaying on the display unit the examination requirement determination rule of the examination rule storage unit that stores a plurality of the examination requirement determination rules shown in FIG.
Receiving a selection input of the examination requirement determination rule from the user via the input unit;
The processing unit obtaining the selected examination-required determination rule from the examination-required determination rule storage unit;
The processing unit is selected from among the data of the medical fee specification data excluding the data of the medical fee specification statement including the combination of the keyword conditions indicated in any of the selected examination unnecessary determination rules Displaying the data of the medical fee remuneration statement including a combination of keyword conditions indicated in the examination-needed determination rule on the display unit in descending order of the number of keyword condition combinations included ;
A method for supporting examination of medical fee remuneration statements, characterized in that

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