JPH07104885B2 - Dental insurance claim office calculator - Google Patents

Description

TECHNICAL FIELD The present invention relates to a dental insurance claim office computer, and more particularly to a method of calculating medical items.

(B) Conventional technology The insurance claim office calculator that issues counters and monthly medical bills is widely used in general hospitals such as internal medicine and surgery. Technical report
VOL.11 No.1 (1979 edition) ".

In such a system, at the counter work, the medical care code indicating the medical care item given to the patient by the doctor and the number of times were input, but in the dentistry, the part that has been treated is also described in the medical treatment statement. Therefore, in the conventional insurance claim office machine for dentistry, in the window work, the part treated, the medical treatment code, and the number of times of treatment are input.

(C) Problems to be Solved by the Invention In the conventional dental insurance claim calculator, as described above, the operator has to input the medical treatment site, the medical treatment code, and the number of times, so Was troublesome.

Also, in dentistry, insurance points differ depending on the type and number of teeth, such as front teeth, premolars, and molars, even with the same medical treatment content. Therefore, in terms of computer processing, those with different insurance points usually have different medical items. , And a different medical care code is assigned to each. Further, the treated site is generally described in the chart by the tooth number called a dental formula.

Therefore, the operator must judge the tooth type and the number of root canals based on the tooth formula, and perform the input operation while performing the thinking work of determining the corresponding medical care code and the number of times based on the judgment result. No, the burden on the operator was very heavy.

In addition to the items that can be calculated for each visit, there are also items that can be calculated only once a month or once a calendar month. How can a computer handle such restrictions regarding the period? It was a problem.

(D) Means for solving the problem A representative code is set for a plurality of medical care items having the same medical care content with different medical care codes depending on factors such as the number of teeth, and the medical care items are related to the medical care item or the representative code. , A storage means for storing in advance the part check data and the part check data relating to the part and the period required for the calculation, and a patient data file for storing the medical care code for each patient and storing the first consultation date. An input means for inputting the representative code, part data indicating a medical part, and medical treatment date; and, when inputting the representative code, from the contents of the patient data file and the input medical treatment date according to the period check data, Determination means for determining whether or not the calculation regarding the period of the medical care item represented by the representative code is possible,
At the time of inputting the representative code, a calculation means for calculating the number of times of calculation of the medical care item represented by the representative code by collating the part check data with the input part data, and a display means are provided, and The above-mentioned problems are solved by displaying the number of times of calculation on the display means according to the determination result of the determination means.

(E) Action In the present invention, the number of times is automatically calculated and displayed as long as the region data indicating the treated region, the medical treatment date, and the representative code representing the medical treatment contents are input. And, the input operation of the number of times becomes unnecessary. That is,
If you do a very simple operation while looking at the chart,
The number of times is calculated automatically.

(F) Example Before explaining the example of the present invention, first, a tooth formula will be described. The tooth formula indicates a tooth portion, and
As shown in the figure, it consists of vertical and horizontal straight lines and numbers. The vertical and horizontal straight lines indicate a boundary that divides the mouth (oral cavity) into upper, lower, left and right, and the numbers indicate tooth numbers sequentially given from the front teeth to the back teeth. Therefore, if a tooth formula as shown in FIG. 20 is shown as the treated site, it is the tooth of the upper right jaw No. 4,
This means that the patient examined the 7th lower left jaw.

Now, FIG. 1 is a block diagram showing a configuration of an embodiment of a dental insurance claim office computer according to the present invention, in which (1) is provided with various keys such as a tooth type key, an input key, a character key and a numeric key. A keyboard, (2) a CRT display as a display device, (3) an external storage device such as a magnetic disk comprising a patient data file (4) and a medical care code file (5), (6) a patient data buffer, ( 7) is a processing target buffer, (8) is a definite buffer, (9) is an arithmetic processing unit, (10) is a control unit, and (13) is a period determination unit including a search unit (14) and a comparison unit (15). is there.

In the present invention, as in the conventional case, even if the medical care contents are the same,
Different medical care codes are assigned to a plurality of medical care items A, B, C, ... having different insurance points depending on factors such as the number of teeth and the types of teeth, but these plural medical care items A, B, C are assigned. A representative code representative of, ... Is newly defined. Then, in the representative code portion (11) of the medical care code file (5), the representative code and the medical care code contained therein are stored as representative data in association with each other as shown in FIG.
I also remember the name.

Further, for each medical care item, as shown in FIG. 3, the medical care code, the name, the points, the part check data regarding the part necessary for automatic calculation and the period check data regarding the period are used as medical care item data. File (5)
It is stored in the medical care code section (12).

The site check data consists of site unit identification data that shows the unit of calculation for the calculation of 1 oral cavity, 1/3 jaw, number of root canals, etc., and site definition data that defines factors such as the number of teeth and tooth types. As will be described in detail in Section 4, the site unit identification data is used to select the type of operation to be performed in the automatic calculation, and the site definition data is used together with the data in the actual operation process. The definition data is specifically represented by a tooth formula, the number of teeth, and the like.

The period check data consists of period calculation unit data showing the calculation unit for the period and first examination month check unit data showing the type of calculation for the first examination month. Specific examples of each data are shown in FIG. 4 and FIG. Show.

On the other hand, the patient data file (4) is a file in which the contents of the medical treatment of the patient are stored as data for each patient, and the file of each patient is as shown in FIG.
An initial data section (16) and a patient data section (17) are provided. The patient data section (17) stores patient data for two months, this month and the previous month, for each medical treatment day. The initial data section (16) mainly stores patient code, name, first consultation date, etc. Data unique to each patient is stored. In addition, in the present embodiment, a code storage area (18) for storing the medical care code and the medical care date is provided in the initial data section (16) for a medical care item that can be calculated only once during the medical care period. 1
For medical items that can be calculated only once, it is possible to judge whether or not they can be calculated.

Next, the contents of the medical care code file (5) will be described in detail by taking specific medical care contents as an example.

(I) Periodontal tissue detailed examination <Period> Calculation is not possible within 1 month from the first medical examination day Calculation is possible only once during the medical examination <Part> Total number of teeth per oral cavity is 20 teeth 180 points 21-24 teeth 300 points 25 More than 400 teeth (ii) Extraction surgery <Period> No restrictions <Site> 140 front teeth per tooth 240 points molars Regarding the medical treatment of (i) and (ii) above, in the present embodiment, the medical treatment code file (5) is used. , And stores data as shown in FIGS. 7 and 8, respectively. The specific contents of the site unit identification data are as shown in FIG.

That is, in the case of (i), there are three medical care items corresponding to the total number of teeth, and as the part definition data of each medical care item, the number of teeth defining the range of the total number of teeth is stored, and the period calculation unit data is stored. And, as the unit data for the first checkup month check, "4" for each
And “2” are stored.

In the case of (ii), there are two medical care items depending on the type of tooth, and the part definition data of each medical care item stores the tooth formula defining the anterior tooth and the dental formula defining the molar, and the period check is performed. As data, there are no restrictions, so "0", "0"
Memorize

Next, the flow of processing of this embodiment will be described with reference to the flowcharts of FIGS. 9 to 17 and the display example of FIG.

As shown in FIG. 9, in the window operation, first, when the patient code and the medical treatment date are input from the keyboard (1), all the patient data of the input patient code from the patient data file (4) is stored in the patient data buffer (6). If there is patient data that has been read out and has an input medical treatment date, that data is written in the confirmation buffer (8).

Next, the tooth formula key is pressed to display a cross line on the display screen of the CRT display (2), and then the tooth number is input to input the tooth formula indicating the site where the medical treatment is performed. Then, after that, a representative code indicating the content of medical treatment is input (Fig. 19 (a)).

Then, the input dental formula is stored in the confirmation buffer (8), and a plurality of medical care item data included in the input representative code is processed from the medical care code part (12) of the medical care code file (5). It is read to the target buffer (7).

In this way, when a plurality of medical care item data are read by the input of the representative code, next, the period judging unit (13) judges whether or not these medical care items can be calculated for the period. This judgment is performed by the comparison unit (15), which is shown in FIG.
It consists of the period calculation unit check shown in FIG. 11, and in the following description, an example of performing both checks will be described in detail.
Of course, depending on the system, only one check may be executed.

First, as shown in FIG. 10, in the initial consultation month check, the initial consultation month check unit data is determined, and depending on the content,
The input medical treatment date and the first medical examination date read out to the patient data buffer (6) are compared with each other to judge whether or not the calculation is possible. And
When the calculation is not possible, the number of calculations based on the part check data described later is not calculated, and only the medical care item name and the input field are displayed on the screen. If the calculation is possible, move to the period calculation unit check.

In the period calculation unit check, as shown in FIG. 11, the period calculation unit data in the read out medical care item data is discriminated, and the processing target buffer ( Each data in the patient data buffer (6) is searched for whether or not there is a medical care code identical to the medical care code read out in 7).

In other words, the period calculation data is "1" indicating "1 visit"
In case of, as shown in the flow chart of FIG. 13, only the patient data for the current day in the confirmation buffer (8) is searched,
When it is "2" indicating "once a month", as shown in the flowchart of Fig. 14, in addition to the data for the current day in the confirmation buffer (8), the patient data for the current month in the patient data buffer (6) If "3" indicating "once a calendar month" is also searched for,
As shown in FIG. 15, when the patient data for the previous month and the current month in the patient data buffer (6) are searched in addition to the current day, and the medical treatment day of the retrieved data is smaller than the input medical treatment day Only the judgment is possible. Further, when "4" indicating "once medical treatment period", as shown in FIG. 16, the code storage area (1) read in the patient data buffer (6) is further added.
The contents of 8) are also searched. Then, in these searches, only when the same medical care code is not searched at all, the calculation count of the next part is calculated. , The number of calculations is not displayed.

As shown in FIG. 12, the calculation of the number of calculations is performed based on the part check data and the input tooth formula in the read medical care item data. First, the calculation processing unit ( The type of calculation to be executed in 9) is selected, the site definition data is referred to in the selected calculation, and the maximum number of times that can be calculated for each medical care item represented by the input representative code is calculated. .

For example, when the site check data is “03” indicating “1 oral cavity / total number of teeth”, first, as shown in the flowchart of FIG. 17, the total number of teeth N is calculated from the input tooth formula, and then, It is determined whether or not the total number of teeth N is included in the number-of-teeth range NL to NH as the part definition data of each medical care item, and the number of medical care items included is set to "1".

Therefore, with respect to the input tooth type as shown in FIG.
If the representative code "Seimitsu" is entered, the total number of teeth N is "27", so as shown in Fig. 19 (b), the CRT display (2) screen shows the clinical item "Periodical tissue detailed examination". (1) in the input field for the number of times (from 25 teeth)
Is displayed.

Therefore, when the operator confirms the displayed number of times of calculation and then presses the input key, as shown in FIG. 19C, only the medical care items for which the number of times of calculation is one or more are displayed on the display screen. It is displayed again in the form of (point) × (number of times) to inform the operator that the input regarding this medical care item has been completed. At the same time, in the apparatus, the number of calculations is added to the medical care item data for the medical care item displayed again and stored in the confirmation buffer (8), and the contents of the processing target buffer (7) are cleared.

In this way, when the medical care item data is stored in the confirmation buffer (8), if the stored medical care item is the period calculation unit data “4”, the medical care code and the medical care date are It is stored in the code storage area (18) of the patient data buffer (6).

When the end key is pressed after the calculation is completed as described above, the dental formula stored in the confirmation buffer (8), the medical care item data excluding the site check data, and the number of calculations are displayed.
The patient data buffer (6) is stored at a location corresponding to the input medical treatment date, and further, all the data of the patient data buffer (6) is stored at a location corresponding to the input patient code of the patient data file (4). .

Here, for example, as shown in FIG.
On the 5th day of June, the same patient entered the representative code "Seimitsu" for the same tooth formula when the periodontal tissue detailed examination (25 teeth ~) had already been calculated "once". However, the number of times is not displayed in the input field as shown in FIG. 19 (d) because it is determined that the calculation is impossible by the above-mentioned period calculation unit check.

By the way, when the medical treatment content is “tooth extraction surgery”, the period calculation unit data and the first-examination-month check unit data are “0”, and therefore the calculation number of the part check data is immediately entered and the calculation result is always displayed. The calculation processing contents in this case are shown in FIG.

In the present embodiment, the site unit identification data, the initial examination month check unit data, and the period calculation unit data are stored in each medical care item data, but instead, they are stored in the representative data shown in FIG. It may be done.

(G) Effect of the Invention According to the present invention, the number of medical care items can be automatically calculated without inputting the number of times by inputting the representative code, the medical treatment site, and the medical treatment date. At the same time, troublesome thinking work becomes unnecessary and the burden on the operator is significantly reduced. In particular, since the automatic calculation checks not only the part but also the period, the automatic calculation is extremely accurate, and even an operator unskilled in dental care can perform complicated insurance claim work.

[Brief description of drawings]

FIG. 1 is a block diagram showing a configuration of an embodiment of a dental insurance claim office computer according to the present invention, FIG. 2 is a diagram showing a data structure of a representative code part of a medical care code file, and FIG. 3 is medical care of a medical care code file. Diagram showing the data structure of the code part,
FIG. 4 is a diagram showing the relationship between the period calculation unit data and the calculation unit, FIG. 5 is a diagram showing the contents of the first-visit-month check unit data, FIG. 6 is a diagram showing the data structure of the patient data file, and FIG. And FIG. 8 is a diagram showing a specific example of the medical care code file, FIGS. 9 to 12 are flowcharts showing the processing contents of this embodiment, and FIGS. 13 to 16 are specific examples in each period calculation unit. A flow chart showing the processing contents,
17 and 21 are diagrams showing the concrete contents of the arithmetic processing, FIG.
FIG. 18 is a diagram showing the contents of the site unit identification data, FIG. 19 is a diagram showing a display example in this embodiment, and FIG. 20 is a diagram for explaining the tooth formula. (1) …… Keyboard, (2) …… CRT display,
(4) …… Patient data file, (5) …… Medical treatment code file, (7) …… Processing target buffer, (8) …… Confirmation buffer, (9) …… Computation processing unit, (10) …… Control Division, (13) …… Period determination section, (14) …… Search section, (15)
…… Comparison department.

 ─────────────────────────────────────────────────── ─── Continuation of front page (72) Inventor Ryuichi Kato 180 Sakata, Oizumi-cho, Gunma-gun Ojizumi-cho, East Kyosanyo Electric Co., Ltd. (72) Etsumi Daimaru 180 Sakata, Oita-gun, Oizumi-gun, Gunma Prefecture Within Kyosanyo Electric Co., Ltd. (72) Inventor Kino Okura 180 Sakata, Ojiizumi-gun, Gunma Prefecture Osamu, East Kyosanyo Electric Co., Ltd. (72) Shuji Ueno 180 Sakata, Oita-gun, Oizumi-gun, Gunma Prefecture Inside Kyosanyo Electric Co., Ltd. (72) Inventor Koji Tsukamoto 180 Sakata, Oizumi-cho, Gunma-gun Osamu-gun, East Kyosanyo Electric Co., Ltd. (56) Reference JP-A-60-68463 (JP, A) JP-A-60 -198670 (JP, A) JP 59-188770 (JP, A) JP 61-123971 (JP, A)

Claims (1)

[Claims] 1. A representative code is defined for a plurality of medical care items having the same medical care content with different medical care codes depending on factors such as the number of teeth, and the site necessary for calculation in relation to the medical care item or the representative code. And storage means for storing the part check data and the period check data for each period in advance, a patient data file for storing the medical care code for the patient for each patient and the first medical examination date, the representative code and the medical care. When inputting the representative code, the input means for inputting the site data indicating the site and the medical treatment date,
Determination means for determining whether or not the calculation regarding the period of the medical care item represented by the representative code can be calculated from the contents of the patient data file and the input medical treatment date according to the period check data; Comparing the check data with the input site data, a calculating means for calculating the number of times the medical care item represented by the representative code is calculated, and a display means are provided, and according to the determination result of the determining means, A dental insurance claim office computer, wherein the number of calculations is displayed on the display means.