CN110391006A - Drug for medical insurance clearing marks method certainly - Google Patents
Drug for medical insurance clearing marks method certainly Download PDFInfo
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- CN110391006A CN110391006A CN201910666229.1A CN201910666229A CN110391006A CN 110391006 A CN110391006 A CN 110391006A CN 201910666229 A CN201910666229 A CN 201910666229A CN 110391006 A CN110391006 A CN 110391006A
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- drug
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
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- General Health & Medical Sciences (AREA)
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- Medicinal Chemistry (AREA)
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Abstract
The invention discloses the drugs settled accounts for medical insurance from mark method, it is characterized in that, described method includes following steps: S1: inventory's drug data in hospital is imported in target audit library, and the drug data being stored into target audit library is classified, and drug data is divided into limitation medication, unrestricted medication, Class A drug, Class B drug and drug at one's own expense；S2: medication doctor enters the drug that suitable patient condition is checked in target audit library, audits the remark information in library in drug list according to target and chooses drug, target audits library generation drug and audits inventory；S3: drug audit inventory is imported in patient electronic medical record, and patient submits electronic health record in medical insurance settlement window, and medical insurance settlement window export drug audit inventory is settled accounts.Currently, needing to carry out audit confirmation to patient medication in medical insurance settlement window in medication audit, because annual drug classification is different, there are many drugs that may be exchanged every year from the reimbursement list of medical insurance office.
Description
Technical field
The present invention relates to a kind of drugs to mark method certainly, and in particular to the drug for medical insurance clearing marks method certainly.
Background technique
With the continuous growth of social economy, the medical service level in China is also obviously improved, and medical insurance expenditure is in
The trend risen year by year.Medical insurance work is also faced with huge medical insurance Closing Check work while achieving many achievements
Pressure.In order to cope with huge medical insurance Closing Check work, the medical act of hospital is standardized, is fundamentally guaranteed insured
The legitimate rights and interests of people, and realize the balance between revenue and expenditure and safety of medical insurance fund, it is necessary to existing medical insurance examination into
Row improves and innovation.
It in the prior art, is artificial review to audit, verification of medical insurance reimbursement document etc., i.e. auditor holds report
Pin document is checked one by one, and review efficiency and Quality of Auditing are low, it is easy to omit the reimbursement document data of violation, and then occur big
The suspicious actions such as fraud, abuse, the waste of amount, cause Medical Benefits Fund to incur loss.In addition, to medical insurance reimbursement document
Audit be concentrated mainly on clearing after audit, entire review process can not be monitored, not can avoid thus in violation of rules and regulations
The generation of behavior is only to punish to the unlawful practice occurred after the completion of clearing, lacks the control in prompting and thing in advance.
Due to being had differences between the careful medical insurance data standard of existing hospital data standard and core, hospital data into
Enter the matching that data code between artificial carry out standard is needed when medical insurance audit, this not only adds artificial implementation cost, efficiency
Lowly, and for some there is word that can not audit without the not high data of the qualities of data such as code.In the prior art mainly according to
According to the big catalogue of medical insurance three, the extraction for carrying out rule is summarized, in conjunction with information personal in clearing forms data, designated medical organization
Information carries out the data that collision comparison filters out violation with rule one by one.This audit mode is mainly audited according to rule,
Violation, fraud except rule are then had no way out, and the anti-fraud that shortage carries out intersecting in various dimensions big data identification is patrolled
Volume, so that the result that simple regular audit mode detected is limited, it cannot preferably protect the risk that medical insurance fund uses.
Summary of the invention
It is in medical insurance settlement window, due to medical insurance the technical problem to be solved by the present invention is to previous limitation medication audit
Auditor will lead to extend patient's waiting time to limitation medication familiarity, audit limitation medication, cause patient satisfaction
Decline, so, in order to reduce patient's waiting time, increase medication audit precision.Limitation medication audit is preposition, allow doctor's advice to cure
Life audit to limitation medication just extremely urgent.Present specification is designed to provide the drug for medical insurance clearing from the side of marking
Method solves the problem above-mentioned.
The present invention is achieved through the following technical solutions:
Drug for medical insurance clearing marks method certainly, which is characterized in that described method includes following steps: S1: by hospital
Interior inventory's drug data imports in target audit library, and the drug data being stored into target audit library is classified, by drug
Data are divided into limitation medication, unrestricted medication, Class A drug, Class B drug and drug at one's own expense；S2: medication doctor enters target and examines
The drug that suitable patient condition is checked in verifying the turnover of materials stored audits the remark information in library in drug list according to target and chooses drug, mesh
Mark audit library generates drug and audits inventory；S3: drug audit inventory is imported in patient electronic medical record, patient settles accounts window in medical insurance
Mouth submits electronic health record, and medical insurance settlement window export drug audit inventory is settled accounts.
Currently, needing to carry out audit confirmation to patient medication in medical insurance settlement window, because every year in medication audit
Drug classification it is different, have many drugs that may be exchanged every year from the reimbursement list of medical insurance office, need medical insurance auditor
Member is familiar with limitation medication, and the reimbursement ratio for auditing each similar drug will lead to extension in the waiting time of medical insurance settlement window, past
Too long in the medical insurance settlement window residence time toward will cause sufferer, audit limitation medication will lead to extend patient's waiting time,
Patient satisfaction is caused to decline, so in order to reduce patient's waiting time, increase medication audit precision.Limitation medication is audited
It is preposition, allow doctor's advice doctor limitation medication audit it is just extremely urgent.Present specification is exactly to use a kind of drug from the side of marking
The audit of drug is audited in advance by database, allows medication doctor when writing a prescription, can audit to drug by method
Confirmation.
Further, there are also storage diagnosis and treatment item data in target audit library, medication doctor carries out step S2 selection
While drug, chooses corresponding diagnosis and treatment item and reinforce therapeutic effect, and the diagnosis and treatment item of selection is imported into drug and audits inventory
In.When hospital carries out diagnosis and treatment, often has some diagnosis and treatment items and match, such as massage, acupuncture, bonesetting, massage etc.
Diagnosis and treatment item mating can export these diagnosis and treatment items out of target audit library to drug when medication doctor selects drug
It audits in inventory, allows medication doctor that can get the medical insurance settlement information of drug when writing a prescription, certainly by database
Row clearing generate drug inventory and price.
Further, remarks have medicine information in the drug data in target audit library, and the medicine information includes
Drug specifications, price, quantity and applicable symptom information are checked and approved by medicine information the case where choosing drug.With
When medicine doctor carries out selection drug, can the price of understanding drug definitely can select medicine for some particular customers
When, it can be according to patient's economic conditions and medicine information.Allow medication doctor that can choose the drug being directed to.
Further, drug data is compared, and carry out by target audit library when generating drug inventory
Mark audit confirmation generates drug inventory by medication doctor to using drug to carry out after confirming one by one.Medication doctor is allowed to carry out
Confirmation audit comparison, it is possible to reduce the queuing situation of medical insurance settlement window allows each medication doctor by drug data directly from careful
After being exported in nuclear data depositary drug price inventory can be determined, the expense of medical insurance drug is arranged when choosing drug
It is bright, it allows medical insurance settlement window that can quickly handle patient's bill, avoids blocking in medical insurance settlement window.
Further, the medication doctor carries out confirmation audit to drug, and drug is audited by being directly entered drug inventory
Interior, drug is audited not by the way that drug is then classified as drug at one's own expense, is confirmed whether after being included in drug inventory to patient, and drug is generated
Inventory.There are Some Drugs that may be overlapped use, need to list extra drug from medical insurance inventory at this time, doctor's confirmation is allowed to examine
Batch, because the button that these drugs cannot enjoy medical insurance at this time is exempted from, patient is needed to carry out at one's own expense, so needing secondary-confirmation.
Further, the electronic health record is stored in hospital database, by the unlatching key storage of corresponding electronic health record
In the medical magnetic card of corresponding patient, entered in hospital database by the unlatching key of medical magnetic card, reads Patients ' Electronic disease
Go through information.All it is the key opener by medical magnetic card as diagnosis and treatment data at present, is determined by this medical magnetic card
The information of each patient.
Compared with prior art, the present invention having the following advantages and benefits:
1, the present invention promotes medical personnel's working efficiency, it is not necessary to Hua great Liang for the drug of medical insurance clearing from method of marking
Time, which is used in, consults drug restrictive condition；
2, the present invention improves medical insurance settlement window working efficiency, reduces patient for the drug of medical insurance clearing from method of marking
Waiting time improves the social satisfaction of patient satisfaction, hospital；
3, the present invention reduces the medical insurance as caused by limitation medication audit mistake for the drug of medical insurance clearing from method of marking
Wrong report.Avoid the loss of patient and hospital.Improve Hospital medical image.
Specific embodiment
To make the objectives, technical solutions, and advantages of the present invention clearer, the present invention is made below with reference to embodiment
Further to be described in detail, exemplary embodiment of the invention and its explanation for explaining only the invention, are not intended as to this
The restriction of invention.
Embodiment
Drug of the present invention for medical insurance clearing marks method certainly, which is characterized in that described method includes following steps: S1:
Inventory's drug data in hospital is imported in target audit library, and the drug data being stored into target audit library is classified,
Drug data is divided into limitation medication, unrestricted medication, Class A drug, Class B drug and drug at one's own expense；S2: medication doctor enters
The drug that suitable patient condition is checked in target audit library audits the remark information in library in drug list according to target and chooses medicine
Product, target audit library and generate drug audit inventory；S3: drug audit inventory is imported in patient electronic medical record, patient is in medical insurance
Settlement window submits electronic health record, and medical insurance settlement window export drug audit inventory is settled accounts.
Currently, needing to carry out audit confirmation to patient medication in medical insurance settlement window, because every year in medication audit
Drug classification it is different, have many drugs that may be exchanged every year from the reimbursement list of medical insurance office, need medical insurance auditor
Member is familiar with limitation medication, and the reimbursement ratio for auditing each similar drug will lead to extension in the waiting time of medical insurance settlement window, past
Too long in the medical insurance settlement window residence time toward will cause sufferer, audit limitation medication will lead to extend patient's waiting time,
Patient satisfaction is caused to decline, so in order to reduce patient's waiting time, increase medication audit precision.Limitation medication is audited
It is preposition, allow doctor's advice doctor limitation medication audit it is just extremely urgent.Present specification is exactly to use a kind of drug from the side of marking
The audit of drug is audited in advance by database, allows medication doctor when writing a prescription, can audit to drug by method
Confirmation.
Drug is carried out from marking using this method, previous limitation medication audit is in medical insurance settlement window, since medical insurance is examined
Core personnel will lead to extend patient's waiting time to limitation medication familiarity, audit limitation medication, cause under patient satisfaction
Drop, so, in order to reduce patient's waiting time, increase medication audit precision.Limitation medication is audited preposition, allows doctor's advice doctor
Limitation medication audit just extremely urgent.So coming into being from mark window.We are patient institute inside mark window certainly
Restricted payment drug all extracts in this program, and the relevant information of this medicine all is extracted.Such as
Specification, price, the expense when generated and the most important this medicine limit any symptom, and such doctor is just not
Need to go to consult again related data to determine whether this medicine belongs to this diagnosis.Know that oneself is opened in order to facilitate doctor
What kind of medicine, if belong to limitation medication, we added the mark of this medicine if it is limit before all drugs
Medication processed, then front has ' (limit) ', first and second then have ' (first) ', ' (second) ', ' (certainly) ' to remind respectively from three similar drugs
Doctor's rational use of medicines.
There are also storage diagnosis and treatment item data in target audit library, medication doctor carries out step S2 and chooses the same of drug
When, it chooses corresponding diagnosis and treatment item and reinforces therapeutic effect, and the diagnosis and treatment item of selection is imported in drug audit inventory.In hospital
When carrying out diagnosis and treatment, often has some diagnosis and treatment items and matches, such as the diagnosis and treatment items such as massage, acupuncture, bonesetting, massage,
When medication doctor selects drug, mating these diagnosis and treatment items can be exported out of target audit library to drug and audit inventory
In, allow medication doctor that can get the medical insurance settlement information of drug when writing a prescription, it is raw by database self-clearing
At drug inventory and price.
Remarks have a medicine information in drug data in target audit library, the medicine information include drug specifications,
Price, quantity and applicable symptom information are checked and approved by medicine information the case where choosing drug.It is carried out in medication doctor
When choosing drug, can the price of understanding drug definitely can be when selecting medicine for some particular customers, Ke Yigen
According to patient's economic conditions and medicine information.Allow medication doctor that can choose the drug being directed to.
Drug data is compared, and be labeled audit by target audit library when generating drug inventory
Confirmation generates drug inventory by medication doctor to using drug to carry out after confirming one by one.Medication doctor is allowed to carry out confirmation audit
Comparison, it is possible to reduce the queuing situation of medical insurance settlement window allows each medication doctor by drug data directly from audit database
After middle export drug price inventory can be determined, the expense of medical insurance drug be listed, allow medical insurance when choosing drug
Settlement window can quickly handle patient's bill, avoid blocking in medical insurance settlement window.
The medication doctor carries out confirmation audit to drug, and drug is audited by being directly entered in drug inventory, and drug is examined
Core does not pass through, and drug is classified as drug at one's own expense, is confirmed whether after being included in drug inventory to patient, generates drug inventory.There is portion
Drug dispensing product may be overlapped use, need to list extra drug from medical insurance inventory at this time, allow doctor to confirm examination & approval, because thus
When these drugs cannot enjoy the button of medical insurance and exempt from, need patient to carry out at one's own expense, so needing secondary-confirmation.
The electronic health record is stored in hospital database, by the unlatching key storage of corresponding electronic health record in corresponding patient
Medical magnetic card in, entered in hospital database by the unlatching key of medical magnetic card, read patient electronic medical record's information.At present
All it is the key opener by medical magnetic card as diagnosis and treatment data, the letter of each patient is determined by this medical magnetic card
Breath.
Above-described specific embodiment has carried out further the purpose of the present invention, technical scheme and beneficial effects
It is described in detail, it should be understood that being not intended to limit the present invention the foregoing is merely a specific embodiment of the invention
Protection scope, all within the spirits and principles of the present invention, any modification, equivalent substitution, improvement and etc. done should all include
Within protection scope of the present invention.
Claims (6)
1. the drug for medical insurance clearing marks method certainly, which is characterized in that described method includes following steps:
S1: by hospital inventory's drug data import target audit library in, and be stored into target audit library in drug data into
Drug data is divided into limitation medication, unrestricted medication, Class A drug, Class B drug and drug at one's own expense by row classification；
S2: medication doctor enters the drug that suitable patient condition is checked in target audit library, audits drug in library according to target and arranges
Remark information in table chooses drug, and target audits library and generates drug audit inventory；
S3: drug audit inventory is imported in patient electronic medical record, patient submits electronic health record, medical insurance knot in medical insurance settlement window
Window export drug audit inventory is calculated to be settled accounts.
2. the drug according to claim 1 for medical insurance clearing marks method certainly, which is characterized in that the target audits library
It is interior that there are also store diagnosis and treatment item data while medication doctor carries out step S2 selection drug to choose corresponding diagnosis and treatment item and add
Strong therapeutic effect, and the diagnosis and treatment item of selection is imported in drug audit inventory.
3. the drug according to claim 1 for medical insurance clearing marks method certainly, which is characterized in that the target audits library
In drug data in remarks have a medicine information, the medicine information includes drug specifications, price, quantity and applicable symptom letter
Breath is checked and approved by medicine information the case where choosing drug.
4. the drug according to claim 1 for medical insurance clearing marks method certainly, which is characterized in that the target audits library
When generating drug inventory, drug data is compared, and is labeled audit confirmation, by medication doctor to using
Drug carries out after confirming one by one, generates drug inventory.
5. the drug according to claim 4 for medical insurance clearing marks method certainly, which is characterized in that the medication doctor couple
Drug carries out confirmation audit, and drug is audited by being directly entered in drug inventory, and drug by not being classified as certainly then by drug audit
Take drug, be confirmed whether after being included in drug inventory to patient, generates drug inventory.
6. the drug according to claim 1 for medical insurance clearing marks method certainly, which is characterized in that the electronic health record is deposited
Storage opens key storage in the medical magnetic card of corresponding patient in hospital database, by corresponding electronic health record, passes through medical treatment
The unlatching key of magnetic card enters in hospital database, reads patient electronic medical record's information.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910666229.1A CN110391006A (en) | 2019-07-23 | 2019-07-23 | Drug for medical insurance clearing marks method certainly |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910666229.1A CN110391006A (en) | 2019-07-23 | 2019-07-23 | Drug for medical insurance clearing marks method certainly |
Publications (1)
| Publication Number | Publication Date |
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| CN110391006A true CN110391006A (en) | 2019-10-29 |
Family
ID=68287187
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201910666229.1A Pending CN110391006A (en) | 2019-07-23 | 2019-07-23 | Drug for medical insurance clearing marks method certainly |
Country Status (1)
| Country | Link |
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| CN (1) | CN110391006A (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111312359A (en) * | 2020-02-03 | 2020-06-19 | 广东省第二人民医院（广东省卫生应急医院） | Intelligent recommendation method and device for medication scheme |
| CN112786214A (en) * | 2021-01-31 | 2021-05-11 | 云知声智能科技股份有限公司 | Detection method and detection system for restrictive medication violation |
Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104008449A (en) * | 2014-05-27 | 2014-08-27 | 乔岭梅 | System for managing hospitalized patients with medical insurance |
| CN106530166A (en) * | 2016-08-31 | 2017-03-22 | 中国人民解放军总医院第附属医院 | Hospital medical insurance expense nonpayment prevention auxiliary management information system and nonpayment prevention method |
| CN108010566A (en) * | 2017-11-29 | 2018-05-08 | 普华和诚（北京）信息有限公司 | The preposition auditing system of Medication order in hospital |
| CN108154443A (en) * | 2017-07-18 | 2018-06-12 | 邹鑫洋 | A kind of medical treatment medical insurance data processing equipment and method |
| CN109637620A (en) * | 2018-12-13 | 2019-04-16 | 平安医疗健康管理股份有限公司 | Prescription based on data analysis generates monitoring method, device, equipment and medium |
| CN109830273A (en) * | 2018-12-13 | 2019-05-31 | 平安万家医疗投资管理有限责任公司 | Electronic prescription generation method, device, computer equipment and readable storage medium storing program for executing |
-
2019
- 2019-07-23 CN CN201910666229.1A patent/CN110391006A/en active Pending
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104008449A (en) * | 2014-05-27 | 2014-08-27 | 乔岭梅 | System for managing hospitalized patients with medical insurance |
| CN106530166A (en) * | 2016-08-31 | 2017-03-22 | 中国人民解放军总医院第附属医院 | Hospital medical insurance expense nonpayment prevention auxiliary management information system and nonpayment prevention method |
| CN108154443A (en) * | 2017-07-18 | 2018-06-12 | 邹鑫洋 | A kind of medical treatment medical insurance data processing equipment and method |
| CN108010566A (en) * | 2017-11-29 | 2018-05-08 | 普华和诚（北京）信息有限公司 | The preposition auditing system of Medication order in hospital |
| CN109637620A (en) * | 2018-12-13 | 2019-04-16 | 平安医疗健康管理股份有限公司 | Prescription based on data analysis generates monitoring method, device, equipment and medium |
| CN109830273A (en) * | 2018-12-13 | 2019-05-31 | 平安万家医疗投资管理有限责任公司 | Electronic prescription generation method, device, computer equipment and readable storage medium storing program for executing |
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111312359A (en) * | 2020-02-03 | 2020-06-19 | 广东省第二人民医院（广东省卫生应急医院） | Intelligent recommendation method and device for medication scheme |
| CN111312359B (en) * | 2020-02-03 | 2023-12-29 | 广东省第二人民医院（广东省卫生应急医院） | Intelligent recommendation method and device for medication scheme |
| CN112786214A (en) * | 2021-01-31 | 2021-05-11 | 云知声智能科技股份有限公司 | Detection method and detection system for restrictive medication violation |
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