Internet-based remote medical reimbursement auditing system and use method

Abstract

The invention discloses an internet-based remote medical reimbursement auditing system and a use method, the system comprises a user terminal, the user terminal is bidirectionally and electrically connected with a PC platform server and a mobile terminal platform server, and the PC platform server and the mobile terminal platform server are bidirectionally and electrically connected with an account management unit. Through the user terminal, the PC platform server, the mobile terminal platform server, the account management unit, the cloud, the verification unit, the hospital platform server, the file uploading module, the reimbursed mark storage module, the cost screening unit, the retrieval unit and the hospital patient consumption database, remote medical reimbursement auditing can be carried out on the Internet; and the reimbursed medical invoices are marked and stored, so that secondary reimbursement is prevented, hospital consumption invoices and personal information are identified and verified, and the economic loss of users due to the fact that other people pretend to carry out medical reimbursement is prevented.

Description

Technical Field

[0001] The present invention relates to the technical field of medical reimbursement review systems, and in particular to an Internet-based remote medical reimbursement review system and a use method thereof. Background Art

[0002] The scope of medical insurance reimbursement refers to the purpose of guaranteeing the basic medical needs of insured persons and standardizing the management of basic medical insurance drug use, diagnosis and treatment. Basic medical insurance stipulates the reimbursement scope of drug catalogues, diagnosis and treatment items and medical service facilities. The medical insurance fund will pay for the relevant medical expenses incurred by insured persons in designated hospitals that meet the three major catalogues in accordance with the regulations.

[0003] The invention patent with patent application publication number CN104134157B discloses a suspicious behavior review system in the medical insurance reimbursement process, which includes a consumption information database, a retrieval unit, a cost screening unit, an analysis execution unit and a human-computer interaction unit. The retrieval unit can automatically obtain the reimbursement documents to be reviewed from the consumption information database, and then use the cost screening unit to classify multiple data in the prescription details information, and display the medical registration information, cost settlement information and classified prescription details information on the human-computer interaction unit, so that the reviewer can intuitively review the suspicious objects. At the same time, by inputting the parameters and thresholds corresponding to each data in the prescription details information into the analysis execution unit, the analysis execution unit automatically reviews each data in the prescription details information, realizes batch processing of multiple data, and greatly reduces the time of manual review. Therefore, with the assistance of the review system, efficient, fast and accurate review of medical insurance reimbursement documents is achieved.

[0004] However, the above device still has some shortcomings in actual use. The most obvious one is that medical expenses settlement is achieved through card-insertion password verification technology. This card-insertion settlement method is mainly aimed at ensuring the safety of funds, but it brings obvious disadvantages. It cannot achieve cardless settlement through actual card-insertion settlement, and can only be achieved through a large number of windows or self-service machines, but cannot be achieved through the popular mobile phones and other smart terminals to achieve direct Internet settlement. Every time a patient settles the fee, he needs to go to the window or self-service machine to do card-insertion settlement, especially he needs to queue up for a long time each time.

[0005] Therefore, it is necessary to invent an Internet-based remote medical reimbursement review system and a method of use to solve the above problems. Summary of the invention

[0006] The purpose of the present invention is to provide an Internet-based remote medical reimbursement review system and a method of use, which has the advantages of remote medical reimbursement review and prevention of reimbursement by others or twice, and solves the problem that cardless settlement cannot be achieved through actual card insertion settlement, and can only be achieved through a large number of windows or self-service machines, but cannot be achieved through the current popular mobile phones and other smart terminals to achieve direct Internet settlement.

[0007] To achieve the above-mentioned purpose, the present invention provides the following technical solutions: a remote medical reimbursement review system based on the Internet, comprising a user terminal, wherein the user terminal is bidirectionally electrically connected to a PC platform server and a mobile platform server respectively, the PC platform server and the mobile platform server are bidirectionally electrically connected to an account management unit, the account management unit is bidirectionally electrically connected to a cloud, the cloud is bidirectionally electrically connected to a verification unit and a hospital platform server respectively, the verification unit is bidirectionally electrically connected to a file upload module, the file upload module is bidirectionally electrically connected to the hospital platform server, the hospital platform server is bidirectionally electrically connected to a reimbursed mark storage module and a cost screening unit respectively, the cost screening unit is bidirectionally electrically connected to a retrieval unit, and the retrieval unit is bidirectionally electrically connected to a hospital patient consumption database.

[0008] Preferably, the user terminal includes a PC terminal, a mobile terminal and an IPAD terminal, the PC terminal is bidirectionally electrically connected to the PC platform server, and the mobile terminal and the IPAD terminal are both bidirectionally electrically connected to the mobile platform server.

[0009] Preferably, the account management unit includes a user registration module, a password modification module, a modification progress notification method module and a password retrieval module, and the PC platform server and the mobile platform server are respectively bidirectionally electrically connected to the user registration module, the password modification module, the modification progress notification method module and the password retrieval module, and the user registration module, the password modification module, the modification progress notification method module and the password retrieval module all have bidirectional electrical connections to the cloud.

[0010] Preferably, the verification unit includes an invoice verification module and a personal information verification module, the cloud is bidirectionally electrically connected to the invoice verification module and the personal information verification module respectively, and the invoice verification module and the personal information verification module are both bidirectionally electrically connected to the file upload module.

[0011] Preferably, the hospital patient consumption database includes a medical expense module, a treatment expense module, a test expense module, an examination expense module and a medication expense module, and the medical expense module, the treatment expense module, the test expense module, the examination expense module and the medication expense module are all bidirectionally electrically connected to the retrieval unit.

[0012] Preferably, the hospital platform server is bidirectionally electrically connected to the review completion module, the report generation module and the third-party reimbursement and refund module, and the reimbursement mark storage module is bidirectionally electrically connected to the hospital patient consumption database.

[0013] Preferably, the output end of the hospital platform server is electrically connected to a progress notification module, and the output end of the progress notification module is electrically connected to the input end of the user terminal.

[0014] Preferably, the PC terminal, mobile terminal and IPAD terminal all include a local photo module and a shooting module, and the shooting module is a camera on the terminal.

[0015] A method for using an Internet-based telemedicine reimbursement review system comprises the following steps:

[0016] A) Users log in through the APP on the user terminal. New or old users can register and log in through the user registration module. When the login password is forgotten, it can be retrieved through the password modification module and password retrieval module;

[0017] B) Upload the invoice and personal information through the local photo and shooting module, and verify it under the action of the verification unit. If the verification fails, feedback is given on the user terminal in a timely manner to prevent others from impersonating the reimbursement review. After the verification is completed, the information is transmitted to the hospital platform server under the action of the file upload module, and the information is fed back to the reimbursed mark storage module to compare it with the stored reimbursed invoices;

[0018] C) When the reimbursement mark exists in the middle of the storage module, the expense list in the hospital patient consumption database is compared through the expense screening unit and the hospital patient consumption database. Reimbursement is made when the search and screening are correct. After the review is completed and a report is generated, reimbursement and refund are made through a third party.

[0019] Compared with the prior art, the present invention has the following beneficial effects:

[0020] The present invention has the advantage of being able to conduct remote medical reimbursement review on the Internet through the cooperation of a user terminal, a PC platform server, a mobile platform server, an account management unit, a cloud, a verification unit, a hospital platform server, a file upload module, a reimbursement mark storage module, a cost screening unit, a retrieval unit and a hospital patient consumption database. It can also mark and store reimbursed medical invoices to prevent secondary reimbursement, and identify and verify hospital consumption invoices and personal information to prevent others from impersonating to make medical reimbursement and causing economic losses to users. While improving security, it can increase the speed of reimbursement and realize the function of reimbursement in a different place, bringing convenience to personnel, and they can log in and review reimbursement through different terminals. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Figure 1 It is the principle diagram of the system of the present invention;

[0022] Figure 2 A block diagram of an account management unit of the present invention;

[0023] Figure 3 is a block diagram of a verification unit of the present invention;

[0024] Figure 4 This is a block diagram of the hospital patient consumption database of the present invention. DETAILED DESCRIPTION

[0025] See also Figure 1-Figure 4 , a remote medical reimbursement review system based on the Internet, including a user terminal, the user terminal is bidirectionally electrically connected to a PC platform server and a mobile platform server respectively, the PC platform server and the mobile platform server are bidirectionally electrically connected to an account management unit, the account management unit is bidirectionally electrically connected to a cloud, the cloud is bidirectionally electrically connected to a verification unit and a hospital platform server respectively, the verification unit is bidirectionally electrically connected to a file upload module, the file upload module is bidirectionally electrically connected to the hospital platform server, the hospital platform server is bidirectionally electrically connected to a reimbursed mark storage module and a cost screening unit respectively, the cost screening unit is bidirectionally electrically connected to a retrieval unit, and the retrieval unit is bidirectionally electrically connected to a hospital patient consumption database;

[0026] User terminals include PC terminals, mobile terminals and IPAD terminals. PC terminals are bidirectionally electrically connected to PC platform servers, and mobile terminals and IPAD terminals are bidirectionally electrically connected to mobile platform servers. By setting PC terminals, mobile terminals and IPAD terminals, users can choose a variety of different terminal login methods and can choose the login platform according to actual conditions, which improves selectivity and is more convenient.

[0027] The account management unit includes a user registration module, a password modification module, a modification progress notification module and a password retrieval module. The PC platform server and the mobile platform server are respectively bidirectionally electrically connected to the user registration module, the password modification module, the modification progress notification module and the password retrieval module. The user registration module, the password modification module, the modification progress notification module and the password retrieval module are all bidirectionally electrically connected to the cloud. By setting the user registration module, the password modification module, the modification progress notification module and the password retrieval module, the functions of user account registration, password modification and password retrieval are realized, so that new users can register and log in and old users can retrieve their passwords when they forget them, thereby improving the flexibility and security of the system.

[0028] The verification unit includes an invoice verification module and a personal information verification module. The cloud is bidirectionally electrically connected to the invoice verification module and the personal information verification module respectively. The invoice verification module and the personal information verification module are bidirectionally electrically connected to the file upload module. By setting the invoice verification module and the personal information verification module, the user's invoice and personal information can be identified and verified to prevent others from impersonating for medical reimbursement and causing economic losses to the user, thereby improving the security of the system.

[0029] The hospital patient consumption database includes a medical fee module, a treatment fee module, a test fee module, an examination fee module and a medication fee module. The medical fee module, the treatment fee module, the test fee module, the examination fee module and the medication fee module are all bidirectionally electrically connected to the retrieval unit. By setting the medical fee module, the treatment fee module, the test fee module, the examination fee module and the medication fee module, the patient's medical fee sheet, the treatment fee sheet, the test fee sheet, the examination fee sheet and the medication fee sheet are stored, so as to facilitate retrieval when reimbursement is made;

[0030] The hospital platform server is bidirectionally electrically connected to the review completion module, the report generation module and the third-party reimbursement refund module. The reimbursement mark storage module is bidirectionally electrically connected to the hospital patient consumption database. By setting the review completion module, the display and record of the review completion are realized. By setting the report generation module, the medical reimbursement review is displayed in the form of a report. By setting the third-party reimbursement refund module, the medical expenses are refunded to the user after reimbursement.

[0031] The output end of the hospital platform server is electrically connected to a progress notification module, and the output end of the progress notification module is electrically connected to the input end of the user terminal. By setting the progress notification module, it is convenient for users to understand the progress of reimbursement review in a timely manner and prevent users from making erroneous operations;

[0032] The PC terminal, mobile terminal and IPAD terminal all include a local photo module and a shooting module. The shooting module is a camera on the terminal, and the reimbursed mark storage module is a solid-state hard disk;

[0033] Mobile phone cameras mainly include built-in and external cameras. Built-in cameras refer to cameras installed inside mobile phones, which are more convenient to use. External cameras refer to connecting mobile phones to digital cameras through data cables or other methods to achieve shooting. This shooting method is more convenient. At present, the digital camera functions of mobile phones are still in the development stage, and many technical research and development are just starting. The digital camera functions of mobile phones mainly include continuous shooting, built-in flash and automatic white balance. The shooting effect is closely related to the resolution of the mobile phone screen and the mobile phone camera.

[0034] The cloud is a small software, but it is also a big platform. After installing the cloud, you no longer need to install or download other software and can use them directly. Moreover, through the virtualized operating environment, the system can be kept clean and green for a long time, and the software and the system can be kept securely isolated. This aspect is similar to the sandbox. In short, the cloud = a safe environment for application software that does not require installation or is portable. Reminder: The word "cloud" in the cloud software platform does not refer to the "cloud computing" that is being hyped. The cloud is software based on application virtualization technology. It has similarities in technology with VMware ThinApp, Symantec SVS, and Microsoft APP-V, but these three provide services for the enterprise market, while the cloud is free software for ordinary users.

[0035] A server is a type of computer that runs faster, has a higher load, and is more expensive than an ordinary computer. A server provides computing or application services to other clients (such as PCs, smartphones, ATMs, and even large devices such as train systems) in the network. A server has high-speed CPU computing power, long-term reliable operation, powerful I / O external data throughput, and better scalability;

[0036] Solid-state drives are storage devices that do not require read / write heads or the movement (rotation) of storage media to read and write data, as opposed to magnetic disks and optical disks. Solid-state storage devices store data by changing the switching state of transistors inside the storage chip. Since solid-state storage devices do not have read / write heads and do not need to rotate, they have the advantages of low power consumption and strong shock resistance. Due to their high cost, mechanical hard disks are still mostly used in large-capacity storage; however, solid-state storage devices have great advantages in small-capacity, ultra-high-speed, and small-volume electronic devices. In high-speed data exchange devices, solid-state storage devices use transistors to store data, so they can perform very fast data exchange at high frequencies. For example, cache memory and CPU;

[0037] A method for using an Internet-based telemedicine reimbursement review system comprises the following steps:

[0038] A) Users log in through the APP on the user terminal. New or old users can register and log in through the user registration module. When they forget their login password, they can retrieve it through the password modification module and password retrieval module, and modify their password to log in;

[0039] B) Upload the invoice and personal information through the local photo and shooting module, and verify it under the action of the invoice verification module and the personal information verification module. If the verification fails, timely feedback is given on the user terminal to prevent others from impersonating the reimbursement review. After the verification is completed, the information is transmitted to the hospital platform server under the action of the file upload module, and the information is fed back to the reimbursed mark storage module, and the stored reimbursed invoices are compared. If there is an invoice that has been reimbursed, it will be rejected and displayed as reimbursed on the user terminal;

[0040] C) When the reimbursement mark exists in the middle of the storage module, the cost screening unit and the hospital patient consumption database are used to compare the medical expense bills, treatment expense bills, test expense bills, examination expense bills and medication expense bills of the medical expense module, treatment expense module, test expense module, examination expense module and medication expense module corresponding to the personal information in the hospital patient consumption database. Reimbursement is made when the search and screening are correct, and the review is completed and a report is generated, and then reimbursement and refund are made through a third party.

[0041] To sum up: the Internet-based remote medical reimbursement review system and usage method, through the cooperation of user terminals, PC platform servers, mobile platform servers, account management units, cloud, verification units, hospital platform servers, file upload modules, reimbursed mark storage modules, expense screening units, retrieval units and hospital patient consumption databases, solves the problem that cardless settlement cannot be achieved through actual card insertion settlement, and can only be achieved through a large number of windows or self-service machines, but cannot be achieved through direct Internet settlement through popular smart terminals such as mobile phones.

Claims

1. An Internet-based telemedicine reimbursement review system, comprising a user terminal, characterized in that: The user terminal is bidirectionally electrically connected to a PC platform server and a mobile platform server respectively, the PC platform server and the mobile platform server are bidirectionally electrically connected to an account management unit, the account management unit is bidirectionally electrically connected to a cloud, the cloud is bidirectionally electrically connected to a verification unit and a hospital platform server respectively, the verification unit is bidirectionally electrically connected to a file upload module, the file upload module is bidirectionally electrically connected to the hospital platform server, the hospital platform server is bidirectionally electrically connected to a reimbursed mark storage module and a cost screening unit respectively, the cost screening unit is bidirectionally electrically connected to a retrieval unit, and the retrieval unit is bidirectionally electrically connected to a hospital patient consumption database.

2. The Internet-based telemedicine reimbursement review system according to claim 1, characterized in that: The user terminal includes a PC terminal, a mobile terminal and an IPAD terminal. The PC terminal is bidirectionally electrically connected to a PC platform server, and the mobile terminal and the IPAD terminal are both bidirectionally electrically connected to a mobile terminal platform server.

3. The Internet-based telemedicine reimbursement review system according to claim 1, characterized in that: The account management unit includes a user registration module, a password modification module, a modification progress notification module and a password retrieval module. The PC platform server and the mobile platform server are respectively bidirectionally electrically connected to the user registration module, the password modification module, the modification progress notification module and the password retrieval module. The user registration module, the password modification module, the modification progress notification module and the password retrieval module are all bidirectionally electrically connected to the cloud.

4. The Internet-based telemedicine reimbursement review system according to claim 1, characterized in that: The verification unit includes an invoice verification module and a personal information verification module. The cloud is bidirectionally electrically connected to the invoice verification module and the personal information verification module respectively. The invoice verification module and the personal information verification module are both bidirectionally electrically connected to the file upload module.

5. The Internet-based telemedicine reimbursement review system according to claim 1 is characterized in that: The hospital patient consumption database includes a medical fee module, a treatment fee module, a test fee module, an examination fee module and a medication fee module, and the medical fee module, the treatment fee module, the test fee module, the examination fee module and the medication fee module are all bidirectionally electrically connected to the retrieval unit.

6. The Internet-based telemedicine reimbursement review system according to claim 1, characterized in that: The hospital platform server is bidirectionally electrically connected to an audit completion module, a report generation module and a third-party reimbursement refund module, and the reimbursement mark storage module is bidirectionally electrically connected to a hospital patient consumption database.

7. The Internet-based telemedicine reimbursement review system according to claim 1 is characterized in that: The output end of the hospital platform server is electrically connected to a progress notification module, and the output end of the progress notification module is electrically connected to the input end of the user terminal.

8. The Internet-based telemedicine reimbursement review system according to claim 1, characterized in that: The PC terminal, mobile terminal and IPAD terminal all include a local photo module and a shooting module, and the shooting module is a camera on the terminal.

9. A method for using an Internet-based remote medical reimbursement review system according to any one of claims 1 to 8, characterized in that The following steps are involved: A) Users log in through the APP on the user terminal. New or old users can register and log in through the user registration module. When the login password is forgotten, it can be retrieved through the password modification module and password retrieval module; B) Upload the invoice and personal information through the local photo and shooting module, and verify it under the action of the verification unit. If the verification fails, feedback is given on the user terminal in a timely manner to prevent others from impersonating the reimbursement review. After the verification is completed, the information is transmitted to the hospital platform server under the action of the file upload module, and the information is fed back to the reimbursed mark storage module to compare it with the stored reimbursed invoices; C) When the reimbursement mark exists in the middle of the storage module, the expense list in the hospital patient consumption database is compared through the expense screening unit and the hospital patient consumption database. Reimbursement is made when the search and screening are correct. After the review is completed and a report is generated, reimbursement and refund are made through a third party.

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