Information processing device, information processing method and information processing program

Abstract

To maximize profits of medical institutions and nursing care facilities.SOLUTION: There is provided an information processing device comprising: a storage unit that stores, for each of a plurality of clinical practices that may be conducted in medical institutions or nursing care facilities, disease classification codes, medical fee items, medical fee scores, facility standards regarding facilities for claiming for medical fee scores, and calculation requirements regarding patients for claiming for medical fee scores, in association with each other; an extraction unit that extracts disease classification codes from a plurality of pieces of receipt data with regards to clinical practices conducted in a medical institution or a nursing care facility; a calculation unit that refers to the storage unit using the disease classification codes extracted by the extraction unit and calculates a theoretical value of calculatable medical fee scores; and a display control unit that displays the theoretical value.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present invention relates to an information processing device, an information processing method, and an information processing program. [Background technology]

[0002] In the above technical field, patent documents disclose a technique for checking whether medical institutions are properly claiming for medical fees. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] JP 2003-108662 A Summary of the Invention [Problem to be solved by the invention]

[0004] However, the technology described in the above document was merely a mechanism for checking the appropriateness of remuneration for specific medical treatment fee items provided by medical institutions, and did not aim to maximize the profits of medical institutions or nursing facilities.

[0005] An object of the present invention is to provide a technique for solving the above-mentioned problems. [Means for solving the problem]

[0006] In order to achieve the above object, the device according to the present invention comprises: A storage unit that stores, for each of a plurality of medical procedures that may be performed at a medical institution or a nursing facility, a disease classification code, a medical fee item, a medical fee point, a facility standard for the facility for claiming the medical fee point, and a calculation requirement for the patient for claiming the medical fee point, in association with each other; a calculation unit which inputs a disease classification code, refers to the storage unit, and calculates a theoretical value of a calculable medical fee point; A display control unit that displays the theoretical value; The information processing device is provided with:

[0007] In order to achieve the above object, the method according to the present invention comprises: a calculation step in which the calculation unit refers to a storage unit that stores, in association with each other, disease classification codes, medical fee items, medical fee points, facility standards for facilities for claiming the medical fee points, and calculation requirements for patients for claiming the medical fee points for each of a plurality of medical procedures that may be performed at a medical institution or a nursing facility, and calculates a theoretical value of the medical fee points that can be calculated from the input disease classification code; a display control step in which a display control unit displays the theoretical value; Includes.

[0008] In order to achieve the above object, the program according to the present invention comprises: a calculation step of calculating a theoretical value of the medical fee points that can be calculated from the inputted disease classification code by referring to a memory unit that stores disease classification codes, medical fee items, medical fee points, facility standards for the facility for claiming the medical fee points, and calculation requirements for the patient for claiming the medical fee points, in association with each other, for each of a plurality of medical procedures that may be performed at a medical institution or a nursing facility; a display control step of displaying the theoretical value; The processor executes the following. Effect of the Invention

[0009] According to the present invention, it is possible to maximize the profits of medical institutions or nursing facilities. [Brief description of the drawings]

[0010] [Figure 1] 1 is a block diagram showing a configuration of an information processing device according to a first embodiment. [Diagram 2] FIG. 1 is a diagram explaining medical fees. [Diagram 3] FIG. 11 is a block diagram showing a configuration of an information processing device according to a second embodiment. [Figure 4] FIG. 11 is a diagram illustrating a configuration of a storage unit of an information processing device according to a second embodiment. [Diagram 5] FIG. 11 is a diagram illustrating a configuration of a storage unit of an information processing device according to a second embodiment. [Figure 6] FIG. 11 is a diagram showing a display example of an information processing device according to the second embodiment. [Figure 7] 10 is a flowchart illustrating a flow of processing in an information processing device according to a second embodiment. [Figure 8] 13 is a flowchart showing the flow of facility criterion determination processing by an information processing device according to a second embodiment. [Figure 9] 13A to 13C are diagrams illustrating an example of a method for calculating a theoretical value in the information processing device according to the second embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0011] Hereinafter, an embodiment of the present invention will be described in detail with reference to the drawings. However, the components described in the following embodiment are merely examples, and are not intended to limit the technical scope of the present invention.

[0012] [First embodiment] An information processing device 100 according to a first embodiment of the present invention will be described with reference to Fig. 1. The information processing device 100 is a device for evaluating remuneration for medical treatments performed in medical institutions or nursing facilities.

[0013] As shown in FIG. 1, the information processing device 100 includes a storage unit 101, an extraction unit 102, a calculation unit 103, and a display control unit 104.

[0014] The storage unit 101 stores, in association with each of a plurality of medical procedures that may be performed at the medical institution or nursing facility 110, a disease classification code, a medical fee item, a medical fee point, a facility standard, and a calculation requirement. The facility standard is a standard required of a facility for claiming medical fee points, and the calculation requirement is a condition related to a patient for claiming medical fee points. The disease classification code broadly means a code for classifying the condition of a patient, and is a concept that includes ICD codes, injury and disease codes, and so-called facility standard codes.

[0015] The extraction unit 102 extracts medical fee items 121 and disease classification codes 122 from a plurality of receipt data 120 regarding past medical treatments performed at a medical institution or a care facility 110 .

[0016] The calculation unit 103 refers to the memory unit 101 using the disease classification code 122 extracted by the extraction unit 102, derives the facility criteria 123, the calculation requirements 124, and the remuneration points 125, and calculates the theoretical value 131 of the medical remuneration points that can be calculated.

[0017] The display control unit 104 displays the medical fee points 141 claimed for past medical treatments performed at the medical institution or care facility 110 and the theoretical value 142 in comparison.

[0018] With the above configuration, medical institutions or nursing care facilities can easily and accurately compare the actually claimed remuneration points with the theoretical value, making it easier to consider measures to maximize profits.

[0019] [Second embodiment] Next, an information processing device according to a second embodiment of the present invention will be described with reference to FIG. (Regarding medical fees) Before describing the configuration of the information processing device, a description will be given of the remuneration calculated for the actions taken in a medical institution or a care facility.

[0020] In this embodiment, the so-called medical fee stipulated in the "Medical Treatment Fee Schedule" established by the Ministry of Health, Labor and Welfare of Japan will be described, but the present invention is not limited thereto. Medical fee is the remuneration that insurance medical institutions and insurance pharmacies receive from insurers as compensation for insurance medical services. It is decided by the Minister of Health, Labor and Welfare (Minister of Health, Labor and Welfare Public Notification) based on discussions at the Central Social Insurance Medical Council (Chuikyo).

[0021] Medical fees are determined by taking into consideration the evaluation of technology and services and the price of goods (prices for pharmaceuticals are set according to the drug price standard), and in the medical fee schedule, each technology and service is scored (1 point is 10 yen) for evaluation (listed in the notice). There are three types of point schedule: medical, dental, and pharmacy. Hospital income is calculated by multiplying the number of patients by the unit price, but the unit price is controlled by medical fees.

[0022] Medical treatment fees are classified into approximately 1,700 categories, and the number of drug price-listed items is approximately 14,000 (drug price: insurance reimbursement price of pharmaceuticals). The medical treatment fee schedule is broadly divided into "basic medical fees," "special medical fees," and "medical fees for residents of nursing care facilities for the elderly."

[0023] Basic medical fees are classified into "initial consultation fee," "re-examination fee," "basic hospitalization fee," "basic hospitalization fee surcharge," "specific hospitalization fee," and "basic fee for short-term stay surgery, etc." Special medical fees are classified into "medical management, etc.", "home medical care," "examination," "imaging diagnosis," "medication," "injections," "rehabilitation," "specialized psychiatric therapy," "treatment," "surgery," "anesthesia," "radiotherapy," and "pathological diagnosis."

[0024] The facility standards and calculation requirements for what points can be claimed for activities included in each category are specified in detail by notices and notifications.

[0025] The calculation requirements are those requirements that are listed along with points in the above-mentioned "Medical Treatment Fee Schedule."

[0026] The facility standards are the personnel and equipment that an insured medical institution must meet when calculating medical fees. They are set by a separate notification from the Minister of Health, Labour and Welfare, and detailed handling is also provided in notifications.

[0027] As shown in FIG. 2, when calculating medical fees, it is first necessary to satisfy facility standards 201 defined for the medical fee item 200. If the facility standards are not satisfied, medical fee points cannot be claimed without even considering the calculation requirements. Specifically, facility standards 201 include personnel standards 211 and equipment standards 212. Only after the facility standards are satisfied can the calculation requirements 202 be considered. Calculation requirements 202 include basic requirements 221 and excluded requirements 222.

[0028] For example, the initial consultation fee when an initial consultation is made at an insured medical institution is generally 288 points, but if the initial consultation is made using information and communications devices at an insured medical institution that has notified the director of a local health bureau that it complies with the facility standards set by the Minister of Health, Labour and Welfare, 251 points will be calculated.

[0029] Furthermore, for the medical fee items 200, in addition to the calculation requirements 202, additional items 210 (and additional points) are specified.

[0030] If the patient being treated is under 6 years old, 75 points will be added as an infant surcharge. If the first consultation is made outside of business hours, on a holiday, or late at night, 85 points, 250 points, or 480 points will be added to the specified points as an out-of-hours surcharge, holiday surcharge, or late-night surcharge, respectively (200 points, 365 points, or 695 points, respectively, for infants under 6 years old). However, for health insurance medical institutions established solely to ensure emergency medical care at night, if the first consultation is made at night during hours separately determined by the Minister of Health, Labor, and Welfare, 230 points will be added to the specified points (345 points for infants under 6 years old). For health insurance medical institutions that advertise themselves as pediatricians, if the first consultation is made at night during hours separately determined by the Minister of Health, Labor, and Welfare, on a holiday, or late at night (limited to the hours within the business hours displayed by the health insurance medical institution), 200 points, 365 points, or 695 points will be added to the specified points, respectively.

[0031] Medical fee points are charged at 1 point x 10 yen. As mentioned above, the calculation method for fee points is set in very detailed and difficult terms, and is revised approximately every two years.

[0032] (Excerpt from the 2020 medical fee score table) Furthermore, for example, when providing rehabilitation to patients with cerebrovascular disease, facility standards are set out by public notice and notification as follows, but since the granularity of each standard varies, it is difficult to make a judgment.

[0033] (Standards for facilities regarding rehabilitation fees for cerebrovascular diseases, etc., as stipulated by notification) (i) There are appropriate full-time dedicated doctors in charge of the following rehabilitation services: cardiovascular disease rehabilitation, cerebrovascular disease rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0034] (b) There are an appropriate number of full-time nurses, physical therapists, occupational therapists or speech-language-hearing therapists in charge of cardiac and large vascular disease rehabilitation, cerebrovascular disease rehabilitation, disuse syndrome rehabilitation, musculoskeletal rehabilitation or respiratory rehabilitation.

[0035] (c) Having sufficient facilities to provide rehabilitation services for cardiovascular disease, cerebrovascular disease, etc., disuse syndrome, musculoskeletal rehabilitation, or respiratory rehabilitation.

[0036] (ii) The facility is equipped with the necessary equipment and instruments for the provision of rehabilitation services for cardiovascular disease, cerebrovascular disease, etc., disuse syndrome, musculoskeletal rehabilitation, or respiratory rehabilitation services.

[0037] In response to this, the Ministry of Health, Labor and Welfare's notification entitled "Regarding facility standards for special medical fees and procedures for their notification" clearly defines the facility standards in more detail as follows (partial excerpt): "Article 40: Rehabilitation fees for cerebrovascular diseases, etc. (I) 1. Facility standards for rehabilitation fees for cerebrovascular diseases, etc. (I) (1) The insured medical institution must have two or more full-time doctors working there. However, one of them must have three or more years of clinical experience in rehabilitation medicine for cerebrovascular disease, etc., or a history of attending (or serving as a lecturer in) training sessions and seminars on rehabilitation medicine for cerebrovascular disease, etc. In addition, if two or more full-time part-time doctors who regularly work three or more days a week and whose scheduled working hours are 22 or more hours a week are combined and these part-time doctors are assigned during the same working hours as the full-time doctors, the actual working hours of the part-time doctors can be converted into full-time hours and included in the number of full-time doctors. However, when converting full-time doctors who have three or more years of clinical experience in rehabilitation medicine for cerebrovascular disease, etc., or a history of attending (or serving as a lecturer in) training sessions and seminars on rehabilitation medicine for cerebrovascular disease, etc., into full-time hours, this is limited to the part-time doctors who have the experience or history of attending (or serving as a lecturer in) training sessions and seminars on rehabilitation medicine for cerebrovascular disease, etc.

[0038] (2) All of the following items A through D are met.

[0039] A. There must be five or more full-time physical therapists working in the facility. However, they may not serve concurrently with full-time physical therapists in wards that charge the ADL maintenance and improvement system surcharge, the rehabilitation ward admission fee for recovery, and the comprehensive community care ward admission fee, or in wards that have rooms that charge the comprehensive community care inpatient medical management fee, but they may serve concurrently with full-time physical therapists in disuse syndrome rehabilitation fees (I), (II), or (III), musculoskeletal rehabilitation fees (I), (II), or (III), respiratory rehabilitation fees (I), or (II), rehabilitation fees for disabled children (adults), and rehabilitation fees for cancer patients.

[0040] A. There must be three or more full-time occupational therapists working for the facility. However, they may not serve concurrently with full-time occupational therapists in wards that charge the ADL maintenance and improvement system surcharge, the rehabilitation ward admission fee for recovery, and the comprehensive community care ward admission fee, and in wards that have rooms that charge the comprehensive community care inpatient medical management fee, but they may serve concurrently with full-time occupational therapists in disuse syndrome rehabilitation fees (I), (II), or (III), musculoskeletal rehabilitation fees (I), (II), or (III), respiratory rehabilitation fees (I), or (II), rehabilitation fees for disabled children (adults), and rehabilitation fees for cancer patients.

[0041] In the case of speech-language-hearing therapy, there must be at least one full-time speech-language-hearing therapist on staff. However, except as otherwise provided for in each item of Section 1 of Part 7 Rehabilitation, which requires a full-time speech-language-hearing therapist, it is possible for them to hold concurrent positions.

[0042] A. A total of 10 or more full-time employees from A to C must be employed. If the time spent on disease-specific rehabilitation (excluding cardiovascular disease rehabilitation), rehabilitation for disabled children (adults), and rehabilitation for cancer patients at the health insurance medical institution does not meet the prescribed working hours set by the health insurance medical institution, employees may be allowed to engage in other work outside of the time spent on rehabilitation. If a combination of two or more full-time part-time physical therapists, occupational therapists, or speech-language-hearing therapists who regularly work three or more days a week and whose prescribed working hours are 22 hours or more per week are arranged during the same working hours as full-time physical therapists, occupational therapists, or speech-language-hearing therapists, respectively, the actual working hours of these part-time physical therapists, occupational therapists, or speech-language-hearing therapists may be converted to full-time hours and included in the number of full-time physical therapists, occupational therapists, or speech-language-hearing therapists, respectively. However, the number of full-time physical therapists, full-time occupational therapists, or full-time speech-language-hearing therapists that can be counted as full-time is limited to four full-time physical therapists, two full-time occupational therapists, and one full-time speech-language-hearing therapist.

[0043] If the following requirements (i) or (ii) are met, and there are no patients to whom the full-time staff members listed in (a) through (c) are to provide disease-specific rehabilitation, the full-time staff members may engage in day rehabilitation provided by the insured medical institution, even during the hours when rehabilitation for cerebrovascular disease, etc. is being carried out.

[0044] (i) All physical therapists, occupational therapists, and speech-language-hearing pathologists other than full-time employees as defined in the facility standards for disease-specific rehabilitation fees are engaged in work other than long-term care insurance rehabilitation or other disease-specific rehabilitation.

[0045] (b) All physical therapists, occupational therapists, and speech-language-hearing pathologists employed at the insurance medical institution are full-time employees according to the facility standards for any disease-specific rehabilitation fee.

[0046] (3) The facility must have a dedicated functional training room (at least 160 square meters measured according to the internal method) that is large enough to carry out treatment and training. The dedicated functional training room may be used for other purposes outside of the hours when the therapy in question is being carried out. Furthermore, a dedicated functional training room is "dedicated" during the hours when disease-specific rehabilitation, rehabilitation for disabled children (adults), or rehabilitation for cancer patients is being carried out, and it is acceptable for disease-specific rehabilitation, rehabilitation for disabled children (adults), or rehabilitation for cancer patients to be carried out simultaneously in the same functional training room. However, when cardiovascular disease rehabilitation is being carried out during the same hours, the respective facility standards must be met. Furthermore, when speech-language-hearing therapy is being carried out, at least one dedicated individual therapy room (8 square meters or more measured according to the internal method) that takes into consideration shielding, etc. must be provided.

[0047] (4) The following facilities and equipment / tools necessary for carrying out the therapy must be provided. These equipment / tools may be used by users of the designated rehabilitation facility when the health insurance medical institution provides designated rehabilitation services and when doing so does not impede the provision of rehabilitation services.

[0048] Walking aids, training mats, treatment tables, weights such as sandbags, various measuring instruments (angle meters, grip strength meters, etc.), blood pressure monitors, parallel bars, tilt tables, posture correction mirrors, various wheelchairs, various walking aids, various braces (long and short leg braces, etc.), household equipment, various equipment for activities of daily living, etc. However, if speech-language hearing therapy is performed, hearing test equipment, audio recording and playback devices, video recording systems, etc. If necessary, rehabilitation medical equipment to assist flexion and extension of the joint on the paralyzed side and increase the amount of movement must be provided.

[0049] (5) In cases where only speech-language-hearing therapy is provided, if all of the following criteria (a) to (d) are met, notwithstanding the above criteria, the criteria for cerebrovascular disease, etc. rehabilitation fee (I) are met.

[0050] A. There must be at least one full-time doctor on the job. However, if there are two or more full-time part-time doctors who regularly work at least three days a week and whose scheduled working hours are at least 22 hours a week, and these part-time doctors are assigned during the same hours as the full-time doctors, the said standard may be considered to be met.

[0051] A. There are three or more full-time speech-language-hearing therapists. However, if two or more full-time part-time speech-language-hearing therapists who regularly work three or more days a week and whose scheduled working hours are 22 or more hours a week are combined and these part-time speech-language-hearing therapists are assigned during the same working hours as the full-time speech-language-hearing therapists, the actual working hours of these part-time speech-language-hearing therapists can be converted to full-time hours and included in the number of full-time speech-language-hearing therapists. However, only two of the full-time staff can be converted to full-time hours and included in the number of full-time speech-language-hearing therapists.

[0052] C) Having a dedicated individual therapy room (8 square meters or more as measured according to internal dimensions) with consideration given to shielding, etc.

[0053] E. The facility is equipped with the necessary equipment for speech-language-hearing therapy, such as hearing testing equipment, audio recording and playback devices, and video recording systems.

[0054] (6) With regard to health insurance medical institutions that have actually filed the relevant rehabilitation fee report as of March 31, 2014, they shall be deemed to be satisfying the provisions of (3) and (5) of the Internal Law until they carry out an expansion or complete reconstruction of the relevant functional training rooms, etc.

[0055] (7) Records concerning rehabilitation (such as doctor's instructions, implementation time, training content, and person in charge) must be kept centrally for each patient and must be available for viewing by medical professionals at all times.

[0056] (8) Regular conferences are held in which relevant professionals from various professions participate.

[0057] (9) Physical therapists, occupational therapists, and speech-language-hearing pathologists other than the full-time employees listed in (2) (a) through (c) above are to be able to engage in outpatient rehabilitation provided by the health insurance medical institution, except during the hours when they are engaged in disease-specific rehabilitation.

[0058] (Requirements for calculating rehabilitation fees for cerebrovascular diseases, etc.) On the other hand, the calculation requirements and additional requirements for the rehabilitation fee for cerebrovascular disease are stipulated as follows: Rehabilitation fee for cerebrovascular disease (I) (1 unit) 245 points Rehabilitation fee for cerebrovascular disease (II) (1 unit) 200 points Rehabilitation fee for cerebrovascular disease (III) (1 unit) 100 points Note 1: In cases where an insured medical institution that has notified the Director-General of a Regional Bureau of Health and Welfare as conforming to the facility standards separately stipulated by the Minister of Health, Labour and Welfare provides rehabilitation, which is an individual therapy, to a patient separately stipulated by the Minister of Health, Labour and Welfare, the prescribed points shall be calculated according to the classification related to the said standards, up to a maximum of 180 days from the date of onset, surgery, acute exacerbation, or first diagnosis. However, for patients separately stipulated by the Minister of Health, Labour and Welfare, in cases where it is medically determined that continued treatment is expected to improve their condition, or in other cases separately stipulated by the Minister of Health, Labour and Welfare, the prescribed points may be calculated for more than 180 days.

[0059] Note 2: Note 1: When rehabilitation is provided to patients who are hospitalized or other patients as specified by the Minister of Health, Labour and Welfare separately as provided for in the main text (limited to stroke patients who have been discharged from the relevant health insurance medical institution or those who have been discharged from another health insurance medical institution (limited to patients for whom the regional collaboration medical plan surcharge listed in Note 4 of classification number A246 has been calculated)), 30 points per unit will be added to the specified points as an early rehabilitation surcharge, for a maximum of 30 days from the onset, surgery or acute exacerbation, respectively.

[0060] Note 3: In cases where an insurance medical institution that has notified the Director-General of a Regional Bureau of Health and Welfare, etc., as complying with the facility standards separately specified by the Minister of Health, Labour and Welfare as provided for in the main text of Note 1 provides rehabilitation to patients who are hospitalized or other patients who are not hospitalized and who are specified by the Minister of Health, Labour and Welfare separately, as provided for in the main text of Note 1 (limited to stroke patients who have been discharged from the insurance medical institution or who have been discharged from another insurance medical institution (limited to patients for whom the Regional Collaboration Medical Plan Surcharge listed in Note 4 of Classification Number A246 has been calculated)), an additional 45 points per unit will be added to the specified points as an initial surcharge, for a maximum of 14 days from the onset, surgery, or acute exacerbation of the condition, respectively.

[0061] Note 4 Notwithstanding the provisions of the main text of Note 1, for patients specified by the Minister of Health, Labour and Welfare as specified in the main text of Note 1, other than insured persons requiring long-term care, etc., who undergo rehabilitation beyond 180 days from the date of onset, surgery, acute exacerbation, or initial diagnosis, only 13 units per month may be billed.

[0062] Note 5 Notwithstanding the provisions of Note 1, for patients who are separately designated by the Minister of Health, Labour and Welfare as provided for in the main text of Note 1 and who are insured persons requiring long-term care and are hospitalized, if necessary, and rehabilitation is provided for more than 180 days from the date of onset, surgery, acute exacerbation, or first diagnosis, the following points may be calculated in accordance with the classification of facility standards provided for in Note 1, limited to 13 units per month. A. Rehabilitation fee for cerebrovascular disease, etc. (I) (1 unit): 147 points B. Rehabilitation fee for cerebrovascular disease, etc. (II) (1 unit): 120 points C. Rehabilitation fee for cerebrovascular disease, etc. (III) (1 unit): 60 points Note 6 Note 1: In the case of continuing rehabilitation for patients (limited to insured persons requiring long-term care, etc.) separately specified by the Minister of Health, Labour and Welfare as stipulated in the main text 60 days have passed since the onset, surgery, acute exacerbation, or initial diagnosis, respectively, and if the goal setting support and management fee set forth in H003-4 has not been calculated within the past three months, it shall be calculated at the points equivalent to 90 / 100 of the prescribed points.

[0063] Note 7: In the case where an insurance medical institution that has notified the Director-General of a Regional Bureau of Health and Welfare, etc., as complying with the facility standards separately set forth by the Minister of Health, Labour and Welfare is continuously submitting data on the status of medical fee claims and the contents of medical treatment at said insurance medical institution to the Ministry of Health, Labour and Welfare, and provides rehabilitation to patients other than hospitalized patients as separately specified by the Minister of Health, Labour and Welfare as stipulated in the main text of Note 1, a rehabilitation data submission surcharge of 50 points will be added to the specified points, limited to once a month.

[0064] (Basic requirements: Eligible patients) The requirements for patients are set out as follows. "Appendix 9-5" sets out the facility standards, and the Ministry of Health, Labour and Welfare basically specifies the patient's illness name, etc. as part of the facility standards, and notifies the finer details as points to note for the calculation method. However, for the sake of clarity, this specification treats it as part of the calculation requirements.

[0065] Attached Table 9-5: Patients eligible for rehabilitation fees for cerebrovascular disease, etc. 1. Patients with cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, and other acute cerebrovascular diseases or patients who have undergone surgery for such diseases. 2. Patients with brain tumors, brain abscesses, spinal cord injuries, spinal cord tumors, and other acute central nervous diseases or patients who have undergone surgery for such diseases. 3. Patients with multiple neuritis, multiple sclerosis, peripheral neuropathy, and other neurological diseases. 4. Patients with Parkinson's disease, spinocerebellar degeneration, and other chronic neuromuscular diseases. 5. Patients with aphasia, agnosia, apraxia, and higher brain dysfunction. 6. Patients with hearing and language disorders due to hearing loss, cochlear implant surgery, etc. 7. Patients with speech disorders due to congenital abnormalities of the jaw and oral cavity. 8. Patients with speech disorders due to surgery for malignant tongue tumors, etc. 9. Patients who require rehabilitation and who have a certain level of decline in basic and applied motor skills, speech and hearing skills, and daily living skills (excluding patients who qualify for the cardiovascular disease rehabilitation fee, disuse syndrome rehabilitation fee, musculoskeletal rehabilitation fee, respiratory rehabilitation fee, disabled children (adults) rehabilitation fee, or cancer patient rehabilitation fee) (Notice regarding implementation points to note in relation to the partial revision of the calculation method for medical fees) In addition to the above calculation requirements, the following points have also been notified. "H001 Rehabilitation fee for cerebrovascular disease, etc. (1) Rehabilitation fee for cerebrovascular disease, etc. is calculated at insurance medical institutions that have notified the Director of the Regional Bureau of Health and Welfare as conforming to the facility standards separately set by the Minister of Health, Labor and Welfare, and is calculated when various types of exercise therapy, practical walking training, daily living activity training, physical therapy, occupational therapy aimed at the recovery of applied movement ability and social adaptability, etc. are combined and performed according to individual cases in order to promote independence in practical activities in daily life through the recovery of basic movement ability, etc., or when training related to language function or hearing function is performed for patients with speech and hearing impairments. In addition, when only physical therapy such as massage or heat therapy is performed, it is calculated according to the item on treatment in Chapter 2 Special Medical Fees Part 9.

[0066] (2) Patients eligible for the rehabilitation fee for cerebrovascular disease, etc. are those listed in Schedule 9-5 of the Facility Standards for Special Medical Fees, who fall under any of the following and who a doctor recognizes as needing rehabilitation for cerebrovascular disease, etc. A. Patients with acute cerebrovascular disease or after surgery include those with cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, brain trauma, encephalitis, acute encephalopathy (hypoxic encephalopathy, etc.), meningitis, etc. B. Patients with acute central nervous system disease or after surgery include those with brain abscess, spinal cord injury, spinal cord tumor, post-craniotomy such as brain tumor removal, status epilepticus, etc. C. Neurological disease includes polyneuritis (Guillain-Barré syndrome, etc.), multiple sclerosis, peripheral neuropathy (facial nerve paralysis, etc.), etc. D: Chronic neuromuscular diseases include Parkinson's disease, spinocerebellar degeneration, motor neuron disease (amyotrophic lateral sclerosis), hereditary motor and sensory neuropathy, peripheral neuropathy, dermatomyositis, polymyositis, etc. E: Patients with aphasia, agnosia, apraxia, and higher brain dysfunction F: Patients with hearing and language impairments due to hearing loss or cochlear implant surgery, etc. include patients with voice disorder, speech disorder, language development disorder, hearing and language impairments due to hearing loss, or hearing and language impairments due to cochlear implant surgery, etc. G: Patients with speech disorders due to congenital abnormalities of the jaw and oral cavity H: Patients with speech disorders due to surgery for malignant tongue tumors, etc. K: Patients who require rehabilitation and have a certain level of decline in basic motor ability, applied motor ability, speech and hearing ability, and daily living ability include patients with congenital developmental disorders due to cerebral palsy, etc., with FIM 115 or less and BI 85 or less at the start of treatment. (3) The prescribed points for the rehabilitation fee for cerebrovascular disease, etc. include manual muscle strength tests and other tests associated with rehabilitation. (4) The rehabilitation fee for cerebrovascular disease, etc. is calculated for tests conducted under the supervision of a physician and under the supervision of a physical therapist, occupational therapist, or speech-language-hearing therapist. Even if a full-time physician directly conducts the training, it may be calculated in the same way as if a physical therapist, occupational therapist, or speech-language-hearing therapist conducted it.(5) Rehabilitation for which the fee for rehabilitation for cerebrovascular disease, etc. is to be calculated is when it is deemed necessary for one practitioner to provide intensive individual training for one patient, and is to be performed one-on-one between a physical therapist, occupational therapist, or speech-language-hearing therapist and the patient. The number of units of rehabilitation to be performed shall be 18 units per day per practitioner as standard, up to a maximum of 108 units per week, with a maximum of 24 units per day. The number of units to be performed shall be the combined number of units of other disease-specific rehabilitation and group communication therapy. In this case, if the practitioner performs cardiovascular disease rehabilitation, the calculation shall be made with each 20 minutes of actual time spent in cardiovascular disease rehabilitation considered to be one unit. (6) In a health insurance institution that has filed a notice of rehabilitation fee for cerebrovascular disease, etc. (II) (limited to those with two or more full-time physical therapists on the staff) or a health insurance institution that has filed a notice of rehabilitation fee for cerebrovascular disease, etc. (III) (limited to those with a full-time physical therapist on the staff), if, in addition to physical therapists, occupational therapists or speech-language-hearing pathologists, training is provided by massage therapists or other personnel who have attended a functional training skills course for exercise therapy and regularly complete appropriate training courses, the specified points for rehabilitation fee for cerebrovascular disease, etc. (III) may be calculated only when the following conditions are met: a doctor or physical therapist gives instructions in advance and subsequently receives a report on the therapy; and any of (1) to (5) above is satisfied. (7) In facilities that have filed a notice for cerebrovascular disease rehabilitation fee (II) or (III), where physical therapy is provided by staff other than physical therapists, such as nurses or masseurs, the physical therapists must accurately understand the content of the motor function training of the patients under the supervision of a physician. (8) For patients who have difficulty maintaining their posture in a wheelchair and therefore have a reduced ability to perform activities of daily living, such as eating, a physical therapist or occupational therapist may select or adjust cushions or accessories for pressure dispersion and support after evaluating the patient's trunk function and seating function to maintain proper posture in a wheelchair or seating device and prevent bedsores.However, if the patient is made to sit up in a wheelchair simply for the purpose of getting out of bed, this cannot be calculated. (9) The standard calculation period stipulated in "Note 1" is within 180 days from the date of onset, surgery, or acute exacerbation if the date is clear, and within 180 days from the date of initial diagnosis of the disease in other cases. (10) For patients who exceed the standard calculation period, the designated points for the rehabilitation fee for cerebrovascular disease, etc. can be calculated up to 13 units per month as stipulated in "Notes 4" and "Notes 5". In addition, for patients other than hospitalized patients, appropriate evaluation should be made as to whether rehabilitation under the long-term care insurance applies, and necessary support should be provided to receive rehabilitation services under the long-term care insurance based on the patient's wishes. In addition, for hospitalized patients who are insured persons requiring long-term care as stipulated in Article 62 of the Long-Term Care Insurance Act, the points stipulated in "Note 5" should be calculated according to their respective classifications. However, for patients who fall under the category of Appendix 9-8 of the Facility Standards for Special Medical Fees and who fall under the category of Appendix 9-9, even if the period exceeds the standard calculation days, it can be calculated in the same way as for periods within the standard calculation days. The points to note are as follows: (a) "Other patients who fall under the category of Appendix 9-4 to Appendix 9-7 and who are medically recognized as needing continued rehabilitation" as specified in Item 1 of Appendix 9-8 of the Facility Standards for Special Medical Fees refers to patients who fall under the category of Appendix 9-4 to Appendix 9-7 and who are medically recognized as needing continued rehabilitation, and who are expected to see improvement in their condition through continued rehabilitation. (a) "Persons suffering from illnesses resulting from physical and mental changes that occur with aging" as defined in Item 8 of Appendix 9 of the Facility Standards for Special Medical Fees means persons aged 40 or older who are in a state of need for nursing care or assistance and whose physical or mental disability that is the cause of their state of need for nursing care or assistance has arisen from a specific illness as defined in Item 2 of Paragraph 3 of Article 7 of the Long-Term Care Insurance Act.(11) The surcharge specified in "Note 2" is an evaluation of the implementation of rehabilitation at the facility from the onset, surgery, or acute exacerbation of cerebrovascular disease, etc., and can be calculated when one or more units of individual therapy are performed on hospitalized patients or patients other than hospitalized patients (limited to stroke patients who have been discharged from the insurance medical institution or those who have been discharged from another insurance medical institution (limited to patients for whom the regional cooperation medical plan surcharge in classification number "A246" Note 4 has been calculated). In addition, for hospitalized patients, it can be calculated even if it is performed in a ward (including bedside) other than the training room. In addition, for patients listed in 3, 4, 6, and 7 of Schedule 9-5 of the Facility Standards for Special Medical Fees, the surcharge specified in "Note 2" cannot be calculated, except for those who have undergone surgery or have acute exacerbation. (12) The surcharge specified in "Note 3" is an evaluation of the implementation of rehabilitation at the facility from the onset, surgery, or acute exacerbation of cerebrovascular disease, etc., and can be calculated separately from the surcharge specified in "Note 2". In addition, the patients eligible for this surcharge are hospitalized patients or patients other than hospitalized patients (limited to stroke patients who have been discharged from the relevant health insurance medical institution or from another health insurance medical institution (limited to patients for whom the regional collaboration medical plan surcharge under Note 4 of classification number "A246" has been calculated)). In addition, for patients listed in Items 3, 4, 6, and 7 of Schedule 9-5 of the Facility Standards for Special Medical Fees, the surcharge specified in Note 3 cannot be calculated, except for those who have undergone surgery or have experienced an acute exacerbation. (13) When calculating the surcharge specified in Note 2 or Note 3 for patients other than hospitalized patients (limited to stroke patients who have been discharged from another health insurance medical institution), it must be stated in the summary column of the medical fee statement that the patient is for whom the regional collaboration medical plan surcharge under Note 4 of classification number "A246" has been calculated. (14) For patients who continue rehabilitation beyond the standard number of days set forth in "Notes 4" and "5," if the standard number of days is exceeded during the course of a month, the amount of disease-specific rehabilitation provided after the day when the standard number of days for calculation in that month is exceeded must be 13 units or less. (15) The "prescribed points" in "Note 6" are the points calculated by applying "Notes 1" to "Note 5."(16) The treatment of the rehabilitation data submission surcharge stipulated in "Note 7" is the same as that in (12) of the classification number "H000" cardiovascular disease rehabilitation fee." (Summary of facility standards and calculation requirements) As described above, for each medical fee item (~ fee), the basic points, detailed facility standards, detailed calculation requirements, corresponding surcharge requirements, and surcharge points are defined. If the detailed items of medical fees and surcharges were to be listed, the total would amount to several thousand. The surcharge items do not exist independently, but are linked to one of the medical fee items. Not all medical fee items are necessarily linked to surcharge items. The medical fee items (~ fee) and surcharge items each have their own facility standards and calculation requirements, but they are not compiled in a single document, and it is necessary to compare various notices and multiple notifications. Remuneration can be claimed from patients who meet all of these facility standards and calculation requirements. However, facility standards and calculation requirements are not clearly defined for all medical fee items. In particular, facility standards and calculation requirements are often not clearly defined for items that involve clinical judgment.

[0067] For example, Section 6 of Appendix 9 of the Facility Standards for Special Medical Fees, "Patients eligible for musculoskeletal rehabilitation fees" is defined as follows:

[0068] 1. Patients with multiple injuries of the upper and lower limbs, quadriplegia due to spinal cord injury, or other acute musculoskeletal disorders or those who have undergone surgery (2) Patients who have a certain degree of decline in motor function and ability to perform daily activities due to degenerative joint diseases, inflammatory joint diseases, or other chronic musculoskeletal diseases. In addition, patients who are eligible for musculoskeletal rehabilitation fees are those listed in Item 6 of Appendix 9 of the Facility Standards for Special Medical Fees, who meet any of the following criteria and who a doctor individually recognizes as being in need of musculoskeletal rehabilitation.

[0069] A. Patients with acute musculoskeletal disease or after surgery for such disease refer to those with complex injuries to the upper and lower limbs (complex injuries to three or more of the following: bone, muscle / tendon / ligament, nerve, and blood vessel), quadriplegia (one or more limbs) due to spinal cord injury, trauma and fractures of the trunk and upper and lower limbs, amputation and detachment (prosthetic limb), malignant tumors of the musculoskeletal system, etc.

[0070] "Patients who have a certain degree of decline in motor function and ability to perform daily activities due to chronic musculoskeletal diseases" refers to those with degenerative joint diseases, inflammatory joint diseases, joint contractures due to burn scars, musculoskeletal instability, diabetic foot diseases, etc.

[0071] However, there is a discrepancy between the above expression and the name of the illness or injury written on the receipt, and it is difficult to determine whether or not a patient is eligible for the above-mentioned musculoskeletal rehabilitation fee just by looking at the receipt.

[0072] Due to the above circumstances, it is extremely difficult to accurately calculate medical fees for procedures performed at medical institutions and nursing care facilities. In particular, because the additional items are detailed and diverse, it is easy for oversights to occur.

[0073] It takes a lot of time to verify the performance of the target population (population) of medical fee items. Furthermore, it is difficult to create an action plan on what to do (because it is calculated based on people, facilities, patient conditions, etc.).

[0074] (Configuration of information processing device) Under the above circumstances, the information processing system 300 according to this embodiment will be described with reference to FIG. 3 and subsequent figures. FIG. 3 is a diagram for explaining the configuration of the information processing system 300 according to this embodiment. The information processing system 300 is a medical fee database / platform for evaluating and analyzing medical fees for actions performed in medical institutions or nursing facilities and maximizing them. The information processing device 300 has a current situation analysis function (visualizing the discrepancy between theoretical values ​​and current situations = opportunity losses) and an improvement proposal function (proposing raising and increasing medical fees by adding and optimizing medical resources). The current situation analysis function includes a function for automatically calculating the maximum value of medical fees that can be calculated.

[0075] As shown in FIG. 3, the device includes a storage unit 301, an extraction unit 302, a calculation unit 303, a display control unit 304, and an update unit 305.

[0076] The storage unit 301 stores, for each of a plurality of medical procedures that may be performed at the medical institution or nursing facility 310, a disease classification code, a medical fee item, a medical fee point, a facility standard, and a calculation requirement in association with each other. The facility standard is a standard required for a facility to claim medical fee points, and the calculation requirement is a condition related to a patient to claim medical fee points. Each medical fee item is further linked with an additional item and an additional point, an additional facility standard, and an additional calculation requirement. This storage unit 301 does not necessarily have to exist as hardware inside the information processing system 300. For example, the concept of the present invention also includes a case where an external server installed outside Japan functions as the storage unit 301 of the information processing system 300.

[0077] The memory unit 301 includes a first memory unit 311 for storing the fee points, facility standards, and calculation requirements defined in the Ministry of Health, Labor, and Welfare's "Medical Medical Fee Schedule," and a second memory unit 312 for storing facility standards and calculation requirements that are not clearly defined in the Ministry of Health, Labor, and Welfare's "Medical Medical Fee Schedule."

[0078] The disease classification code stored in memory unit 301 may be, for example, an ICD (International Statistical Classification of Diseases and Related Health Problems) code established by the World Health Organization (WHO), or an injury / disease name code established by the Ministry of Health, Labor and Welfare, or both.

[0079] In the storage unit 301, all facility standards 400 are registered for each medical fee item (~ fee), and are stored, for example, as shown in FIG. 4. As shown in FIG. 5, the storage unit 301 may store disease classification codes in a format in which they are incorporated into the calculation requirements (associated with the names of injuries and illnesses listed in the "Medical Fee Schedule"), or may store them separately from the calculation requirements. As disease classification codes corresponding to "musculoskeletal diseases" listed in the "Medical Fee Schedule", codes representing, for example, "spinal injury", "rheumatoid arthritis", "ligament loss", etc. are stored. Regarding the medical fee items, flags may be attached so that it can be determined whether or not they require a doctor's clinical judgment.

[0080] The contents of the storage unit 301 are examined by multiple experts, and for example, calculation requirements described as "similar to XX" in the "Medical Treatment Fee Schedule" are specifically registered. Items that are not described in the "Medical Treatment Fee Schedule" but require clinical judgment are added as calculation requirements.

[0081] Furthermore, the memory unit 301 stores, as hospital information 313, information on personnel and equipment required for determining facility standards and calculation requirements, such as the number of hospital beds, number of doctors, number of nurses, types and number of medical equipment, and working status, for each hospital, linked to the hospital ID.

[0082] In addition to the above information, the storage unit 301 may store the following information: UKE file: disease name, date of birth, sex, medical department, medicine, medical procedure, score data H file: date of birth, severity, nursing necessity data EF file: date of birth, sex, ward, medical department, disease name, medicine, medical procedure data FF1 file: patient basics, ward, medical department, life history, admission and discharge route, illness, care level, outcome data Bed function report: bed function, medical department, number of patients, route, staff, number of main procedures, etc. of medical institutions nationwide Other public data: prefectural medical information (unified standard), patient survey, demographics, list of national facility standards, medical facility survey, hospital report, diagnosis procedure classification (DPC) data, nursing care facility / business survey, etc. Other hospital-specific data: electronic medical record data, medical data, number of personnel, hospital structure, financial statements, labor management data, departmental statistics, etc.

[0083] The extraction unit 302 extracts medical fee items 321 and disease classification codes 322 as patient information from a plurality of receipt data 320 regarding medical procedures performed at a medical institution or a care facility 310. The extraction unit 302 may extract the main disease name, the number of days to be billed, and the like from the receipt data 320.

[0084] The calculation unit 303 refers to the storage unit 301 using the disease classification code 322 extracted by the extraction unit 302, derives the facility standard 323, the calculation requirement 324, and the remuneration points 325, and compares them with the receipt data 320 to calculate the total theoretical value 331 of the calculable medical fee points. Specifically, if a hospital and a patient satisfy the facility standard 323 and the calculation requirement 324 corresponding to the disease classification code 322 derived from the receipt data 320, the linked remuneration points 325 is set as the theoretical value of the receipt (maximum billable points). The theoretical values ​​corresponding to multiple receipts are accumulated to derive the total theoretical value 331. The calculation unit 303 calculates the total theoretical value for each classification to which the medical fee items belong. The calculation unit 303 calculates the theoretical value taking into account the additional items and additional points.

[0085] The display control unit 304 displays the medical fee points claimed for past medical procedures performed at the medical institution or nursing facility 310 in comparison with the total theoretical value 331. Specifically, as shown in a screen example 600 in FIG. 6, the calculated amount at the hospital is displayed in comparison with the theoretical value for each medical procedure. For example, a specific disease medical care management fee of 1,027,500 yen is claimed, but the theoretical value calculated by the calculation unit 303 is 1,335,000 yen, and the calculation rate is displayed as 77.7%. This actual claimed amount of 1,027,500 yen is high compared to the national average of 850,500 yen, but compared to the theoretical value of 1,335,000 yen, it indicates that there is a 22% billing omission. Similarly, the actual claimed amount is displayed in comparison with the theoretical value for cerebrovascular rehabilitation, musculoskeletal rehabilitation, etc.

[0086] Furthermore, the "Status" column automatically calculates and displays the percentage of illnesses and the number of patients undergoing rehabilitation, making it possible to suggest measures that can be taken to improve billing rates.

[0087] The display control unit 304 may display additional items corresponding to additional points that were not included in the medical fee points claimed for past actions performed at the medical institution or care facility 310.

[0088] The update unit 305 updates at least one of the facility standards and the calculation requirements stored in the storage unit 301 in response to a user's input. The update unit 305 may update at least one of the facility standards and the calculation requirements to correspond to a revision of the "Medical Medical Fee Schedule" of the Ministry of Health, Labor and Welfare. In addition, the update unit 305 updates facility standards or calculation requirements that are not clearly defined in the "Medical Medical Fee Schedule" based on a user's input according to the review results of the medical receipt review committee.

[0089] Based on the result of the judgment by the medical receipt examination committee, the update unit 305 updates the facility standard and the billing requirement stored in the memory unit 312. The update unit 305 includes a judgment unit 351 that judges whether or not the facility standard and the billing requirement stored in the memory unit 312 should be updated in response to a user input.

[0090] FIG. 7 is a flowchart illustrating the overall processing flow of the information processing system 300.

[0091] First, in step S701, receipt data is acquired from the hospital database (UKE). The receipt data includes patient information, health information, injury / disease code, medical treatment information, etc. (Master standard of the Ministry of Health, Labor and Welfare).

[0092] Next, in step S702, the injury / disease name code is converted into an IDC code using the Ministry of Health, Labor and Welfare's injury / disease name master.

[0093] Next, in step S703, the ICD code is used to query the storage unit 301. That is, from among the medical fee items stored in the storage unit 301, medical fee items linked to the ICD code related to the medical receipt data are picked up.

[0094] In step S704, the facility criteria of the picked up medical fee items are compared with the facility information to further narrow down the medical fee items that meet the facility criteria. At this time, medical fee items that are not included in the receipt data and that involve the doctor's clinical judgment may be controlled to be excluded from the judgment of the theoretical value. This is because there are cases where it is necessary to be careful when determining the theoretical value of a medical fee item that involves the doctor's clinical judgment. On the other hand, if a medical fee item that involves the doctor's clinical judgment is already included in the receipt data, a theoretical value may be calculated by adding an additional point to the additional item linked to the medical fee item that involves the doctor's clinical judgment. Next, in step S705, the facility standards and calculation requirements for the additional items are determined. Furthermore, in step S706, the total value of the medical fee points and the additional points is calculated as a theoretical value. Then, in step S707, the theoretical value is compared with the actual value (the billing points on the receipt).

[0095] FIG. 8 is a flowchart illustrating the flow of the facility criterion determination process performed by the calculation unit 303.

[0096] In step S801, facility criteria corresponding to medical fee items are read from the storage unit 301. In step S803, the facility structure data of the hospital is compared with the read facility criteria, and if the criteria are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0097] If the facility structure of the hospital meets the criteria, the process proceeds to step S807, where the personnel structure (number of doctors, number of certified doctors, number of nurses, number of physical therapists, etc.) is judged by comparing the hospital's personnel structure data with the facility criteria read out from the storage unit 301. If the criteria are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0098] If the criteria are met, the process proceeds to step S809, where the medical equipment is judged by comparing the equipment configuration data of the hospital with the retrieved facility criteria. If the criteria are not met, the process proceeds to step S805, where improvement measures may be proposed.

[0099] If the criteria are met, the process proceeds to determining the calculation requirements corresponding to the medical fee item.

[0100] FIG. 9 is a diagram showing the flow of the process of determining the calculation requirements. In this example, it is assumed that the number of calculation days 901 and the calculation number 902 are specified for each medical fee item as calculation requirements. Here, the maximum number of times per day (here, 1 time) and the maximum number of days (here, 150 days from onset) are set as the number of days for calculation. In addition, the calculation number is set to an upper limit of 13 times per month if it exceeds 150 days. It is not limited to the medical fee standards established by the Ministry of Health, Labor and Welfare, and original standards (upper limit 3 times per week, number of days excluded from calculation after onset: 14) may be set. As an example, let us assume that receipt data 903 to 905 have been acquired. In other words, the injury was a femur fracture, and the onset date was June 15th. The actual billed points were 555 points for June and 3700 points for July. For this, the theoretical value for musculoskeletal rehabilitation fee (I) is calculated as the sum of 2960 points for the 16 days from onset to the end of June, and 5735 points for the 31 days of July. As described above, this embodiment refers to pre-registered facility standards and calculation standards, automatically selects the "items" that the hospital can bill, and automatically calculates the "theoretical maximum value" of those items. As described above, according to this embodiment, a medical fee database / platform can be constructed, and the theoretical value of the maximum fee that the hospital can calculate can be calculated.

[0101] [Other embodiments] Although the present invention has been described above with reference to the embodiments, the present invention is not limited to the above embodiments. Various modifications that can be understood by those skilled in the art can be made to the configuration and details of the present invention within the technical scope of the present invention. In addition, systems or devices that combine the separate features included in each embodiment in any way are also included in the technical scope of the present invention.

[0102] The present invention may be applied to a system consisting of multiple devices, or to a single device. Furthermore, the present invention is also applicable to a case where an information processing program for implementing the functions of the embodiments is supplied to a system or device and executed by a built-in processor. In order to implement the functions of the present invention with a computer, a program installed on a computer, a medium storing the program, a server for downloading the program, and a processor for executing the program are also included in the technical scope of the present invention. In particular, at least a non-transitory computer readable medium storing a program for causing a computer to execute the processing steps included in the above-mentioned embodiments is included in the technical scope of the present invention.

Claims

1. For each of the multiple medical procedures that may occur in a medical institution or nursing home, a disease classification code and Medical fee items and Medical fee points and Facility standards for facilities for claiming the medical fee points; Calculation requirements for the patient, including at least one of the following: disease name, date of birth, sex, medical department, medicine, medical procedure, severity, nursing need data, ward, medical department, life history, admission / discharge route, disease condition, care level, and outcome data, for claiming the medical fee points; a storage unit that stores the above in association with each other; a determination unit that inputs information indicating the patient's condition, refers to the calculation requirements in the storage unit, and determines the medical fee items for which the patient may be calculated; An information processing device comprising:

2. The storage unit further stores additional items and additional points in association with the medical fee items, The information processing device according to claim 1 , wherein the determination unit determines the medical fee items taking into consideration the additional items and additional points.

3. A calculation unit that inputs a disease classification code, refers to the storage unit, and calculates a theoretical value of the medical fee points that can be calculated; a display control unit that displays the theoretical value calculated by the calculation unit; The information processing device according to claim 1 , further comprising:

4. The method further includes an extraction unit that extracts the disease classification code from a plurality of receipt data regarding medical treatments performed at a medical institution or a nursing facility, The information processing device according to claim 3 , wherein the calculation unit refers to the storage unit using the disease classification code extracted by the extraction unit.

5. The information processing device according to claim 1, further comprising an update unit that updates the facility standards and calculation requirements stored in the memory unit based on user input in response to a judgment by a prescription review committee.

6. The information processing device according to claim 3 , wherein the calculation unit calculates a total of the theoretical values ​​for each category to which the medical fee items belong.

7. The storage unit includes a first storage unit for directly storing the medical fee points, facility standards, and calculation requirements defined in the "Medical Fee Point Table" created by the Ministry of Health, Labor, and Welfare, and a second storage unit for temporarily storing facility standards and calculation requirements that are not clearly defined in the "Medical Fee Point Table" created by the Ministry of Health, Labor, and Welfare, The information processing device according to claim 5 , wherein the update unit updates the facility standards and calculation requirements stored in the second storage unit based on the judgment results of the medical receipt review committee.

8. The information processing device according to claim 5 , wherein the update unit determines whether or not the facility standards and the calculation requirements stored in the storage unit should be updated in response to a user input.

9. The information processing device according to claim 3 , wherein the display control unit displays additional items corresponding to additional points that were not included in the medical fee points claimed for past actions performed at the medical institution or nursing facility.

10. The information processing device according to claim 3 , wherein the calculation unit does not calculate the theoretical value for a medical fee item that involves a doctor's clinical judgment.

11. The information processing device according to claim 10 , wherein the calculation unit calculates the theoretical value by adding additional points for additional items linked to medical fee items in which the doctor's clinical judgment is involved.

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