DPC receipt inspection system, inspection method and program

Abstract

To inspect, from the DPC receipt data itself, with regard to an inconsistency between the need for operation and an extraction classification number.SOLUTION: A surgery inspection means 13 of a DPC receipt inspection system 1 retrieves a record related to surgery from one or a plurality of performance records, and warns that the relationship between an extraction classification number and the necessity for surgery is inconsistent when a surgery code in a digit pertaining to surgery that is included in an extraction classification number indicates that surgery is unnecessary and a performance record associated with surgery exists in the DPC receipt data, or when the surgery code included in the extraction classification number indicates that surgery is needed and the performance record associated with surgery does not exist in the DPC receipt data.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present invention relates to a DPC receipt inspection system, inspection method, and program. [Background technology]

[0002] Since 2003, specialized medical hospitals that provide advanced medical care have implemented a comprehensive medical fee billing system called DPC (Diagnosis Procedure Combination) for acute hospitalizations. This system determines medical fee points (comprehensive points) per day of hospitalization according to a "diagnosis group classification" for each patient, which combines the name of the illness or injury, age, level of consciousness disturbance, and whether or not surgery or treatment was performed. The diagnosis group classification is assigned a 14-digit classification number according to the name of the illness or injury that requires the most medical resources (hereinafter simply referred to as "illness or injury"), whether or not surgery or prescribed treatment was performed, etc., and a daily point amount is determined for each classification number and length of hospitalization.

[0003] Like other receipts, DPC receipts are reviewed by a review and payment agency for their validity, and medical fees are paid by the insurer to the medical institution for receipts that pass the review. Receipts that do not pass the review are returned to the medical institution.

[0004] Conventionally, patent documents relating to the digitization of medical receipts include, for example, Patent Document 1. Patent Document 1 discloses a system for digitizing paper medical receipts and automatically examining them. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Japanese Patent Application Laid-Open No. 2005-050245 Summary of the Invention [Problem to be solved by the invention]

[0006] However, although Patent Document 1 describes the items to be inspected for medical receipts, it does not describe how the inspection should be carried out in detail.

[0007] Therefore, the present invention aims to make it possible to check the validity of DPC receipts based on the DPC receipt data itself. [Means for solving the problem]

[0008] In order to achieve the above-mentioned object, the present invention is a DPC receipt inspection system that inspects DPC receipts based on electronic data of DPC receipts, and is equipped with a means for reading DPC receipt data, which is electronic data of DPC receipts, a classification number extraction means for extracting comprehensive evaluation classification numbers from the read DPC receipt data, and a surgery inspection means for inspecting the consistency of whether or not surgery has been performed corresponding to the extracted classification numbers, which are classification numbers extracted by the classification number extraction means. The surgery checking means searches for records related to surgery from one or more fee records, which are records indicating the fee point portion included in the DPC receipt data, and one or more coding data records, which are coding data records indicating the details of medical procedures in the comprehensive evaluation portion. Furthermore, the surgery checking means warns of an inconsistency between the extracted classification number and the presence or absence of surgery when the surgery code, which is a code for the digits related to surgery included in the extracted classification number, is data indicating no surgery and at least one of the coding data record related to surgery and the fee record related to surgery is present in the DPC receipt data, or when the surgery code included in the extracted classification number is data indicating surgery and neither the coding data record related to surgery nor the fee record related to surgery is present in the DPC receipt data.

[0009] With this configuration, the DPC receipt data itself can be checked for inconsistencies between the presence or absence of surgery and the extracted classification number, and a warning can be issued to the user if there is an inconsistency.

[0010] The system may further include an illness name checking means for checking the consistency between the extracted classification number and the illness name (the illness name entered in the DPC prescription data as the "illness name with the most medical resources invested"). The illness name inspection means executes an illness name extraction process that extracts illness codes from DPC prescription data, an illness name inspection process that refers to an illness master that stores illnesses in correspondence with parts of classification numbers, and determines whether the illness code corresponding to the extracted classification number in the illness master matches the illness code extracted by the illness name extraction process, and determines that there is a match if there is a match, and determines that there is no match if there is no match, and a process that issues a warning that the illness name does not match the extracted classification number if the illness name inspection process determines that there is no match.

[0011] With this configuration, the DPC receipt data itself can be checked for inconsistencies between the input information on the illness or injury name and the extracted classification number, and a warning can be issued to the user if an inconsistency is found.

[0012] The system may further include a secondary illness name checking means for checking the consistency of the DPC receipt data with the secondary illness name when the extracted classification number includes a corresponding code indicating whether or not there is a defined secondary illness. The secondary illness name inspection means executes a secondary illness extraction process that extracts secondary illness codes from DPC prescription data, and a secondary illness inspection process that, if the extracted classification number includes a corresponding code indicating the presence of a defined secondary illness, refers to a secondary illness master that stores a correspondence between part of the classification number and one or more defined secondary illness codes, and determines whether the code of the defined secondary illness corresponding to the extracted classification number in the secondary illness master matches the secondary illness code extracted by the secondary illness extraction process, and determines that there is a match if there is a match, and determines that there is no match if there is no match or if the secondary illness code could not be extracted by the secondary illness extraction process, and a process that warns that the secondary illness name does not match the extracted classification number if the secondary illness inspection process determines that there is no match.

[0013] With this configuration, the DPC receipt data itself can be checked for inconsistencies between the input secondary illness information and the extracted classification number, and a warning can be issued to the user if an inconsistency is found.

[0014] In the secondary illness inspection process, if the extracted classification number includes a corresponding code indicating that there is no defined secondary illness, the secondary illness name inspection means may refer to the secondary illness master and determine whether the code of the defined secondary illness corresponding to the extracted classification number in the secondary illness master matches the secondary illness code extracted in the secondary illness extraction process, and may determine that there is no match if there is a match, or that there is a match if there is no match.

[0015] With this configuration, if a classification number without a defined secondary injury or illness is entered as an extracted classification number, it is possible to warn the user of the possibility of an error.

[0016] The system can further comprise a procedure code checking means for checking whether the corresponding code is correct when the extracted classification number includes the corresponding code of the procedure. The treatment code inspection means refers to a treatment master that stores a correspondence between a portion of a classification number and one or more treatment codes, searches the DPC receipt data for treatments related to the treatment code that corresponds to the extracted classification number, and if there is no treatment data corresponding to the treatment code, executes a process to warn that there is an error in the treatment corresponding code among the extracted classification numbers.

[0017] With this configuration, the DPC receipt data itself can be checked for inconsistencies between the presence or absence of treatment and the extracted classification number, and a warning can be issued to the user if there is an inconsistency.

[0018] The system may further comprise a date checking means for checking whether the date of the operation or procedure is within the hospital stay period. The date check means performs a hospital stay period extraction process to extract the hospital stay period from the DPC receipt data, and a process to determine whether the dates of the medical treatment-related records and coding data records included in the DPC receipt data are within the hospital stay period, and if it is determined that they are not within the hospital stay period, to issue a warning that the date of the surgery or procedure is not within the hospital stay period.

[0019] With this configuration, it is possible to check the DPC receipt data itself for errors in inputting information about the length of hospital stay or the dates of surgery or treatment, and to warn the user of any errors.

[0020] In order to achieve the above-mentioned object, the present invention also provides a DPC receipt inspection method for inspecting a DPC receipt based on electronic data of the DPC receipt using a computer. This method involves the following steps: reading DPC receipt data, which is electronic data for DPC receipts; a classification number extraction process that extracts comprehensive evaluation classification numbers from the read DPC receipt data; and a surgery inspection process that checks for consistency between the presence or absence of surgery corresponding to the extracted classification numbers, which are the classification numbers extracted in the classification number extraction process. In the surgery inspection process, records related to surgery are searched for from one or more fee records, which are records that indicate the fee point portion included in the DPC receipt data, and if the surgery code, which is the code for the digits related to surgery included in the extracted classification number, is data indicating no surgery and a fee record related to surgery exists in the DPC receipt data, or if the surgery code included in the extracted classification number is data indicating surgery and a fee record related to surgery does not exist in the DPC receipt data, a warning is issued that there is an inconsistency between the extracted classification number and whether or not surgery has occurred.

[0021] In order to achieve the above-mentioned object, the present invention is also a program for checking DPC receipts based on electronic data of the DPC receipts using a computer. This program causes the computer to function as a means for reading DPC receipt data, which is electronic data of DPC receipts, a classification number extraction means for extracting comprehensive evaluation classification numbers from the read DPC receipt data, and a surgery inspection means for inspecting the consistency of whether or not surgery has been performed corresponding to the extracted classification numbers, which are classification numbers extracted by the classification number extraction means. The surgery inspection means searches for records related to surgery from one or more fee records, which are records that indicate the fee point portion included in the DPC receipt data, and if the surgery code, which is a code for the digits related to surgery included in the extracted classification number, is data indicating no surgery and a fee record related to surgery exists in the DPC receipt data, or if the surgery code included in the extracted classification number is data indicating surgery and a fee record related to surgery does not exist in the DPC receipt data, it warns that there is an inconsistency between the extracted classification number and whether or not surgery has occurred. [Effects of the Invention]

[0022] According to the present invention, the DPC receipt data itself can be checked for inconsistencies between the presence or absence of surgery and the extracted classification number, and a warning can be issued to the user if an inconsistency is found. [Brief explanation of the drawings]

[0023] [Figure 1] FIG. 1 is a diagram showing the DPC receipt inspection system and related devices. [Figure 2] This is a block diagram of the DPC receipt inspection system. [Figure 3] This is an example of a classification tree and the corresponding surgeries and procedures. [Figure 4] FIG. 1 is a diagram illustrating the structure of DPC receipt data. [Figure 5] This is an example of DPC prescription data. [Figure 6] 10 is an example of a surgery code master. [Figure 7] 10 is an example of an injury / illness master. [Figure 8] 10 is an example of a secondary injury / illness master. [Figure 9] 10 is an example of a treatment master. [Figure 10] 1 is a flowchart showing an example of processing executed by the DPC receipt inspection system. [Figure 11] 11 is a flowchart continuing from FIG. 10. [Figure 12] This is the screen display after inspection in the DPC prescription inspection system. [Figure 13] FIG. 13 is an enlarged view of the first window in FIG. [Figure 14] FIG. 13 is an enlarged view of the second window of FIG. [Figure 15] This is an example of a tree diagram that is displayed when a classification number is selected. [Figure 16] 10 is an example of a screen showing a warning about a procedure and date. [Figure 17] 10 is an example of a screen showing a warning about a secondary illness name. [Figure 18] 1 is an example of a medicine master. DETAILED DESCRIPTION OF THE INVENTION

[0024] Next, an embodiment of the present invention will be described in detail with reference to the accompanying drawings. The DPC receipt inspection system 1 of this embodiment is a system that inspects DPC receipts based on the electronic data of the DPC receipts. As shown in Figure 1, the DPC receipt inspection system 1 is realized by having a computer such as a personal computer execute a program, and can also be implemented on a stand-alone computer that is not connected to a network. Although not shown in the figure, each processing function of the present invention is realized by having a computer equipped with a CPU (controller), RAM, ROM, etc. execute the program.

[0025] The DPC receipt inspection system 1 reads DPC receipt data saved with a file extension ".UKE," for example, determines whether there are any inconsistencies in the content of the DPC receipt data, and if there are any inconsistencies, issues a warning to the user. The storage device recording the data to be read, such as the DPC receipt data and master data required for inspection, may be stored within a computer constituting the DPC receipt inspection system 1, may be stored in a storage device S1 (including a USB memory stick, etc.) locally connected to the DPC receipt inspection system 1, or may be stored in a storage device S2 connected to the DPC receipt inspection system 1 via a network N. In this embodiment, for convenience, as an example, the DPC receipt data is assumed to be stored in the storage device S1.

[0026] Furthermore, part of the configuration of the DPC receipt inspection system 1 may be implemented on another computer. For example, part of the processing may be implemented by another computer, such as a server SV connected via a network N.

[0027] As shown in Figure 2, the DPC receipt inspection system 1 includes, as functional means, a reading means 11, a classification number extraction means 12, a surgery inspection means 13, an injury / illness name inspection means 14, a secondary injury / illness name inspection means 15, a treatment code inspection means 16, a date check means 17, and a warning display means 18. In addition, a surgery code master 21, an injury / illness master 22, a secondary injury / illness master 23, and a treatment master 24 are stored in the storage device S1.

[0028] The reading means 11 executes a process of reading DPC receipt data, which is electronic data of DPC receipts.

[0029] The classification number extraction means 12 executes a process of extracting the comprehensive evaluation classification number from the read DPC receipt data. The classification number is also called the diagnosis group classification or the diagnosis group classification code, but in this embodiment, the term "classification number" is basically used.

[0030] Here, we will explain in detail the classification number and DPC receipt data. The classification number is a 14-digit alphanumeric number, such as 130080xx99xxxx, as shown in Figure 3. This number is classified according to the illness that was the primary cause of hospitalization, whether surgery was performed, whether prescribed treatment was performed, whether a defined secondary illness was recognized, etc. A per-day hospitalization fee (points) is set for each number, and medical institutions bill health insurance associations and other organizations for medical fees according to the points obtained by multiplying these points by the number of days of hospitalization.

[0031] Using Figure 3 as an example, the first six digits of the classification number indicate the general name of the illness that was the primary cause of hospitalization, with 130080 representing aplastic anemia. The ninth and tenth digits are determined by whether or not surgery was performed; 99 is assigned if no surgery was performed, and 97 if surgery was performed. Furthermore, classification is based on whether or not a specific surgery or treatment was performed (column 2 of Surgery, Treatment, etc.). If surgery or treatment was performed, it is assigned a number (corresponding code) of 1, 2, or 3 depending on the type of surgery or treatment. The table at the bottom of Figure 3 shows the type of surgery or treatment that applies to each of the cases 1, 2, and 3. If surgery was performed, the third digit from the bottom of the classification number is assigned a number (1, 2, or 3) depending on the type of surgery or treatment, and the last two digits are marked with an "x." If no surgery or treatment was performed, a "0" is assigned to the third digit from the bottom, and a "0" or "1" is assigned to the second digit from the bottom depending on the presence or absence of a defined secondary illness.

[0032] Next, the DPC receipt data will be described with reference to FIGS. DPC receipt data is recorded in CSV format and saved with the extension ".UKE." In DPC receipt data, record identification information is recorded in the first column of each row (record), and data related to that identification information is recorded in each record. As shown in Figure 4, record identification information includes medical institution information record (IR), common receipt record (RE), insurer record (HO) as receipt information, public expense record (KO), National Health Insurance Federation of Japan specific information record (KH), etc. Basically, one or more records related to each record identification information are recorded in the order shown in Figure 4, starting from the first record of the DPC receipt data.

[0033] For example, in the example data shown in Figure 5, from the beginning, one line each of medical institution information record (IR) and common receipt record (RE) is recorded, followed by two lines of receipt information, one line of diagnosis group classification record (BU), five lines of injury / illness record (SB), one line of patient basic record (KK), one line of medical treatment-related record (SK), three lines of comprehensive evaluation information, ten lines of fee-for-service records (fee-for-service information), and numerous coding data records (CD). Note that the example in Figure 5 is an example in which data is entered to the extent necessary to explain the invention.

[0034] Among the DPC receipt data in Figure 5, the data necessary for understanding the invention will be explained. The receipt common record (RE) records common information about patients and DPC receipts. DPC receipts are created for each month. For example, in the example in Figure 5, "201901" is recorded in the fourth column, indicating that the data is for January 2019. The receipt common record (RE) also records the patient code "0009220402" that identifies the patient.

[0035] In the diagnosis group classification record (BU), the classification number is recorded in the second column. The third and fourth columns indicate the date of admission and the date of discharge, respectively. The first four characters of the date data indicate the year, and in the example in Figure 5, the first four characters "2021" mean "2021." For example, "20210106" means January 6, 2021.

[0036] The injury / illness record (SB) records information about injuries and illnesses. The first record with "01" recorded in the sixth column is the record for the injury / illness name, and "D619" in the fifth column indicates the ICD code (classification code for injuries and illnesses according to the International Classification of Diseases) for the injury / illness name. The second record with "02" recorded in the sixth column is the record for the secondary injury / illness, and "C795" in the fifth column indicates the ICD code for the secondary injury / illness.

[0037] The medical treatment record (SK) is a record that records the medical treatment code, classification number, date of (planned) surgery or procedure, medical treatment classification code, medical treatment name, etc.

[0038] A fee-for-service record is a record that records billing information for medical procedures that are not included in comprehensive assessment. For example, a record with record identification information SI is a medical procedure record, and a record with record identification information IY is a pharmaceutical record (not shown in the example in Figure 5). The two-digit number in the second column of a medical procedure record (SI) indicates the medical procedure identifier. Examples of medical procedure identifiers include initial consultation (11), medication (21-28), injection (31-33), procedure (40), surgery (50), anesthesia (54), laboratory / pathology (60), diagnostic imaging (70), and hospitalization (90, 92). In other words, the medical procedure identifier code can be used to roughly identify the content of the medical procedure.

[0039] The coding data record (CD) is a record that records information about medical procedures, etc., included in the comprehensive evaluation. The coding data record includes, for example, the date of implementation (second column), medical procedure identification (third column), and a code for the medical receipt computer processing system (sixth column). The medical procedure identification is a code that is predetermined to correspond to a procedure, etc., similar to the fee-for-service record. The code for the medical receipt computer processing system is predetermined to correspond to detailed medical procedures, drugs, specific equipment, etc. In other words, the code for the medical receipt computer processing system can be used to identify the details of the medical procedures, etc.

[0040] Since classification numbers determine the amount of medical expenses that can be claimed per day by medical institutions, errors must be avoided. On the other hand, since DPC receipt data is a data set of medical expense claims according to classification numbers, DPC receipt inspection system 1 determines whether the classification numbers recorded in the DPC receipt data are appropriate by referencing the detailed contents of the DPC receipt data.

[0041] Next, the contents of the master used for each inspection and each of the means 13 to 18 will be explained.

[0042] [Inspection of surgery] As shown in Figure 6, the surgery code master 21 is a master that stores the MDC code, classification code, corresponding code, point table name, and K code in association with each other. The six-digit number consisting of the MDC code and classification code corresponds to the first six digits of the classification number and is a code corresponding to the general disease name (hereinafter referred to as the "disease code"). The corresponding code indicates whether or not surgery was performed in the classification number. Typically, 99 is assigned if no surgery was performed, and 97 if surgery was performed. The K code indicates the specific type of surgery or no surgery. If no surgery was performed, "KKK0" is assigned. If surgery was performed, a code starting with K is assigned depending on the type of surgery. Each of these data can be created by extracting them from the "Diagnosis Procedure Combination (DPC) Electronic Point Table" available on the Ministry of Health, Labor, and Welfare's website. The point table name in Figure 6 is left in place to facilitate understanding of the invention and to allow the content of the K code to be understood; it is not necessary.

[0043] The surgery checking means 13 executes a process to check the consistency of whether or not a surgery has been performed corresponding to the extracted classification number, which is the classification number extracted by the classification number extraction means 12. The surgery checking means 13 searches for a record related to surgery from one or more fee records, which are records indicating the fee point portion included in the DPC receipt data, and one or more coding data records, which are records of coding data indicating the content of the medical treatment in the comprehensive evaluation portion. The one or more volume records and the plurality of coding data records are exemplified in FIG. 5 above.

[0044] The surgery inspection means 13 issues a warning that there is an inconsistency between the extracted classification number and whether or not a surgery has been performed if the surgery code, which is a code for the surgery-related digits included in the extracted classification number, is data indicating no surgery and at least one of a coding data record related to surgery and a fee record related to surgery is present in the DPC receipt data. The surgery inspection means 13 also issues a warning that there is an inconsistency between the extracted classification number and whether or not a surgery has been performed if the surgery code included in the extracted classification number is data indicating that surgery has been performed and at least one of a coding data record related to surgery and a fee record related to surgery is not present in the DPC receipt data. When issuing a warning, the surgery inspection means 13 issues the warning via the warning display means 18, which will be described later.

[0045] More specifically, the surgery inspection means 13 references the portion of the surgery code master 21 where the disease code corresponds to the first six digits of the extracted classification number. In Figure 6, the two hatched rows of "130080" correspond to the extracted classification numbers (classification numbers recorded in the diagnosis group classification record) extracted from the DPC receipt data in Figure 5. Then, the means 13 references the row corresponding to the surgery code (the 9th and 10th digits, 97 or 99) included in the extracted classification number, and obtains the K code for this row. If the obtained K code is KKK0, it is determined that no surgery was performed; otherwise, it is determined that surgery was performed.

[0046] In this embodiment, the surgery code master 21 is referenced to determine whether the surgery code included in the extracted classification number indicates surgery or no surgery, but in a simpler manner, without using the surgery code master 21, it can be determined that if the 9th or 10th digit of the extracted classification number is 97, surgery is performed, and if it is 99, no surgery is performed.

[0047] If the surgery checking means 13 determines that the extracted classification number indicates no surgery, it searches the DPC record data, such as that shown in Figure 5, for the presence of a surgery-related volume record. Specifically, it searches for a "surgery" record in the volume record. Then, if the volume record contains a "surgery" record defined for each disease code, the surgery checking means 13 determines that there is a record related to surgery. If the surgery checking means 13 determines that the extracted classification number indicates no surgery and the volume record contains a "surgery" record, this means that surgery was performed but the extracted classification number indicates no surgery, and therefore determines that there is an inconsistency between the extracted classification number and whether or not actual surgery was performed. Note that the surgery checking means 13 may further check for the presence of a record with a medical treatment identification of 50 (a record indicating "surgery") in the coding record data.

[0048] Furthermore, even when the surgery checking means 13 determines that the extracted classification number indicates that surgery has been performed, it searches the DPC record data for the presence of an amount record related to "surgery" defined for each disease code. If the surgery checking means 13 determines that the extracted classification number indicates that surgery has been performed and there is no record of "surgery" defined for each disease code in the amount record, it determines that there is an inconsistency between the extracted classification number and whether or not surgery has actually been performed, because the extracted classification number indicates that surgery has been performed even though surgery has not been performed.

[0049] [Regarding the inspection of injury and illness names] As shown in Figure 7, the injury / illness master 22 is a master that stores a portion of a classification number and an injury or illness in association with each other. The injury / illness master 22 stores MDC codes, classification codes, ICD names, and ICD codes in association with each other. The six-digit disease code, which is the combination of the MDC code and classification code, corresponds to the first six digits of the classification number. The ICD code is the ICD code for the injury or illness corresponding to the disease code. A single disease code may correspond to only one ICD code or to multiple ICD codes. Each of these data can be created by extracting them from the "Diagnostic Procedure Combination (DPC) Electronic Point Table" provided on the Ministry of Health, Labor, and Welfare's website. The ICD names in Figure 7 are left in place to facilitate understanding of the invention and to allow the content of the ICD code to be understood; they are not necessary.

[0050] The injury / illness name checking means 14 executes a process of checking whether the extracted classification number matches the injury / illness name. The injury / illness name checking means 14 executes an injury / illness name extraction process and an injury / illness name checking process.

[0051] The illness name extraction process is a process for extracting illness codes from DPC receipt data. As described above, in the DPC receipt data, among the illness records (SB), the record with "01" recorded in the sixth column is the illness name record, and the illness code (ICD code) is extracted from the fifth column of that record. For example, the illness code "D619" is extracted from the DPC receipt data in Figure 5.

[0052] The injury / illness name checking process refers to the injury / illness master 22 and determines whether the injury / illness code (ICD code) corresponding to the extracted classification number in the injury / illness master 22 matches the injury / illness code extracted in the injury / illness name extraction process, and determines that there is a match if they match, and determines that there is no match if they do not match. Note that the injury / illness code corresponding to the extracted classification number in the injury / illness master 22 is, strictly speaking, the injury / illness code corresponding to the disease code in the first six digits of the extracted classification number.

[0053] For example, referring to Figure 7, there are multiple ICD codes that correspond to the disease code 130080. A search is performed to see if "D619," an injury or illness code extracted from DPC receipt data, exists among these multiple codes, and if it does, it is determined to match; if it does not, it is determined to not match. For example, in Figure 7, "D619" exists corresponding to 130080, so it is determined to match.

[0054] If the injury / illness name checking means 14 determines that the injury / illness name does not match the extracted classification number, it executes a process of issuing a warning that the injury / illness name does not match the extracted classification number. If issuing a warning, the injury / illness name checking means 14 issues the warning via the warning display means 18, which will be described later.

[0055] [Regarding secondary injury and illness inspections] As shown in Figure 8, the secondary injury / illness master 23 is a master that stores a portion of a classification number and one or more defined secondary injury / illness codes in association with each other. The secondary injury / illness master 23 stores the MDC code, classification code, corresponding code, ICD name, and ICD code in association with each other. The disease code, which is the combination of the MDC code and classification code, corresponds to the first six digits of the classification number. The corresponding code refers to a code assigned to a specific digit of the classification number when a defined secondary injury / illness is defined for that disease code under the comprehensive evaluation system. For the disease code 130080, a defined secondary injury / illness is defined. If the defined secondary injury / illness is "present," a 1 is assigned to the second digit from the bottom of the classification number (see Figure 3). The ICD code is the ICD code for the secondary injury / illness corresponding to the disease code. A single disease code may correspond to only one ICD code or multiple ICD codes. Each of these data can be created by extracting data from the "Diagnosis Procedure Combination (DPC) Electronic Point Table" provided on the Ministry of Health, Labor, and Welfare's website. The ICD names in FIG. 8 are not necessary and are left in place to allow the contents of the ICD codes to be understood in order to facilitate understanding of the description of the invention.

[0056] The secondary illness name checking means 15 executes a process to check the consistency between the DPC receipt data and the secondary illness name when the extracted classification number includes a corresponding code indicating the presence or absence of a defined secondary illness. The secondary illness name checking means 15 executes a secondary illness extraction process and a secondary illness check process.

[0057] The secondary illness extraction process is a process for extracting secondary illness codes from DPC receipt data. As described above, in DPC receipt data, among the illness records (SB), records with "02" recorded in the sixth column are secondary illness records, and the secondary illness code (ICD code) is extracted from the fifth column of the record. For example, the secondary illness code "C795" is extracted from the DPC receipt data in Figure 5.

[0058] In the secondary injury / illness inspection process, if an extracted classification number includes a corresponding code indicating the presence of a defined secondary injury / illness, the process determines whether the code of the defined secondary injury / illness corresponding to the extracted classification number in the secondary injury / illness master 23 matches the secondary injury / illness code extracted in the secondary injury / illness extraction process. If they match, it is determined that they match. If they do not match, or if a secondary injury / illness code cannot be extracted in the secondary injury / illness extraction process, it is determined that they do not match. Note that the code of the defined secondary injury / illness corresponding to the extracted classification number in the secondary injury / illness master 23 is, strictly speaking, the secondary injury / illness code corresponding to the disease code in the first six digits of the extracted classification number. Furthermore, "the code of the defined secondary injury / illness corresponding to the extracted classification number in the secondary injury / illness master 23 matches the secondary injury / illness code extracted in the secondary injury / illness extraction process" means that, if there are multiple codes of the defined secondary injury / illness corresponding to the extracted classification number in the secondary injury / illness master 23, one of the multiple codes matches the secondary injury / illness code extracted in the secondary injury / illness extraction process.

[0059] For example, referring to Figure 8, there are multiple ICD codes corresponding to the disease code 130080. The secondary illness name checking means 15 searches for the existence of "C795," an illness code extracted from the DPC receipt data, among these multiple codes, and determines that there is a match if it exists, and determines that there is no match if it does not exist. For example, in Figure 8, there is no "C795" corresponding to 130080, so it is determined that there is no match.

[0060] Furthermore, in the secondary illness inspection process, if the extracted classification number further includes a corresponding code indicating that there is no defined secondary illness, the secondary illness name inspection means refers to the secondary illness master and determines whether the code of the defined secondary illness corresponding to the extracted classification number in the secondary illness master 23 matches the secondary illness code extracted in the secondary illness extraction process, and determines that there is no match if there is a match, and determines that there is a match if there is no match. That is, even if the extracted classification number includes a corresponding code indicating that there is no defined secondary injury or illness, if the secondary injury or illness code specified in the DPC record data matches the ICD code corresponding to the extracted classification number (the first six digits) in the secondary injury or illness master 23, it is considered that a number indicating "the presence of a defined secondary injury or illness" should have been selected as the classification number. Therefore, the secondary injury or illness name checking means 15 determines that the code of the defined secondary injury or illness corresponding to the extracted classification number in the secondary injury or illness master 23 does not match the secondary injury or illness code extracted in the secondary injury or illness extraction process.

[0061] If the secondary injury / illness name checking means 15 determines that the secondary injury / illness name does not match the extracted classification number in the secondary injury / illness checking process, it executes a process of issuing a warning that the secondary injury / illness name does not match the extracted classification number. If issuing a warning, the secondary injury / illness name checking means 15 issues the warning via the warning display means 18, which will be described later.

[0062] [Regarding procedure code inspection] As shown in Figure 9, the procedure master 24 is a master that stores a portion of a classification number in association with one or more procedure codes. The procedure master 24 stores the MDC code, classification code, response code, procedure name, and procedure code (represented as the name of the procedure, etc., and the code, respectively, in Figure 9) in association with each other. The disease code, which is the combination of the MDC code and classification code, corresponds to the first six digits of the classification number. The response code is a code that is assigned to a specific digit of the classification number when one or more procedures are defined for the disease code in the comprehensive evaluation system. For the disease code 130080, "Surgery, Treatment, etc. 2" is defined. If "Surgery, Treatment, etc. 2" is "Yes," either 1, 2, or 3 is assigned to the third digit from the bottom of the classification number depending on the type of the procedure (see Figure 3). The procedure code is the code for the procedure corresponding to the combination of the disease code and response code. A single combination of a disease code and response code may correspond to only one procedure code or to multiple procedure codes. These data can be created by extracting them from the "Diagnosis Procedure Combination (DPC) Electronic Point Table" provided on the Ministry of Health, Labor and Welfare's website. The names of the procedures in Figure 9 are left in order to make the contents of the procedure codes clear and to facilitate understanding of the description of the invention, but are not necessary.

[0063] When the extracted classification number includes a treatment response code, the treatment code checking means 16 executes a process of checking whether the response code is correct or not. The procedure code checking means 16 refers to the procedure master 24, searches the DPC receipt data for procedures related to the procedure code corresponding to the extracted classification number (first six digits), and if there is no data corresponding to the procedure code, executes a process to warn that there is an error in the procedure corresponding code among the extracted classification numbers. When issuing a warning, the procedure code checking means 16 issues the warning via the warning display means 18, which will be described later.

[0064] The DPC receipt data includes a procedure code. For example, in the DPC receipt data shown in Figure 5, the procedure code 0028 (cyclosporine (excluding eye drops)) is recorded in the medical care record.

[0065] For example, in the example of Figure 5, 130080xx97x1xx is recorded as the classification number, and the medical care related record has a procedure code of 0028. In addition, in the procedure master of Figure 9, 0028 exists as the procedure code corresponding to the corresponding code 1 of the disease code 130080, so it is determined that there is a match.

[0066] In addition, medical procedure codes are recorded in the second column of the medical related record (SK) (no input in the example of Figure 5), the fourth column of the fee information medical procedure record (SI), and the sixth column of the coding data record, so it is also possible to determine whether the procedure (medication, etc.) identified by the medical procedure code recorded in the fee information and coding data record corresponds to the procedure code.

[0067] To check the correspondence between medical procedure codes and procedure codes, it is sufficient to refer to another master that associates medical procedure codes with procedure codes. For example, the drug master in Figure 18 is a master that associates the drug codes of drugs administered as procedures with the procedure codes. The drug master stores, for each procedure code, a dummy code name for that procedure, the drug's generic name, the specific drug name, the drug price code, and the drug code. The drug price code corresponds to the generic name, and the drug code corresponds to the drug name. For example, for procedure code 0028, "cyclosporine," five different drug names (drug codes) are recorded in the drug master. Therefore, if at least one of these drug codes is recorded in the medical procedure code of the DPC receipt data in Figure 5, it means that the drug corresponding to procedure code 0028 was administered, and therefore it can be determined that there is a match. Conversely, if none of these drug codes is recorded in the medical procedure code of the DPC receipt data, it can be determined that there is no match.

[0068] If the procedure code checking means 16 determines that the extracted classification number is inconsistent, the DPC receipt checking system 1 may search the amount records and coding data records to determine whether a medication corresponding to the disease code (130080 in the example of FIG. 5) of the extracted classification number has been administered. If so, the system may suggest a classification number correction option. For example, referring to FIG. 9, disease code 130080 (classification code 0080) corresponds to multiple medications other than cyclosporine, such as "antithymocyte globulin" (code: 0027) and "eltrombopag olamine" (code: 0252). Therefore, the drug master in FIG. 18 retrieves drug codes corresponding to these codes (dummy codes) and determines whether these drug codes are recorded in the amount records and coding data records. For example, the DPC receipt checking system 1 retrieves the drug code "622036501" corresponding to the dummy code 0252 ("eltrombopag olamine") from the drug master in FIG. 18. If the medical procedure code "622036501" is found in the volume record and coding data record and detected, it means that the procedure was performed with "eltrombopag olamine," which corresponds to the corresponding code "2" in Figure 9. Therefore, it can be inferred that the classification number "130080xx97x2xx" would be appropriate (see Figure 3, where "Surgery / Procedure, etc. 2" corresponds to the corresponding code "2"). Therefore, the DPC receipt inspection system 1 can display a message on the screen, such as, "Since the procedure was performed with eltrombopag olamine, wouldn't the classification number "130080xx97x2xx" be appropriate?" Furthermore, while we have described a case where the procedure code inspection means 16 presents a classification number correction candidate when it determines "inconsistency," even if it determines "consistency," it may also present a classification number correction candidate if it finds a drug related to the disease code in the DPC receipt data by searching for related drugs. Since medical fees vary depending on the classification number, it is very significant to present other classification number candidates even when a classification number is determined to be "consistent," in order to enable more appropriate medical fee claims.

[0069] [About checking the date] The date check means 17 executes a process to check whether the date of surgery or treatment is within the hospitalization period. The date check means 17 first executes a hospitalization period extraction process to extract the hospitalization period from the DPC receipt data. As described above, the DPC receipt data has the admission date and discharge date recorded in the diagnosis group classification record, so the date check means 17 extracts the admission date and discharge date, i.e., the hospitalization period, from the diagnosis group classification record. The date check means 17 then determines whether the dates of the medical care-related records and coding data records included in the DPC receipt data are within the hospitalization period, and if it determines that they are not within the hospitalization period, executes processing to warn that the date of the surgery or procedure is not within the hospitalization period. If a warning is to be issued, the date check means 17 issues the warning via the warning display means 18, which will be described later.

[0070] The date check means 17 not only checks whether the date of the surgery or procedure is within the hospitalization period, but also checks whether the date in the medical care related record and the date of the corresponding procedure in the coding data record and the fee record are consistent with each other. For example, if the medical care related record, coding data record, and fee record contain data corresponding to the same procedure (surgery, procedure, etc.), but the dates of the procedure included in these data are different, it determines that they do not match. If it determines that they do not match, the date check means 17 executes a process to issue a warning that the dates of the procedures recorded in the medical care related record, coding data record, and fee record do not match. If the date check means 17 issues a warning, it issues the warning via the warning display means 18, which will be described later.

[0071] The warning display means 18 is a means for displaying a warning on the computer screen when instructed by any of the means 13 to 17 to issue a warning.

[0072] Next, an example of processing by the DPC receipt inspection system 1 will be described. As shown in Figure 10, when the control unit of the DPC receipt inspection system 1 executes the inspection program, it first reads the DPC receipt data from the storage device S1 (S101), and then extracts the classification number, injury / illness code, secondary injury / illness code, and hospitalization period from the DPC receipt data (S102).

[0073] Next, the control unit determines whether the extracted classification number contains a surgery code (S110). For example, simply, it determines whether the 9th and 10th digits of the classification number are 97 or 99. If the control unit determines that the extracted classification number does not contain a surgery code (S110, No), it searches the DPC receipt data for records related to surgery (S111). For example, it searches for records with a medical treatment ID of 50. If the control unit determines that the DPC receipt data contains records related to surgery (S111, Yes), it displays a warning on the screen indicating a mismatch between the extracted classification number and whether surgery has been performed (S112) and proceeds to step S120. On the other hand, if the control unit determines that the DPC receipt data does not contain records related to surgery (S111, No), it proceeds to step S120 without displaying a warning.

[0074] Furthermore, if the control unit determines that the extracted classification number, which is the extracted classification number, contains a surgery code (S110, Yes), it searches the DPC receipt data for records related to surgery (S115). If the control unit determines that the DPC receipt data does not contain records related to surgery (S115, No), it displays a warning on the screen indicating a mismatch between the extracted classification number and whether or not surgery has been performed (S112) and proceeds to step S120. On the other hand, if the control unit determines that the DPC receipt data contains records related to surgery (S115, Yes), it proceeds to step S120 without displaying a warning.

[0075] In step S120, the control unit determines whether the injury / illness code matches the code corresponding to the extracted classification number in the injury / illness master 22. If it determines that they do not match (S120, No), it displays a warning that there is a mismatch between the extracted classification number and the injury / illness name (S121), and proceeds to step S130. On the other hand, if it determines that they match (S120, Yes), it proceeds to step S130 without displaying a warning.

[0076] In step S130, the control unit determines whether the extracted classification number includes a corresponding code indicating the presence of a defined secondary injury or illness. If the control unit determines that the extracted classification number includes a corresponding code indicating the presence of a defined secondary injury or illness (S130, Yes), it determines whether the extracted secondary injury or illness code matches the code corresponding to the extracted classification number in the secondary injury or illness master 23 (S131). If the control unit determines that the extracted secondary injury or illness code matches the code corresponding to the extracted classification number in the secondary injury or illness master 23 (S131, Yes), it proceeds to step S140 without displaying a warning. On the other hand, if the control unit determines that the extracted secondary injury or illness code does not match the code corresponding to the extracted classification number in the secondary injury or illness master 23 (S131, No), it determines that the extracted classification number and the secondary injury or illness name are inconsistent (S135), displays a warning indicating the inconsistency between the extracted classification number and the secondary injury or illness name (S138), and proceeds to step S140.

[0077] If the control unit determines in step 130 that the extracted classification number does not include a corresponding code indicating the presence of a defined secondary injury or illness (S130, No), it further determines whether the extracted classification number includes a corresponding code indicating the absence of a defined secondary injury or illness (S132). If the control unit determines that the extracted classification number includes a corresponding code indicating the absence of a defined secondary injury or illness (S132, Yes), it determines whether the extracted secondary injury or illness code matches a code corresponding to the extracted classification number in the secondary injury or illness master 23 (S134). If the control unit determines that the extracted secondary injury or illness code matches a code corresponding to the extracted classification number in the secondary injury or illness master 23 (S134, Yes), it determines that the extracted classification number and the secondary injury or illness name are inconsistent (S135), displays a warning of the inconsistency between the extracted classification number and the secondary injury or illness name (S138), and proceeds to step S140. On the other hand, if the control unit determines No in step S132, that is, if there is no code related to the defined secondary illness, or if the control unit determines No in step S134, it proceeds to step S140 without displaying a warning.

[0078] As shown in FIG. 11 , in step S140, the control unit determines whether the extracted classification number includes a code indicating a procedure. If the control unit determines that the extracted classification number does not include a code indicating a procedure (S140, No), the control unit proceeds to step S150 without issuing a warning regarding the procedure. On the other hand, if the control unit determines that the extracted classification number includes a code indicating a procedure (S140, Yes), the control unit searches the procedure master to determine whether a procedure corresponding to the extracted classification number exists in the DPC receipt data (S141). If the control unit determines that a procedure corresponding to the extracted classification number does not exist in the DPC receipt data in the procedure master 24 (S141, No), the control unit displays a warning indicating that the procedure code corresponding to the extracted classification number is incorrect (S142) and proceeds to step S150. On the other hand, if the control unit determines that a procedure corresponding to the extracted classification number exists in the DPC receipt data in the procedure master 24 (S141, Yes), the control unit proceeds to step S150 without displaying a warning.

[0079] In step S150, the control unit determines whether the date of the surgery or procedure is within the hospitalization period. If the control unit determines that the date of the surgery or procedure is not within the hospitalization period (S150, No), it displays a warning that the date of the surgery or procedure is not within the hospitalization period (S151) and terminates the process. On the other hand, if the control unit determines that the date of the surgery or procedure is within the hospitalization period (S150, Yes), it terminates the process without displaying a warning.

[0080] Note that the processes in Figures 10 and 11 are merely examples. For example, the order of the items to be inspected may be different. Also, for ease of understanding, a warning is displayed for each item in the description, but it is also possible to record whether or not to display a warning as a flag, and when creating a warning display screen, add warning text for the items to be warned.

[0081] Next, an example of the operation of the DPC receipt inspection system 1 will be described with reference to the screen display. When the DPC receipt inspection system 1 processes the inspection, it displays a screen such as that shown in Figure 12 (hereinafter referred to as the "receipt display screen") on the monitor. As shown in Figure 12, the receipt display screen displays a first window P1 on the left side and a second window P2 to the right of the first window P1. In this example, the window showing the inspection results spans three pages, with the first and second pages being displayed in the left and right windows P1 and P2, respectively.

[0082] The receipt display screen displays DPC receipt data along with the items indicated by the data in an easy-to-read format. In addition, if any warnings are found as a result of the inspection process, a warning is displayed. As shown in Figure 13, the receipt display screen displays a patient information column 41 and an insurance / department information column 42 at the top of the first window P1. Below these are displayed a classification number column 43, an illness / injury name column 44, a secondary illness / injury column 45, and a column 46 for the date of admission / discharge. Further below these is provided a two-column detail display column 50. The detail display column 50 has a medical treatment-related display column 51, a warning display column En (referred to as E1, etc.) that displays warnings, and a volume display column 52.

[0083] As shown in Fig. 14, the second window P2 has a detail display field 50 that continues from the first window P1. In the example of Fig. 14, a fee display field 52 and a coding data display field 53 that continue from the first window P1 are displayed. In the fee display field 52 and the coding data display field 53, two-digit numbers such as 60 and 90 displayed in the left column represent medical treatment identification. Note that in the examples of Figs. 13 and 14, the coding data display field 53 is displayed in the second window P2, but depending on the content of the DPC receipt data, such as when there are few fee items, it may be displayed in the detail display field 50 of the first window P1.

[0084] In the examples of Figures 12 to 14, the warning display field E1 displays "[1] Mismatch between diagnosis group classification number and surgery." This is because, although the classification number "130080xx97x1xx" is recorded in the DPC receipt data, no information about surgery is listed anywhere in the detailed display field 50. As mentioned above, surgery has a medical treatment ID of 50, but in the examples of Figures 12 to 14, no item with a medical treatment ID of 50 is displayed in the detailed display field 50 (it is not even on the third page, which is omitted from the illustration). For this reason, the DPC receipt inspection system 1 displays a warning about a mismatch between the classification number and surgery.

[0085] In this way, the DPC receipt inspection system 1 of this embodiment can check the DPC receipt data itself for inconsistencies in the presence or absence of surgery and extracted classification numbers, and warn the user if there is a discrepancy.The DPC receipt inspection system 1 also displays the DPC receipt data in a table together with not only the comprehensive evaluation information but also the output information and coding data records, and when the data spans multiple pages, the multiple pages are displayed side by side in the left and right windows (first window P1 and second window P2), making it easy to see where the error occurred when a warning is displayed.

[0086] As shown in Figure 15, the DPC receipt inspection system 1 displays a tree diagram 60 corresponding to the disease code of the recorded classification number (extracted classification number) in response to a selection (e.g., by clicking or tapping) in the classification number field 43. In the example of Figure 15, the classification number for aplastic anemia with disease code "130080" is displayed as a tree diagram branched according to whether surgery was performed, whether treatment 2 was performed, and whether a defined secondary injury or disease was present. Furthermore, if the above-mentioned various inspections determine that the extracted classification number does not match the volume record and coding data record, the portion of the tree diagram corresponding to the classification number that is a candidate for correction may be highlighted, for example, by using a color. For example, in Figure 15, if it is determined that the classification number "no surgery" should have been entered, the "no surgery" portion and the field corresponding to the option for the classification number "130080xx99xxxx" are highlighted. In this way, by selecting the classification number field 43, the tree diagram 60 corresponding to the extracted classification number is displayed, and furthermore, the classification numbers that are candidates for correction are highlighted, so the user can easily consider what classification numbers should have been used as the correct classification numbers. Note that the classification numbers that are candidates for correction may also be displayed in text on this tree diagram screen, or on a screen separate from the tree diagram.

[0087] In the example of Figure 15, a warning is given when the extracted classification number indicates that surgery has been performed but there are no records related to surgery in the DPC receipt data. However, a warning can also be given when the extracted classification number indicates that surgery has not been performed but there are records related to surgery in the DPC receipt data.

[0088] Next, another example of a warning will be described. On the receipt display screen of FIG. 16, the warning display field E2 displays "[2] Inconsistency in diagnosis group classification number and procedure 2." In the example of FIG. 16, the classification number "130080xx97x3xx" is recorded in the DPC receipt data, and the surgery / procedure is recorded in the medical care related display field 51 as "Surgery / Procedure, etc. 0028 Cyclosporine (excluding eye drops) January 8, 2019." However, referring to the procedure master 24 of FIG. 9, the procedure code corresponding to the corresponding code 3 of the disease code 130080 should be "0027" (antithymocyte globulin), but this procedure code is not recorded in the DPC receipt data. Therefore, the DPC receipt inspection system 1 determines that the procedure's corresponding code is incorrect and issues a warning. In this way, the DPC receipt inspection system 1 can inspect the DPC receipt data itself for inconsistencies between the presence or absence of treatment and the extracted classification number, and warn the user if there is an inconsistency.

[0089] Furthermore, on the receipt display screen of Figure 16, the warning display field E3 displays "[3] The date of surgery or treatment (scheduled) is outside the hospitalization period." This is because, although the hospitalization period recorded in the DPC receipt data is from January 6, 2019 to January 7, 2019, the medical treatment related display field 51 records "Surgery, treatment, etc. 0028 Cyclosporine (excluding eye drops) January 8, 2019," and a treatment date of January 8, 2019. In this way, the DPC receipt inspection system 1 can check the DPC receipt data itself for input errors in information about the hospitalization period or the date of the surgery or treatment, and warn the user of the error.

[0090] Furthermore, on the receipt display screen of FIG. 17, the warning display field E4 displays "[2] No or Inconsistent Secondary Illness Name." This is a warning that the DPC receipt data does not contain a secondary illness name, or that the name is incorrect. In the example of FIG. 17, the classification number is "130080xx97x01x" and the secondary illness name is "Breast Cancer Bone Metastasis [C795]." However, when referring to the secondary illness master 23 of FIG. 8, the ICD code for "C795" does not match any of the ICD codes for the secondary illnesses corresponding to the corresponding code 1 of the disease code 130080. Therefore, the DPC receipt inspection system 1 determines that the secondary illness name is inconsistent and displays a warning that the secondary illness name is incorrect. In this way, the DPC receipt inspection system 1 can check the DPC receipt data itself for inconsistencies between the entered secondary illness information and the extracted classification number, and warn the user if an inconsistency is found.

[0091] In the example of Figure 17, a corresponding code indicating the presence of a defined secondary illness was recorded as the classification number. However, if a corresponding code indicating the absence of a defined secondary illness was recorded, the DPC receipt inspection system 1 determines whether the ICD code recorded as the secondary illness matches any of the ICD codes corresponding to the disease code "130080" in Figure 8. If there is a match, the corresponding code indicating the presence of a defined secondary illness should be selected as the classification number, and a warning is displayed indicating that the secondary illness name does not match the extracted classification number. In this way, the DPC receipt inspection system 1 can warn the user of a possible error when a classification number without a defined secondary illness is entered as the extracted classification number.

[0092] Furthermore, in all of the examples in Figures 12 to 17, "aplastic anemia [D619]" is recorded as the disease name. Meanwhile, the disease master 22 in Figure 7 has "D619" as the ICD code for the disease corresponding to the disease code "130080." Therefore, there is no inconsistency with regard to the disease name, and no warning is displayed. However, the DPC receipt inspection system 1 displays a warning if there is an inconsistency in this regard. In this way, the DPC receipt inspection system 1 can check the DPC receipt data itself for inconsistencies between the input disease name information and the extracted classification number, and warn the user if there is an inconsistency.

[0093] Although one embodiment of the present invention has been described above, the present invention is not limited to the above embodiment and can be practiced with appropriate modifications. For example, the method of displaying the warning is not limited to the above-mentioned example of the screen, and the warning may be given not only by displaying it on the screen, but also by sound or Braille.

[0094] Furthermore, instead of determining whether a procedure code matches based on the procedure code itself, the procedure code may be converted into a grouped code, and whether the procedure matches based on the grouped code may be determined.

[0095] In addition, in the above-mentioned inspection of surgery and procedure codes, we focused on one month's worth of DPC receipt data and checked the classification number and whether or not surgery or treatment was performed within that month's DPC receipt data. However, if there is no surgery or procedure corresponding to the extracted classification number, it is also possible to check whether there is a corresponding surgery or procedure in the DPC receipt data of consecutive months in the past. In other words, for the DPC receipt data to be inspected, DPC receipt data with the same patient code and classification number can be extracted, and the extracted DPC receipt data for consecutive months in the past can be searched for whether there is a surgery or corresponding procedure. This allows for more accurate inspections.

[0096] In addition, some tests have a set limit on the number of times they can be performed in a given month. Therefore, for the same patient, other DPC receipt data and other receipt data (for example, outpatient receipt data) for the same month can be referenced to search for tests with a set limit on the number of times they can be performed, and it can be checked whether or not any tests have been performed beyond the limit. If the limit has been exceeded, a warning can be issued to notify the patient of this.

[0097] It would also be more desirable to be able to visually check DPC receipts and other receipts together on the screen. For example, it would be possible to display the summary receipt and the DPC receipt on consecutive pages, or side-by-side in separate windows. It would also be possible to display the DPC receipt and the outpatient receipt on consecutive pages, or side-by-side in separate windows. Furthermore, it would also be possible to display two types of DPC receipts from the same month on consecutive pages, or side-by-side in separate windows.

[0098] It is also possible to configure a DPC receipt inspection system that checks whether surgery has been performed and the consistency of the extracted classification number, but does not check other items. Similarly, it is also possible to configure a DPC receipt inspection system that checks whether the injury / illness name and the extracted classification number are consistent, but does not check other items. It is also possible to configure a DPC receipt inspection system that checks whether the secondary injury / illness is consistent and the extracted classification number, but does not check other items. It is also possible to configure a DPC receipt inspection system that checks whether the treatment is consistent and the extracted classification number, but does not check other items. It is also possible to configure a DPC receipt inspection system that checks whether the length of hospitalization is consistent with the date of treatment, etc., but does not check other items.

[0099] Furthermore, the elements described in the above-described embodiment and modified examples may be combined in any desired manner. [Explanation of symbols]

[0100] 1. DPC Receipt Inspection System 11 Reading Method 12 Classification number extraction means 13 Surgical inspection means 14 Injury and illness name checking method 15 Secondary injury / illness name inspection method 16 Procedure Code Checking Tool 17 Date Checking Method 18 Warning display means

Claims

1. A DPC receipt inspection system that inspects DPC receipts based on electronic data of DPC receipts, A means for reading DPC receipt data, which is electronic data of DPC receipts; A classification number extraction means for extracting a comprehensive evaluation classification number from the read DPC receipt data; a surgery checking means for checking whether or not a surgery corresponding to the extracted classification number, which is the classification number extracted by the classification number extraction means, is performed; The DPC receipt data includes one or more fee records, which are records indicating fee points, and one or more coding data records, which are records of coding data indicating the contents of medical treatment in the comprehensive evaluation portion, The surgical inspection means includes: Search for records related to surgery from the volume record, If the surgery code, which is a code for the digits related to surgery included in the extracted classification number, is data indicating no surgery and a record of amount of surgery-related fees exists in the DPC receipt data, or if the surgery code included in the extracted classification number is data indicating surgery and a record of amount of surgery-related fees does not exist in the DPC receipt data, a warning is issued that there is an inconsistency in the relationship between the extracted classification number and whether or not surgery has been performed. A DPC prescription inspection system that features:

2. Further provided is an injury / disease name checking means for checking whether the extracted classification number and the injury / disease name are consistent with each other, The injury / illness name checking means An illness name extraction process for extracting an illness code from the DPC receipt data; an injury / illness name inspection process that refers to an injury / illness master that stores a correspondence between a part of a classification number and an injury / illness, determines whether the injury / illness code corresponding to the extracted classification number in the injury / illness master matches the injury / illness code extracted in the injury / illness name extraction process, and determines that there is a match if there is a match, and determines that there is no match if there is no match; a process of issuing a warning that the injury or illness name does not match the extracted classification number when it is determined that the injury or illness name does not match in the injury or illness name checking process; The DPC receipt inspection system according to claim 1, characterized in that it executes the following.

3. Further provided is a secondary illness name checking means for checking the consistency between the DPC receipt data and the secondary illness name when the extracted classification number includes a corresponding code indicating the presence or absence of a defined secondary illness; The secondary injury / illness name checking means A secondary illness extraction process for extracting a secondary illness code from the DPC receipt data; a secondary injury / illness inspection process that, when the extracted classification number includes a corresponding code indicating the presence of a defined secondary injury / illness, refers to a secondary injury / illness master that stores a correspondence between a portion of the classification number and one or more defined secondary injury / illness codes, and determines whether the code of the defined secondary injury / illness corresponding to the extracted classification number in the secondary injury / illness master matches the secondary injury / illness code extracted in the secondary injury / illness extraction process; and determines that there is a match if there is a match, or determines that there is no match if there is no match or if the secondary injury / illness code could not be extracted in the secondary injury / illness extraction process; If it is determined that the secondary injury / illness inspection process does not match, a process of issuing a warning that the secondary injury / illness name does not match the extracted classification number; 3. The DPC receipt inspection system according to claim 1, wherein the DPC receipt inspection system executes the following.

4. The secondary injury / illness name inspection means, in the secondary injury / illness inspection processing, Furthermore, if the extracted classification number includes a corresponding code indicating that there is no defined secondary illness, the system refers to the secondary illness master to determine whether the code of the defined secondary illness corresponding to the extracted classification number in the secondary illness master matches the secondary illness code extracted by the secondary illness extraction process, and if they match, it determines that there is no match, and if they do not match, it determines that there is a match.

5. further comprising a treatment code checking means for checking whether the corresponding code is correct when the extracted classification number includes the corresponding code of the treatment; The treatment code checking means A DPC receipt inspection system as described in any one of claims 1 to 4, characterized in that it refers to a treatment master that stores a correspondence between a portion of a classification number and one or more treatment codes, searches the DPC receipt data for treatments related to the treatment code corresponding to the extracted classification number, and if there is no treatment data corresponding to the treatment code, executes a process to warn that there is an error in the treatment corresponding code among the extracted classification numbers.

6. Further comprising a date checking means for checking whether the date of the operation or treatment is within the hospitalization period; The date checking means A hospitalization period extraction process for extracting a hospitalization period from the DPC receipt data; A DPC receipt inspection system as described in any one of claims 1 to 5, characterized in that it determines whether the dates of the medical care-related records and the coding data records included in the DPC receipt data are within the hospitalization period, and if it determines that they are not within the hospitalization period, it executes a process to warn that the date of the surgery or procedure is not within the hospitalization period.

7. A DPC receipt inspection method for inspecting a DPC receipt based on electronic data of the DPC receipt using a computer, The computer A process of reading DPC receipt data, which is electronic data of DPC receipts; A classification number extraction process for extracting a comprehensive evaluation classification number from the read DPC receipt data; a surgery check process for checking whether or not a surgery corresponding to the extracted classification number, which is the classification number extracted in the classification number extraction process, is performed; In the surgical inspection process, Searching for a record related to surgery from one or more fee records, which are records indicating fee points included in the DPC receipt data; If the surgery code, which is a code for the digits related to surgery included in the extracted classification number, is data indicating no surgery and a record of amount of surgery-related fees exists in the DPC receipt data, or if the surgery code included in the extracted classification number is data indicating surgery and a record of amount of surgery-related fees does not exist in the DPC receipt data, a warning is issued that there is an inconsistency in the relationship between the extracted classification number and whether or not surgery has been performed. A method for checking DPC receipts characterized by the following.

8. A program for checking DPC receipts based on electronic data of DPC receipts using a computer, The computer A means for reading DPC receipt data, which is electronic data of DPC receipts; A classification number extraction means for extracting a comprehensive evaluation classification number from the read DPC receipt data; functioning as a surgery checking means for checking whether or not a surgery corresponding to the extracted classification number, which is the classification number extracted by the classification number extraction means, is performed; The surgical inspection means includes: Searching for a record related to surgery from one or more fee records, which are records indicating fee points included in the DPC receipt data; If the surgery code, which is a code for the digits related to surgery included in the extracted classification number, is data indicating no surgery and a record of amount of surgery-related fees exists in the DPC receipt data, or if the surgery code included in the extracted classification number is data indicating surgery and a record of amount of surgery-related fees does not exist in the DPC receipt data, a warning is issued that there is an inconsistency in the relationship between the extracted classification number and whether or not surgery has been performed. A program characterized by.

9. A DPC receipt inspection system that inspects DPC receipts based on electronic data of DPC receipts, A means for reading DPC receipt data, which is electronic data of DPC receipts; A classification number extraction means for extracting a comprehensive evaluation classification number from the read DPC receipt data; The classification number extraction means further includes an injury / disease name checking means for checking whether the extracted classification number is consistent with the injury / disease name, The injury / illness name checking means An illness name extraction process for extracting an illness code from the DPC receipt data; an injury / illness name inspection process that refers to an injury / illness master that stores a correspondence between a part of a classification number and an injury / illness, determines whether the injury / illness code corresponding to the extracted classification number in the injury / illness master matches the injury / illness code extracted in the injury / illness name extraction process, and determines that there is a match if there is a match, and determines that there is no match if there is no match; a process of issuing a warning that the injury or illness name does not match the extracted classification number when it is determined that the injury or illness name does not match in the injury or illness name checking process; The DPC receipt inspection system described above is characterized by executing the above.

10. A DPC receipt inspection system that inspects DPC receipts based on electronic data of DPC receipts, A means for reading DPC receipt data, which is electronic data of DPC receipts; A classification number extraction means for extracting a comprehensive evaluation classification number from the read DPC receipt data; The method further includes a secondary illness name checking means for checking whether the DPC receipt data and the secondary illness name are consistent when the extracted classification number, which is the classification number extracted by the classification number extraction means, includes a corresponding code indicating the presence or absence of a defined secondary illness; The secondary injury / illness name checking means A secondary illness extraction process for extracting a secondary illness code from the DPC receipt data; a secondary injury / illness inspection process that, when the extracted classification number includes a corresponding code indicating the presence of a defined secondary injury / illness, refers to a secondary injury / illness master that stores a correspondence between a portion of the classification number and one or more defined secondary injury / illness codes, and determines whether the code of the defined secondary injury / illness corresponding to the extracted classification number in the secondary injury / illness master matches the secondary injury / illness code extracted in the secondary injury / illness extraction process; and determines that there is a match if there is a match, or determines that there is no match if there is no match or if the secondary injury / illness code could not be extracted in the secondary injury / illness extraction process; If it is determined that the secondary injury / illness inspection process does not match, a process of issuing a warning that the secondary injury / illness name does not match the extracted classification number; A DPC receipt inspection system characterized by executing the following.

11. A DPC receipt inspection system that inspects DPC receipts based on electronic data of DPC receipts, A means for reading DPC receipt data, which is electronic data of DPC receipts; A classification number extraction means for extracting a comprehensive evaluation classification number from the read DPC receipt data; further comprising a treatment code checking means for checking whether or not a treatment code is correct when an extracted classification number, which is a classification number extracted by the classification number extracting means, includes the treatment code; The treatment code checking means A DPC receipt inspection system characterized by referring to a treatment master that stores a correspondence between a portion of a classification number and one or more treatment codes, searching the DPC receipt data for treatments related to the treatment code corresponding to the extracted classification number, and if there is no treatment data corresponding to the treatment code, executing a process to warn that there is an error in the treatment corresponding code among the extracted classification numbers.

12. A DPC receipt inspection system that inspects DPC receipts based on electronic data of DPC receipts, A means for reading DPC receipt data, which is electronic data of DPC receipts; Further comprising a date checking means for checking whether the date of the operation or treatment is within the hospitalization period; The date checking means A hospitalization period extraction process for extracting a hospitalization period from the DPC receipt data; A DPC receipt inspection system characterized by determining whether the dates of the medical treatment-related records included in the DPC receipt data and the dates of one or more coding data records, which are coding data records indicating the content of the medical treatment procedures in the comprehensive evaluation portion, are within the hospitalization period, and if it is determined that they are not within the hospitalization period, executing a process to warn that the date of the surgery or procedure is not within the hospitalization period.

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