What is a Closing Transaction?

To enable commodity transactions and settlement business to proceed normally, China's settlement system stipulates that the following three principles must be followed for settlement: Money and goods are cleared. That is to say, the seller must deliver the goods on time, and the buyer must pay in accordance with the regulations, and must not default on the payment and unreasonably refuse to pay the payment. Protect the legitimate rights and interests of both parties. The receiving and paying parties shall strictly implement the relevant provisions of the contract and implement the provisions of the settlement system. Banks should organize their settlement work in the interests of the whole, and must not favor any party. The bank does not allow advances. Banks provide settlement services for enterprises. They are only responsible for transferring funds from the payer's account to the payee's account. When an enterprise entrusts a bank to make a payment, it must have sufficient funds in its bank account; when it entrusts a bank to receive a payment, it must wait for the payment to be received before it can be used.

There are two types of settlement:

It can be regarded as social bookkeeping, and its functions are shown in: Facilitating commodity transactions, shortening the settlement process and time, accelerating capital turnover, and accelerating society

The medical expenses incurred by the rural cooperative medical patients in different places in China need to be paid in advance before returning to the local reimbursement. The reimbursement cycle is generally 1 to 3 months, and patients need to advance a large amount of funds, which is very inconvenient. In order to achieve the full use of medical resources and people's desire for better medical services, the need for medical treatment in different places is becoming stronger. In order to realize the settlement of medical treatment in different places, each province has invested a lot of effort to start building a regional rural cooperative settlement platform. There is no unified platform. Since 2010, the hospital has been actively exploring the establishment of a unified settlement platform for rural cooperative medical services. Through interaction with the rural cooperative settlement system in various places, we can achieve one-stop services for patients to visit, reimburse, and settle in our hospital, improve the quality of hospital services, reduce the pressure on patients' funds, increase the utilization rate of medical resources in our hospital, Provide quality medical services to patients within.

Exploring the Construction of a Settlement Integration Rural Cooperative Settlement Platform

The HIS information system of our hospital was constructed and used in 2003. From 2008 to 2009, new settlement systems such as the New Rural Cooperative Medical System of this city were successively constructed. At the same time, new rural cooperative medical systems in Anhui, Shandong, Henan and other places were gradually constructed . It is more and more urgent to be able to provide data interaction services externally, and to realize the settlement and reimbursement of patients at various places in the hospital through the integrated rural cooperative settlement platform. After analyzing the network and information system of the hospital, the hospital started construction of a unified settlement platform. The integrated settlement platform can not only simplify the network environment in the hospital, but also reduce or even avoid the modification of the HIS system. It is the most convenient way to integrate the hospital's information system with the local rural cooperative medical system.

Integration of settlement network and settlement process

In order to realize the interconnection and interoperability with the rural cooperative center, first of all, it is necessary to realize network connectivity and provide a basis for data interaction; secondly, data interaction between systems, and upload and release data through open interfaces between systems.

network construction

The network situation of rural cooperative centers varies from place to place. In some areas, the external interaction is to establish a VPN private connection through the Internet and software or hardware. In other areas, hospitals are required to communicate through leased lines of communication companies. For economic reasons, the hospital prefers to use the Ineternet network. To isolate access between the hospital and other sites of the rural cooperative center, routing equipment was added, and then connected to the hospital for exchange. Then add a firewall between the hospital network and the outside to prevent illegal access and intrusion. Through these methods, the hospital will be gradually connected to the network of 28 surrounding rural cooperative centers to realize data communication. See Figure 1.

figure 1

Establishment of a unified settlement platform

In order to avoid frequent modification of the hospital's HIS system, the hospital considers designing a unified settlement platform. The settlement platform mainly has two functions. The first is that the platform interacts with the HIS side of the hospital and is responsible for executing the application submitted by the HIS and returning the transaction results of the HIS system. Second, the platform trades with rural cooperative centers in various places to achieve data communication. When a new rural cooperative settlement unit is added, it is only necessary to increase the interaction between the platform and the rural cooperative heart. The HIS system does not need to be modified and can be simply configured. In this way, combined with the characteristics of more than 20 medical structure settlement systems, a common method library and parameter library were sorted out. The in-patient process of NCMS patients in the hospital is detailed, and it is concluded that the following processes are roughly included. as shown in picture 2. Each process has a fixed number of parameters, parameter formats, and parameter definitions. The hospital HIS system and the platform interact according to the above process methods and parameters. In these processes, the interaction process between HIS and the settlement platform and the format of the interaction parameters are the same.

figure 2

Integration of interactive processes

The interaction process between the settlement platform and the rural cooperative center is quite different. The regional rural cooperative settlement system is not the same. It needs to be developed and designed according to the interface documents of each place. The interactive process methods, methods, and parameters are very different, and it is necessary to integrate the predefined general process methods with the methods provided by the other party. For example, the outpatient registration is defined as a process method (MZGH), but the other party provides two methods, one is checking the account status (checkzhzt), and the other is registration (MZDJ). The platform must integrate the account inquiry provided by the center with the registered registration, corresponding to the registered registration application of the HIS system. When the platform receives an outpatient registration application from the HIS system, the platform will call an account check. If the account status is abnormal, it will directly return the HIS system failure flag (-1) and return the failure reason to HIS. Then the registration method of the other party is called. If successful, the HIS success flag (1) is returned, and the failure flag (-1) is returned, and the reason for the failure is returned to the HIS. Through the integration of process methods, the interaction between two systems with different standards is realized.

Parameter definition

The definition of the parameters follows the principle of maximization. The general parameter format includes as many parameter needs as possible. There are many parameters submitted by the HIS system. The settlement platform can choose the necessary ones to use. There are many parameters returned by the platform. The HIS system can also be selective. Save meaningful data. At the same time, in order to ensure the scalability of the platform, 20 parameters are reserved, and new requirements can be achieved through reserved parameters.

Establish the contrast relationship of basic data

Each rural cooperative center has its own library of medicines and diagnosis and treatment items, which provides downloading functions. The project code of the center must be provided when uploading the patient expense details in the hospital. The same need to provide the disease code when settling the bill. Our hospital uses the ICD-10 universal code, some centers have omitted, and some still use the ICD-9 code. In view of this, the hospital establishes a comparison relationship between the HIS library and the central library. Through this comparison relationship, the center code is found and uploaded according to the in-hospital fee number when the fee is uploaded; the settlement is based on the ICD-10 code entered by the doctor in the hospital to find the disease of the corresponding center. Encode and upload the billing information. The comparison of diseases, medicines, and medical treatment libraries is entrusted to specific departments.

Effectiveness of the implementation of the integrated settlement rural settlement settlement platform

Real-time settlement with 28 rural cooperative centers has been achieved, and patients no longer need to advance a large amount of funds during the hospital to avoid the timely treatment of diseases due to the slow settlement of patients. In response to the new needs of the development of medical insurance, the hospital is also considering to provide greater convenience for the auditing units through the settlement platform; to meet the needs of single disease pricing, clinical pathways and even DRGS development in various places. ^[2]