Edogawa Nishiguchi Ayakashi Clinic - Chapter 31
End of the month.
This week is the Medical Billing Audit period. [1]
Dr. Tengo told me not to render overtime, but it was impossible not to do so.
I turned off the lights at the entrance and the examination room, and I was alone in the office.
This task was rather novel and unknown to me.
In stores, transactions would usually be completed after payments have been made.
In the case of hospitals, it would end once the medical statement has been properly handed to the patient.
But for medical facilities — especially those catering to pediatrics, that is not the case at all.
“… Is this an additional fee for outpatient services? Or is it for follow-up? Ah, it’s for a newborn checkup.”
In this district, medical treatment for children 16 years old and below is free.
Although the patients do not have to pay anything during billing, these services still incur medical expenses. However, payments are covered by the corresponding district which issued the child’s medical card. [2]
Although the hospital or medical facility bills the district for the cost of treatment, there’s still one problem.
This problem is commonly known as the Marume medical care. [3]
For children under a certain age, there is a flat rate no matter the amount of medical care or treatment is rendered.
“Ah, Dr. Tengo administered an inhalation treatment on this one… What should I do about this?”
In other words, no matter how many intravenous fluids are administered, or how many hours the inhalation treatment was given, or how many tests were done, the medical facility will receive a fixed rate for it.
From the medical facility’s perspective, the better, kinder, and gentler the medical care, the more they would lose money because of pediatric treatments.
“Ah, so this is an order for asthma treatment… Then it’s fine. I’ll place this under the fees for treatment and management of specific diseases.”
So what can be done about it?
Before billing the district, we should look for any additional charges that can be made according to the patient record.
Of course, if you do it too much, the statement would be returned and if you lie, it would be considered fraud.
In reality, it’s a really complicated process so you have to be very careful about it.
“Aaaah, I don’t know anymore… But if I leave it like this, the clinic will lose money, but… but…”
Dr. Tengo did tell me to just submit it as is, but I didn’t want to waste the examination and treatment he rendered.
But it’s just impossible. I give up.
I’m sorry.
I promise I’ll do my best next month, so please let me submit this as is.
The submission of the billing report is at the beginning of the month, so this has to be done by tomorrow.
Why am I such a useless medical clerk? I’m just a receptionist, so I just have to do what I’m told. What should I do? I wonder if there are any short courses I can take?
“Excuse me, sorry to bother you!”
When I looked up, I saw an army of suits gathered by the doorway.
They’re not patients, right?
“…May I help you?”
They simultaneously took out and offered their business cards to me.
And then, the army of suits tried to restrain each other.
Hold up, is this some sort of war?
Then does this mean they all belong to different companies?
“Are you sales representatives?”
“Yes, we are—”
“We’re the sales representatives—”
“From before—”
“Is the head doctor in?”
You guys aren’t elementary schoolers anymore so please don’t talk all at once.
Wait, wait. There are still some people in suits preparing their business cards, so wait a minute.
They all had various business titles, but what company did they come from?
“Then… May I know the nature of your business?”
“We’re here for the medical and infectious waste disposal!”
Impressive.
The way they all said it at once was superb.
“Please wait a moment.”
Dr. Tengo’s room was conveniently connected to the back of the outpatient area by an inner passage.
Come to think of it, he did say something about someone coming over today.
I wonder if this is it… I’ve been so preoccupied by the Medical Billing Audit that it just went over my head.
“Yo, Azuki-chan. Are you doing overtime today?”
When I turned around, I saw Chairman Takeru standing there in a casual suit.
No, that’s not it. That collar area seems like a tuxedo.
Well, that waistcoat surely looks good on him, but when did he get behind me?
“Hello. It’s rare seeing you here, Chairman.”
“Man, talk about a cold reception. Were you doing the audit?”
“I was, but these people arrived.”
When Chairman Takeru took a peek, the suit army bowed in unison and began taking out their business cards.
Translator’s Notes:
The terms are contain a lot of jargon this time, but bear with me lol
[1] Medical Billing Audit
Not a direct translation, but the original is 診療報酬請求 (shinryouhoushuuseikyuu) or レセプト請求 (reseputo seikyuu).
This is a task that involves preparing medical fee statements (receipts) based on the contents of medical records and submitting them to the appropriate insurers. During the period between the end of the current month and the beginning of the next month, an office staff member checks and corrects receipts to ensure that they are properly billed in accordance with the rules for calculation, and consults with and makes proposals to the physicians. Source
[2] Child Medical Card
In order to reduce the financial burden during the child-rearing period and to support the healthy growth and development of children, the local government provides benefits for medical expenses (covered by insurance) incurred when a child receives medical care at a medical institution. An application must be made in advance to avail the program. If the child is deemed eligible, a “Child Medical Card” will be issued by the city or district that the parent is residing in. Source
[3] Marume
“Marume” refers to the “fixed price health care system”.
In a “fee-for-service” medical care system, medical institutions can increase their income as they provide more advanced and intensive treatment, and patients, partly because they bear a portion of the cost, are more likely to receive excessive care because they want the highest quality medical care.
In the “Marume” medical system, the more treatment a patient receives, the more the income is reduced from the fixed amount, so patients are encouraged to limit their treatment to the minimum, which is expected to have the effect of controlling the rising cost of medical care. Source
