"After submitting a rezept, we noticed our own error"—this is when procedures such as error adjustment, requested return, and withdrawal come into play. All of them are for correcting or withdrawing an already-submitted rezept, but which procedure you use changes depending on the timing—before or after payment. This article organizes what error adjustment is, centering on that, along with its differences from requested return and withdrawal by timing.
Premise: these are procedures for "when you notice your own error"
The first thing to grasp is that error adjustment, requested return, and withdrawal are all procedures for a medical institution to correct or withdraw a claim on its own when it notices an error in the claim content. Their starting point differs from a "return" sent back by the review and payment organization, or an "assessment" that reduces points. Because the names and handling of the procedures differ subtly by review and payment organization (the SSK and the National Health Insurance federations), always confirm each organization's latest guidance when actually responding.
Organizing by timing
| Timing | State | Main procedure |
|---|---|---|
| After submission, before payment | Payment not yet finalized | Withdrawal / requested return (have the rezept returned) |
| After payment | Payment already made | Error adjustment (withdraw the paid portion and adjust) |
The key is "before or after payment is made." Before payment, you can withdraw the rezept and resubmit it; after payment, you must readjust the portion once paid, so the procedure changes.
What are withdrawal and requested return (before payment)?
Withdrawal is a procedure to withdraw a submitted rezept's claim. It is used when you notice an error in the claim content unrelated to the review result (e.g., it should not have been claimed, or you want to correct the content and resubmit).
Requested return is a term for the procedure by which, at the medical institution's request, an already-submitted rezept is treated as a return (mainly a term used at the National Health Insurance federations). You then correct the returned rezept and reclaim it as a return portion. Both share the point of "pulling the rezept back once, before payment is finalized."
Note that errors related to the review result (such as a missing diagnosis—objections to or corrections of content reduced or returned in review) are subject not to withdrawal but to a reexamination request.
What is error adjustment (after payment)?
Error adjustment (kago-chosei) is a procedure to withdraw a claim and adjust the paid amount when an error is discovered later for a rezept that has already been paid. Unlike withdrawal before payment, it involves processing to return (offset) the portion once paid.
Error adjustment has operational categories, such as reclaiming in the following month after withdrawal, or performing the reclaim together within the same month. Because the specific categories, procedures, and schedules differ by review and payment organization, follow the guidance of each organization (the federations and the SSK).
Organizing points easily confused
- Difference from return/assessment: Return and assessment originate from the review and payment organization; error adjustment, requested return, and withdrawal originate from the medical institution.
- Withdrawal/requested return vs. error adjustment: Before payment, withdrawal/requested return; after payment, error adjustment.
- Withdrawal vs. reexamination request: Errors unrelated to the review result are handled by withdrawal; objections to or corrections of the review result are handled by a reexamination request.
Reducing "claims that need correction" in the first place
Error adjustment and withdrawal are both after-the-fact responses to "noticing an error after submission." These procedures create extra work—confirmation, document preparation, reclaiming—and also affect payment. The most desirable approach is to eliminate errors at the pre-submission stage and reduce the claims that need correction in the first place.
Pottech's integrated receipt-computer "AI Karte" uses AI rezept checking to detect errors—such as missing diagnoses, unmet billing requirements, and missed billing—from the care-input stage. Because care records and billing data reside on the same foundation, opportunities to notice deficiencies before submission increase, curbing the occurrence of after-the-fact procedures such as error adjustment and withdrawal themselves.
In closing
Error adjustment, requested return, and withdrawal are all correction procedures for when you notice your own error, but which one you use divides by the timing of "before or after payment." Remembering it as "withdrawal/requested return before payment, error adjustment after payment" will keep you from hesitating when the time comes. On top of that, having pre-submission checks as a system and reducing the claims that need correction themselves leads to a lighter burden in medical clerical work.
Through the provision of AI Karte, Pottech serves as the optimal business partner for clinics—supporting not only better working conditions for physicians, nurses, and medical clerical staff, but also helping clinics achieve to the fullest what they want to accomplish.
For details, please do not hesitate to contact us.
References / Sources
- Social Insurance Medical Fee Payment Fund, "Method for Reexamination Requests (Withdrawal)" https://www.ssk.or.jp/seikyushiharai/iryoukikan_saisinsa/index.html
- Social Insurance Medical Fee Payment Fund, "Requests for Reexamination, etc." https://www.ssk.or.jp/seikyushiharai/seikyushiharai_07.html
- Osaka National Health Insurance Federation, "About Reexamination and Withdrawal Requests" https://www.osakakokuhoren.jp/index_hk/saisin/
- Nagano National Health Insurance Federation, "How to Withdraw Claim Statements (Requested Return / Error Adjustment)" https://www.kokuho-nagano.or.jp/kaigo/kago.html