Key Takeaways
- A rezept is the statement a covered medical institution prepares for each patient's month of care to claim medical fees, excluding the patient's share, from insurers; for medical and dental care it is the medical fee statement, and for pharmacies the dispensing fee statement.
- Under the claims ordinance, each month's rezepts must be submitted to the review and payment organization by the 10th of the following month, in principle via online claims.
- At the payment fund (now the DX review and payment organization), reviewed fees are transferred to the institution's account by, in principle, the 21st of the second month after the month of care.
- Rezept work runs in a monthly cycle: checking and submitting at the start of the month, reviewing results such as point-adjustment notices and returns, and reclaiming or requesting re-examination.
"What exactly is a rezept?" and "What does rezept work actually involve?" are questions we often hear from new medical administration staff and from physicians preparing to open a clinic. This article covers the basics of the rezept itself: what it means and its types, what it contains, the flow from submission to payment, the monthly rezept workload, and how a rececon differs from an EMR. For specific topics such as how to check rezepts or how to handle returns and assessments, we point you to the relevant articles.
Disclaimer: This article provides general information based on publicly available sources as of October 31, 2026. Ministry ordinances and notices and the guidance of the review and payment organizations are authoritative on claim methods, deadlines and forms. Always check the latest originals and the guidance of your review and payment organization.
The Social Insurance Medical Fee Payment Fund was reorganized in October 2026 as the "Japan Healthcare Payment & Digital Transformation Services" (DX review and payment organization). In this article we use the familiar name "payment fund."
What is a rezept?
A rezept is the statement a covered medical institution prepares for each patient's month of care, listing the services and points, to claim medical fees from insurers (health insurance societies, the Japan Health Insurance Association, municipal National Health Insurance and so on). The word comes from the German "Rezept." Formally it is the medical fee statement for medical and dental care and the dispensing fee statement for pharmacies.
Under Japan's public health insurance, patients pay their share at the counter and the insurer covers the rest. The rezept is how the institution claims that remainder. It is not sent directly to the insurer but to a review and payment organization (the payment fund, or the prefectural National Health Insurance federation), which reviews and then pays it.
- Unit: one per patient per calendar month
- Amount: points set for each service are added up and converted at 10 yen per point
- Where it goes: employee insurance (Japan Health Insurance Association, health insurance societies, etc.) goes to the payment fund; National Health Insurance and late-stage elderly care go to the National Health Insurance federation
Relationship to the claim form
Along with the statements, the institution submits a medical fee claim form (dispensing fee claim form for pharmacies) summarizing the month's count and points. The claims ordinance refers to the claim forms and statements together as the "rezept." With online claims these are sent as data, so no separate paper claim form is needed.
Types of rezept
| Type | Formal name | Prepared by |
|---|---|---|
| Medical | Medical fee statement (separate formats for inpatient and outpatient) | Hospitals and clinics (medical) |
| Dental | Medical fee statement | Dental clinics and hospital dental departments |
| Dispensing | Dispensing fee statement | Covered pharmacies |
There are also others, such as the home-visit nursing statement prepared by visiting nursing stations. A typical clinic prepares medical outpatient rezepts each month.
Main items on a rezept
What to enter and how is set out in the Ministry of Health, Labour and Welfare's notice on how to fill in claim forms and statements, which is revised with each fee revision. The main items are:
| Category | Main contents |
|---|---|
| Institution and month | Institution code, month of care |
| Insurance and public funding | Insurer number, insurance card symbol and number, public funding payer and recipient numbers |
| Patient | Name, sex, date of birth |
| Diagnoses | Diagnosis names, start date of care, outcome (cured, died, discontinued) |
| Days of care | Number of days actually seen that month |
| Services | First or return visit, management, medication, injections, procedures, tests, and their points |
| Totals | Total points, patient co-payment, etc. |
The review and payment organization first uses its system to check entries such as patient name, diagnoses and insurer number and errors in claimed points, and then reviews whether the care follows the fee schedule and other rules. Making sure diagnoses match the tests and medications provided is the foundation of a sound rezept.
From claim to payment
Here is the flow at the payment fund, using care provided in October as an example.
| Timing | What happens |
|---|---|
| During October | Care is provided and patients pay their share. Daily services are entered into the rececon |
| End of October to early November | The month is closed, rezepts are produced and checked |
| By November 10 | Rezepts are submitted to the review and payment organization (online claims accepted November 5 to 10) |
| Mid to late November | The organization checks and reviews. Inappropriate items are assessed (points reduced); unclear or incomplete ones are returned |
| By December 10 | The organization bills the insurers |
| By December 21 (in principle) | Payment is transferred to the institution's designated account |
- The submission deadline (10th of the following month) is set by Article 2 of the ordinance on claims for medical care benefits and publicly funded care
- Payment by, in principle, the 21st of the second month is per the payment fund's guidance. Check each National Health Insurance federation for its own payment dates
- Review results are notified through documents such as point-adjustment notices and return breakdowns. The payment fund distributes them as PDFs through the online claims system around the 5th of each month
In other words, it takes about two months from providing care to receiving the insured portion. This matters when estimating working capital for a newly opened clinic.
What is "rezept work" in medical administration?
Rezept work is the series of tasks from producing and checking each month's rezepts and submitting them on time to responding to the review results. Its defining feature is that the work concentrates at the start of the month.
Example monthly schedule
| Timing | Main tasks |
|---|---|
| Daily | Confirming insurance eligibility at reception, checking entries at checkout, checking for missing diagnoses |
| Month end to around the 4th | Close the month, print rezepts, and have physicians and staff check them (missing diagnoses, billing requirements, incomplete entries) |
| Around the 5th | Point-adjustment notices and return breakdowns for earlier claims arrive; review them |
| 5th to 10th | Submit via online claims. Fix items flagged by the pre-check (reception and clerical check ASP) |
| Mid-month onward | Correct and reclaim returned rezepts, request re-examination of assessments you disagree with, request withdrawal where you found your own errors |
With the payment fund's online claims, the reception and clerical check ASP lets you find clerical errors before sending, and flagged items can be corrected until the 12th. See the basics of rezept checking for how to check, and five ways to streamline rezept work for reducing the workload.
Responding to review results
A point reduction in review is called an "assessment," and sending a rezept back to the institution is called a "return." A returned rezept is reviewed again once corrected and reclaimed, and an assessment you disagree with can be challenged by a re-examination request. The following articles explain each:
- Returns vs. assessments: What is a returned rezept?
- Return reasons and reclaiming: Returned rezept reasons
- Reading point-adjustment notices and requesting re-examination: Point-adjustment notices and re-examination
- When you find your own error: Withdrawing a rezept and error adjustment
How a rececon differs from an EMR
Producing rezepts is the job of the rececon (rezept computer), not the EMR.
| Item | EMR | Rececon |
|---|---|---|
| Main purpose | Recording care (findings, prescriptions, tests, etc.) | Converting care into points and producing accounting and rezepts |
| Main users | Physicians and nurses | Medical administration staff |
| Information handled | Medical records | Insurance information, points, claim data |
The basic relationship is that prescriptions and procedures entered in the EMR are sent to the rececon, which calculates points and produces rezepts. Some products integrate both into one system, while others connect separate products, and where diagnoses and billing information are managed affects how much effort rezept work takes. See rececon vs. EMR (integrated and separate), what is a rececon and ORCA and EMR integration.
Common rezept mistakes
Most rezept errors can be prevented by checking before submission. Typical ones include:
- Insurance eligibility errors: wrong insurer number or card number, visits after loss of coverage. Checking current eligibility at each visit through online eligibility verification is the baseline (online eligibility verification)
- Missing or inconsistent diagnoses: no diagnosis registered that corresponds to tests or prescriptions provided
- Billing requirements not met: frequency limits, combinations that cannot be billed together, additions billed without the required facility-standard filing
- Incomplete entries: missing symptom details where required, errors in public funding entries
- Missed billing: forgetting additions or management fees that could be billed (missed billing checklist)
Summary
- A rezept is the statement a covered institution prepares per patient per month to claim medical fees from insurers: the medical fee statement for medical and dental care, the dispensing fee statement for pharmacies
- Each month's rezepts are submitted to the review and payment organization by the 10th of the following month (claims ordinance). Online claims are accepted from the 5th to the 10th
- At the payment fund, payment is made by, in principle, the 21st of the second month after care: about two months from care to payment
- Rezept work is a monthly cycle of checking and submitting at the start of the month, reviewing results, and handling returns and assessments
- Rezepts are produced by the rececon. How it connects with the EMR affects how often missing diagnoses and missed billing occur
For submission methods see what are online rezept claims, and for AI-assisted checking see what is AI rezept checking.
Pottech provides AI electronic medical records and AI rezept checking that reflects billing requirements for clinics. If the monthly burden of checking rezepts is a concern, please feel free to contact us.
Frequently Asked Questions
- Q. What is a rezept, in simple terms?
- A. It is the statement a medical institution sends to say, in effect, 'we provided this care to this patient this month, so we are claiming the portion covered by insurance.' Formally it is the medical fee statement (medical and dental) or the dispensing fee statement (pharmacies), prepared per patient per month.
- Q. When must rezepts be submitted?
- A. Each month's rezepts must be submitted to the review and payment organization by the 10th of the following month, as set out in the claims ordinance. Online claims are accepted from the 5th to the 10th of the month after care.
- Q. How long does it take to get paid?
- A. At the payment fund (DX review and payment organization), payment is transferred by, in principle, the 21st of the second month after the month of care. For example, October care is submitted by November 10 and paid by December 21. Check each National Health Insurance federation for its own payment dates.
- Q. What does rezept work involve?
- A. Compiling a month of care into rezepts, checking diagnoses and billing for omissions and errors, submitting on time, reviewing point-adjustment notices and returns, and reclaiming or requesting re-examination where needed.
- Q. How do a rececon and an EMR differ?
- A. An EMR is for physicians to record care; a rececon converts care into points to produce accounting and rezepts. Some products integrate both, while others connect separate products.
参考・出典
- e-Gov法令検索「療養の給付及び公費負担医療に関する費用の請求に関する命令」（昭和51年厚生省令第36号）第1条・第2条・附則第3条の4 https://laws.e-gov.go.jp/law/351M50000100036
- 医療情報基盤・診療報酬審査支払機構（旧 社会保険診療報酬支払基金）「審査・支払業務の流れ」 https://www.hpdx.or.jp/shinryohoshu/gyomuflow/index.html
- 医療情報基盤・診療報酬審査支払機構「増減点連絡書・各種通知書の見方」 https://www.hpdx.or.jp/seikyushiharai/mikata/seikyushiharai_04.html
- 医療情報基盤・診療報酬審査支払機構「オンライン請求システムに関するQ&A（概要）」 https://www.hpdx.or.jp/goshitsumon/online/online_01.html
- 厚生労働省「令和8年度診療報酬改定について」（「診療報酬請求書等の記載要領等について」等の一部改正について 令和8年3月27日保医発0327第2号） https://www.mhlw.go.jp/stf/newpage_67729.html
- 国民健康保険中央会「国保中央会のご紹介」 https://www.kokuho.or.jp/about/