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Article 89Authority of the Review Committee

第八十九条(審査委員会の権限)

When the Review Committee finds it necessary in order to review medical bills, it may, upon the approval of the prefectural governor, request the relevant Health Insurance-Covered Medical Institution, etc. or the relevant office providing designated home-nursing to make a report or submit or present medical records or other books and documents, or may request any of the establishers or administrators of such Health Insurance-Covered Medical Institution, etc., the designated home-nursing provider, or any of the health insurance-covered physicians or health insurance-covered pharmacists who are in charge of medical treatment at such Health Insurance-Covered Medical Institution, etc. to appear or provide an explanation.

審査委員会は、診療報酬請求書の審査を行うため必要があると認めるときは、都道府県知事の承認を得て、当該保険医療機関等若しくは指定訪問看護の事業を行う事業所に対して、報告若しくは診療録その他の帳簿書類の提出若しくは提示を求め、又は当該保険医療機関等の開設者若しくは管理者、指定訪問看護事業者若しくは当該保険医療機関等において療養を担当する保険医若しくは保険薬剤師に対して、出頭若しくは説明を求めることができる。

The Federation must pay travel expenses, daily expenses and accommodation expenses to any person who appeared at the Review Committee pursuant to the provisions of the preceding paragraph; provided, however, that this shall not apply to any person who appeared in response to a request for appearance issued due to defective or misleading entries in medical bills or medical records or other books and documents submitted by the relevant Health Insurance-Covered Medical Institution, etc. or the relevant office providing designated home-nursing.

連合会は、前項の規定により審査委員会に出頭した者に対し、旅費、日当及び宿泊料を支給しなければならない。ただし、当該保険医療機関等又は指定訪問看護の事業を行う事業所が提出した診療報酬請求書又は診療録その他の帳簿書類の記載が不備又は不当であつたため出頭を求められて出頭した者に対しては、この限りでない。

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