"I heard the after-hours response addition became the 'after-hours response system addition' in the FY2026 revision. Now that the points went up, should we review our notification?" Clinic directors, office managers, and medical clerks are starting to ask this. The addition, defined in Note 10 of the follow-up consultation fee, rewards a system for handling phone inquiries on holidays and at night, and applies to clinics only. Based on materials published by the Ministry of Health, Labour and Welfare (MHLW), this article organizes the points effective June 1, 2026, the facility standards for types 1–4, the notification procedure, and the link to the comprehensive care addition.
Disclaimer: This article provides general information based on publicly available information as of October 13, 2026. The MHLW's public notices and circulars, and the guidance of your regional bureau of health and welfare, are authoritative for points, facility standards, and notification handling. Always confirm the latest original text and your regional bureau before making a final decision on notification or billing.
For the overall picture of the FY2026 revision, see Medical Fee Revision 2026: Changes Clinics Should Know, and for internal medicine highlights, see Fee Revision: Internal Medicine.
Conclusion: what changed
| Item | Before | From June 1, 2026 |
|---|---|---|
| Name | After-hours response addition | After-hours response system addition |
| Type 1 | 5 points | 7 points |
| Type 2 | 4 points | 5 points |
| Type 3 | 3 points | 4 points |
| Type 4 | 1 point | 2 points |
- The name changed and all four types had their points raised. The setting (follow-up consultations at clinics) and the four-type structure are unchanged.
- Clinics that were billing types 1–4 of the after-hours response addition as of May 31, 2026 do not need a new notification for types that only changed names (transitional measure in the facility standards notification circular).
- The MHLW explains that the points were raised in order to promote further development of systems for handling inquiries and visits on holidays and at night.
One point is 10 yen. For example, type 1 is 7 points = 70 yen, which is about 21 yen for a patient paying 30%. The difference from the former 5 points is 2 points = 20 yen.
Prerequisite: which providers are covered
This addition is based on Note 10 of the follow-up consultation fee. A clinic that has notified the regional bureau adds the points for its notified type to the base points when it provides a follow-up consultation. Hospitals are not covered.
Two requirements apply to all types:
- The provider is a clinic
- It has a system for responding to patients' phone (or similar) inquiries outside its posted hours, and informs patients of the responder, emergency response arrangements, and contact details through in-clinic notices, written handouts with the contact details, notes on appointment cards, or similar means
Note that the standards include informing patients, not just building the system.
Comparing the facility standards for types 1–4
For every type, the target is inquiries by phone or similar means from patients who regularly visit the clinic.
| Type | Points | Hours covered | Who responds | Other conditions |
|---|---|---|---|---|
| Type 1 | 7 | At all times | In principle, the clinic's full-time physicians, nurses, or administrative staff | Ability to call back promptly even if a call could not be answered for unavoidable reasons |
| Type 2 | 5 | At all times | The clinic's part-time physicians, nurses, or administrative staff | Ability to view medical records as needed; callback system |
| Type 3 | 4 | A few hours at night outside posted hours | In principle, the clinic's full-time physicians, nurses, or administrative staff | On holidays, late at night, and on public holidays, guide patients to local emergency facilities via answering machine, etc.; callback system |
| Type 4 | 2 | A few hours at night outside posted hours on duty days | Multiple clinics in cooperation | Up to three cooperating clinics including your own; on non-duty days, guide patients via answering machine, etc. to the on-duty clinic or emergency facilities |
Type 1: round-the-clock response
This is a system that can respond to phone inquiries at all times outside posted hours. The circular states that if the response is covered at all times by part-time physicians, nurses, or administrative staff who regularly work three or more days a week and at least 22 scheduled hours a week, the standard can be deemed satisfied.
The practical question is whether you can operate it with shifts or an on-call rota rather than relying on one full-time person.
Type 2: part-time staff can respond at all times
Part-time physicians, nurses, or administrative staff respond by phone at all times. Because the clinic must be able to view medical records as needed, access to the electronic medical record from outside the clinic (with proper security) becomes a practical issue.
Type 3: a few hours at night
In principle, the clinic itself responds during a few hours at night outside posted hours. For other times (holidays, late at night, public holidays), an answering machine guiding patients to local emergency facilities is acceptable.
Type 4: rotation among several clinics
Multiple clinics cooperate, and the on-duty clinic responds during a few hours at night on its duty day. Up to three clinics can cooperate. This is an option for clinics that cannot cover nights alone.
Operational points common to all types
- For types 1–3, the standards include a system that can call patients back promptly even when a call could not be answered for unavoidable reasons (type 4 has the same requirement for its duty days)
- Notification form 2 has a field for how calls that could not be answered are handled: "callback promptly after a voicemail," "forwarding to a physician's mobile or home phone," or "other"
Notification procedure
- Decide the type (based on clinic hours, staffing, and whether cooperation is possible)
- Decide how to inform patients (notices, handouts with contact details, notes on appointment cards, etc.)
- Complete Form 2 of Attachment 7 and submit it to your regional bureau of health and welfare
- Billing starts on the first day of the month after acceptance (or the first day of the current month if accepted on the first business day of that month)
The main items on Form 2:
| Item | Applicable type |
|---|---|
| Type being notified (one of 1–4) | All |
| Clinical departments (up to four main ones) | All |
| Name of the physician in charge of responding | Type 2 |
| Number of full-time staff, or part-time staff working 22+ hours a week, who respond after hours | Types 1 and 3 |
| Posted clinic hours (start and end times by day of week) | All |
| Arrangements when a call cannot be answered | All |
| Names of cooperating institutions and the cooperation arrangement | Type 4 (also where cooperation applies in other types for unavoidable cases) |
| Contact number communicated to patients | All |
No track record is required for this notification. In other words, you can notify once the system is in place.
Link to the comprehensive care addition
The after-hours response system addition is also used in the facility standards of another evaluation related to primary care functions.
- Comprehensive care addition (Chiiki Hokatsu Shinryo Kasan): One of its facility standards requires meeting any one of the following: (a) notification of any of types 1–4 of the after-hours response system addition; (b) at least two full-time-equivalent physicians (1.4 in certain areas), including at least one full-time physician; or (c) being a home care support clinic
- Comprehensive care fee (Chiiki Hokatsu Shinryo-ryo): The attachment to the notification form (Form 2-3) includes notification of type 1 of the after-hours response system addition among the items to confirm
If you bill or are considering the comprehensive care addition, check how these requirements relate when choosing your type.
Checklist for your clinic
- I confirmed the current notified type (1–4 of the former addition) from the notification copy sent to the regional bureau
- I confirmed that a type billed as of May 31, 2026 needs no new notification
- Patient notification (notices, handouts, appointment cards, etc.) matches actual operations
- The callback procedure for unanswered calls is defined
- The voicemail message for holidays, late nights, and public holidays matches the contact details of local emergency facilities
- The receipt computer shows the new name and points effective June 2026
- If moving up to type 1 or 2, I reviewed staff schedules and the environment for viewing records from outside the clinic
FAQ
Q. If only the name changed, do we need to notify again? A. Clinics that were billing types 1–4 of the former addition as of May 31, 2026 do not need a new notification for types whose name alone changed. If you change types, a notification is required.
Q. Can type 1 be billed if only administrative staff respond? A. The circular lists the responders as "physicians, nurses, or administrative staff, etc." However, the system must allow appropriate responses to patient inquiries. Please confirm the details with your regional bureau.
Q. If we choose type 4, do we need no response at night at all? A. On your duty day, in principle the clinic itself responds for a few hours at night outside posted hours. On non-duty days, you need to give consideration, such as guiding patients to the on-duty clinic or emergency facilities via an answering machine.
Summary
- The after-hours response addition became the "after-hours response system addition" on June 1, 2026, with types 1–4 raised to 7, 5, 4, and 2 points
- Facility standards are divided by the hours covered (all the time or a few hours at night) and who responds (full-time, part-time, or multiple clinics in cooperation)
- Notification uses Form 2 of Attachment 7 and requires no track record. If you are only continuing a type whose name changed, no new notification is needed
- It also relates to the facility standards of the comprehensive care addition, so consider a type change together with other additions
To reduce the burden of after-hours phone handling and missed calls, see How to Automate Clinic Phone and Appointment Handling with AI and AI Tools for Clinic Reception. For preventing billing omissions, see also Why Do Billing Omissions Happen? A Cause-by-Cause Checklist.
Through its electronic medical record "AI Karte," Pottech supports clinics in responding to fee revisions and reducing the burden of phone and reception work. If you would like to talk about revision readiness or reviewing your systems, please feel free to contact us.
References / Sources
- MHLW, "FY2026 Medical Fee Revision: 7. Functional differentiation and strengthening of outpatient care" (enhancement of the after-hours response system addition) https://www.mhlw.go.jp/content/12400000/001681336.pdf
- MHLW Health Insurance Bureau, "Handling of facility standards for basic medical fees and related notification procedures" (Hoi-hatsu 0305 No. 7, March 5, 2026) (Section 2: After-hours response system addition, Form 2, transitional measure Table 4) (posted by Kyushu Bureau) https://kouseikyoku.mhlw.go.jp/kyushu/000476302.pdf
- MHLW, "Partial amendment of the facility standards for basic medical fees" (MHLW Notice No. 70 of 2026) (posted by Kyushu Bureau) https://kouseikyoku.mhlw.go.jp/kyushu/000476301.pdf
- Kyushu Bureau of Health and Welfare, "Notification of facility standards accompanying the FY2026 medical fee revision (medical)" https://kouseikyoku.mhlw.go.jp/kyushu/000456076.pdf