The recent system change with the greatest impact on the outpatient management of internal medicine clinics is the review of the Lifestyle-Related Disease Management Fee and the Specific Disease Treatment Management Fee in the FY2024 (Reiwa 6) medical fee revision. The billing structure for the management fees of the three major lifestyle-related diseases handled daily in internal medicine—hypertension, diabetes, and dyslipidemia—changed significantly. This article organizes the difference between the Lifestyle-Related Disease Management Fee and the Specific Disease Treatment Management Fee, and explains how internal medicine clinics should respond, based on the official materials of the Ministry of Health, Labour and Welfare (MHLW). Note that specific points and requirements are set in notices and notifications, so always confirm them in the primary sources.
The biggest point of the 2024 revision: exclusion of target diseases
The biggest change in the 2024 revision is that diabetes, dyslipidemia, and hypertension—lifestyle-related diseases—were excluded from the target diseases of the Specific Disease Treatment Management Fee. As a result, when managing these three diseases as the main disease, billing shifts in principle to the Lifestyle-Related Disease Management Fee.
Many internal medicine clinics had until now billed the Specific Disease Treatment Management Fee for patients with hypertension and diabetes. Because this revision directly affects the foundation of that daily billing, "a failure to respond" is directly tied to a revenue impact.
The difference between the two management fees
The two differ in both purpose and billing requirements. Here we organize the main differences.
| Item | Lifestyle-Related Disease Management Fee | Specific Disease Treatment Management Fee |
|---|---|---|
| Main targets | Patients with dyslipidemia, hypertension, or diabetes as the main disease | Diseases set by the MHLW Minister (the three major lifestyle diseases excluded) |
| Management content | Formulating a treatment plan and comprehensive treatment management including lifestyle | Treatment management based on a treatment plan |
| Treatment plan | Creation and delivery required (operation differs for (I) and (II)) | Not required |
| Combined billing | Cannot be billed together with the Specific Disease Treatment Management Fee | Cannot be billed together with the Lifestyle-Related Disease Management Fee |
The Lifestyle-Related Disease Management Fee has category (I), which bundles tests and the like, and category (II), which does not. Because points, operation, and the handling of the treatment plan change depending on which you bill, a choice suited to your patient base and practice style is needed. For details of specific points, facility standards, and categories, please check the MHLW and Regional Bureau of Health and Welfare materials cited below.
How internal medicine clinics should respond
To respond reliably to the revision, we recommend the following steps.
- Take inventory of target patients: Identify patients with hypertension, diabetes, or dyslipidemia as the main disease and reorganize the billing categories.
- Decide on (I) or (II): Decide the category suited to your clinic in light of the bundling scope and the operational burden of the treatment plan.
- Build treatment plan operations: Incorporate the flow of creation, patient explanation, and delivery into daily practice without strain (the fiscal 2026 revision removed the patient signature, but creation, explanation, and delivery remain required).
- Confirm the system's revision handling: Confirm whether your electronic chart and receipt computer support the new billing rules.
- Check for billing omissions and returned claims: Because billing mistakes and returns are prone to occur right after a revision, strengthen your checking system.
Especially burdensome are the creation and delivery operations for the treatment plan in step 3, and the system handling and checking in steps 4 and 5. Manual plan creation and manual management of billing rules are areas that easily become a breeding ground for billing omissions and returned claims.
Handling the shift with AI Karte
"AI Karte," developed by Pottech, is an integrated receipt-computer cloud electronic chart in which the system is automatically updated in line with each medical fee revision. It keeps up with the billing-rule changes accompanying the shift to the Lifestyle-Related Disease Management Fee without manual updates on the clinic's side.
Furthermore, a document AI draft function automatically generates a draft of the treatment plan based on the chart content, reducing the burden of creation and delivery. The AI receipt checking function detects billing omissions and erroneous claims in advance, in line with rules such as the prohibition on billing the Lifestyle-Related Disease Management Fee and the Specific Disease Treatment Management Fee together. The system provides constant support for internal medicine billing, which has grown more complex with the revision.
In closing
The shift from the Specific Disease Treatment Management Fee to the Lifestyle-Related Disease Management Fee in the 2024 revision is an important change involving the foundation of outpatient billing in internal medicine clinics. Taking inventory of target patients, deciding on a category, operating the treatment plan, and preparing systems and checking structures are the keys to responding. To reduce the burden of revision handling and prevent billing omissions, a mechanism that automatically handles revisions and supports document creation and receipt checking is effective.
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
- About the FY2024 Medical Fee Revision (MHLW)
- Promotion of effective and efficient disease management and prevention of severe illness in response to the increase in lifestyle-related diseases (MHLW)
- Special Medical Fees B000 Specific Disease Treatment Management Fee (MHLW)
- Facility standards for the Lifestyle-Related Disease Management Fee (Kinki Regional Bureau of Health and Welfare)
Specific requirements for points, facility standards, and categories change by fiscal year and notification. This article does not assert them; please always confirm the latest information in the official sources above.