The home-care management fee (zaitaku sogo kanri ryo) is the pillar of home-care revenue. The FY2026 fee revision reached into its billing requirements directly.
The twice-monthly tier now requires a severe-patient share of 20% or more. Accumulating visits and patients is no longer sufficient to bill it.
The home-care management fee was already prone to billing omissions: its point tiers vary by single-building patient count, visit frequency, and institution type. FY2026 adds a new kind of risk — falling below a requirement without noticing.
This article organizes the billing requirements including the FY2026 changes, and explains how an EMR prevents both missed billing and falling below the threshold.
Disclaimer: This article is general information. Specific points, facility standards, and forms are governed by the ministry notification and regional bureau circulars, and change with revisions and clarifications. Always base billing and filing decisions on the latest primary sources.
What Is the Home-Care Management Fee?
It is a management fee billed when, for a patient receiving care at home who has difficulty attending the clinic, planned medical management and regular home visits are provided with the patient's consent. In principle it is billed once a month. It is the counterpart to the facility-residence management fee for residents of facilities.
As the core reward of home care, it creates stock-like revenue that stabilises as patients accumulate. This is why home-care business plans read more easily than outpatient ones.
Conversely, when a requirement enters the billing tier itself, revenue moves all at once — which is exactly what happened in FY2026.
The 20% Severe-Patient Share Requirement
The central change is this.
At least 20% of patients billed for home-visit care twice or more per month must be severe cases or subject to the comprehensive support add-on. A practice that does not meet this cannot bill the twice-monthly home-care or facility-residence management fee.
Three points matter in practice.
① Practices below 20% must file a notification
Practices billing the fee as of 31 March 2026 fall under this framework from 1 June 2026. A notification is required where the severe-patient share among patients visited twice or more monthly falls below 20%.
② Verification occurs each February, May, August, and November
This is not a one-time check. The share is verified each February, May, August, and November, and where it has changed, filed promptly within that month using form 19 to the regional bureau director.
The severe-patient share has become a number you calculate yourself, four times a year, and answer for. Patient mix shifts constantly through admissions, facility placements, deaths, and new intakes, so a different answer from the last check is unremarkable.
③ Severe dementia care relaxes the threshold to 15%
Under the published clarifications, practices meeting a set standard for severe dementia care see the threshold relaxed from 20% to 15%. Both of the following are broadly required (confirm against primary sources):
- Among patients at dementia independence level IV or M, a set proportion of cumulative treatment months for patients who received continuous decision-making support and whose information was shared with partner organisations within the past three months
- Among those, a set proportion of cumulative treatment months for patients billed the home-care management fee
The key point: this relaxation turns not on whether you treat dementia patients but on whether records of decision-making support and information sharing exist. How you keep daily records decides whether the requirement is met.
Patient counting was also relaxed
The "100 or fewer patients per full-time-equivalent physician" standard was relaxed as well. Patients billed at the multi-patient-per-building rate and patients visited once monthly may be counted as 0.5, up to a cap of 70 (confirm against primary sources).
For practices carrying facility visits, the counting method changes the conclusion. It is worth recalculating under the relaxed method.
For the revision as a whole, see Home Care and the FY2026 Fee Revision.
Factors Affecting Point Tiers
Points vary mainly through combinations of:
- Single-building patient count: the tier based on patients treated in the same building
- Visit frequency: monthly, or twice or more monthly
- Institution type and function: enhanced-function support clinic or not
- Patient condition: tiers by severity
FY2026 layered onto this an institution-level determination of whether you may bill the twice-monthly tier at all. What used to depend only on per-patient conditions now cannot be judged without looking at your whole patient mix.
Situations Prone to Omissions and Errors
| Situation | Common mistakes |
|---|---|
| Counting patients | Miscounting single-building patients and choosing the wrong tier |
| Managing visit counts | Omitting visits from the monthly tally |
| Recording consent and plans | Deficient records of consent or the care plan |
| Concurrent billing | Errors combining with other home-care items |
| The once-a-month rule | Duplicated or omitted billing timing |
| Severe-patient share (from 2026) | The share drifts across checkpoints and the twice-monthly tier is billed unknowingly |
| Records for the relaxation (from 2026) | No records of decision-making support and information sharing, so the 15% relaxation cannot be used |
Because patient counts, destinations, and visit frequency change dynamically, managing all of this by hand is a heavy burden. Not billing where requirements are met is a direct revenue loss.
From 2026, the opposite risk joins it: billing where requirements are not met. That can become subject to recovery, so its impact exceeds that of missed billing.
See also Billing Omission Checklist.
EMR-Based Billing Support
Protecting home-care billing means linking visit records to billing requirements on the system side. There are two distinct angles.
Angle 1: Prevent missed billing (the long-standing problem)
When visit schedules and records live in the EMR, single-building patient counts and visit frequencies can be tallied and determined automatically, cutting human counting errors. A check on requirement fulfilment at claim creation catches recording deficiencies and concurrent-billing errors.
Angle 2: See a shortfall coming (the problem from 2026)
Everything needed to calculate the severe-patient share already lives in the chart.
- How many patients are billed for home visits twice or more monthly
- How many of those are severe or subject to the comprehensive support add-on
Those two counts give you the share. Tracking it monthly means seeing a dip below 20% (or 15%) before it happens. Calculating for the first time at the February, May, August, or November checkpoint leaves you reacting.
The same applies to the relaxation. For patients at dementia independence level IV or M, records of continuous decision-making support and of information sharing with partner organisations within the past three months — if these are structured and retained, applicability can be judged. Without them, you cannot evidence the requirement even when you met it in practice.
Angle 3: Can the record be made on site?
Both of the above presume records exist. Home care means treating at the bedside and moving on, and time and place to write are structurally scarce.
Batching entry back at the office degrades accuracy as memory fades. Whether records can be completed from a tablet or phone at the visit translates directly into how reliably you can file. See Running Home-Care Charts Entirely on iPad and Phone.
Protecting Home-Care Billing with AI Karte
Pottech's AI Karte handles visit scheduling, clinical records, and integrated-rececon billing on one foundation.
- The management dashboard visualises the severe-patient share and emergency house-call and end-of-life counts monthly — visible continuously, not tallied at the checkpoint
- The AI rezept check inspects bundling, mutual exclusions, and frequency limits to prevent missed billing of home-care management fees
- Mobile and offline support completes records at the visit, so decision-making support and information sharing are captured on the spot
- Document generation builds home-care plans from chart records, reducing total paperwork
Designed in compliance with the Three Ministries' Two Guidelines, it supports the intricate billing work of home care.
In Closing
The home-care management fee has long been prone to omissions because of its complex requirements. FY2026 adds a number you calculate and file yourself: the severe-patient share.
Three things to hold onto:
- The twice-monthly tier requires a severe-patient share of 20% (15% where relaxed); falling below requires a notification
- Verification occurs each February, May, August, and November — the next checkpoint is November
- Both the relaxation and the add-on requirements are decided by whether records exist, not by whether the work was done
Points and requirements change with revisions and clarifications. Confirm the latest conditions in MHLW and regional bureau publications, then use EMR-based billing support to build a practice with neither missed billing nor unnoticed shortfalls.
For details, please contact us.
References and Sources
- About the FY2026 (Reiwa 8) Fee Revision | MHLW
- On filing the home-care management fee under the FY2026 revision | Kyoto Medical Practitioners Association
- FY2026 fee revision notifications corrected; relaxation of home-care standards reflected in facility standard circulars | GemMed
- FY2026 fee revision (3): home care and home-visit nursing enter an era judged on quality and efficiency | Mediva
- Social Insurance Medical Fee Payment Fund
Note: points, tiers, facility standards, and filing forms for the home-care and facility-residence management fees change with revisions and clarifications. Always confirm the latest fee schedule and circulars published by the MHLW and the regional bureaus.