One of the pillars supporting the revenue of home care is the home-care management fee (the comprehensive medical management fee for home care). However, because the home-care management fee changes point categories depending on multiple conditions—such as the number of visits and the number of patients per single building—and its requirements are also revised at each revision, it is a management fee prone to billing omissions and errors. This article organizes the points of billing the home-care management fee and EMR-based prevention of billing omissions, based on official MHLW information.
What Is the Home-Care Management Fee?
The home-care management fee is a management fee billed when, for a patient who is receiving care at home and has difficulty visiting the clinic, planned medical management and regular home-visit care are provided with the patient's consent. In principle, it is billed only once a month. It is positioned as a counterpart to the facility-residence management fee, which targets residents of facilities.
The home-care management fee is a core reward of home care, and whether you can correctly manage whether requirements are met is directly tied to the clinic's management.
The Main Factors That Affect Point Categories
The points of the home-care management fee change mainly through combinations of factors like the following.
- Number of patients per single building: The category based on the number of patients treated in the same building
- Number of home-visit consultations: The number of visits per month
- Type and function of the medical institution: Such as whether it is a function-enhanced type
- Patient's condition: Categories according to severity
In the FY2024 revision, the point structure was reviewed, including subdivision of the categories for the number of patients per single building and reductions when the number of visits exceeds a certain level. Because specific point values and category thresholds change with revisions, this article does not state them definitively; be sure to check the latest fee schedule and billing requirements in the official information described below.
Situations Prone to Billing Omissions and Errors
| Situation | Common mistakes |
|---|---|
| Counting patients | Miscounting the number of patients per single building and erring on the category |
| Managing the number of visits | Omitting the tally of visits within the month |
| Recording consent and plans | Deficient recording of consent acquisition or the treatment plan |
| Whether concurrent billing is allowed | Errors in combining with other home-care points |
| The once-a-month rule | Duplication or omission of billing timing |
Because in home care the number of patients, destinations, and visits change dynamically, accurately managing these by hand alone is a large burden. "Missed catches"—not billing even though requirements are met—directly become revenue losses.
Billing Support via the EMR
To prevent omissions in billing the home-care management fee, it is effective to link visit records and billing requirements on the system side. If visit schedules and visit records are recorded in the EMR, and the number of patients per single building and the number of visits can be automatically tallied and determined based on that data, human counting errors can be greatly reduced.
Furthermore, if there is a mechanism that checks the fulfillment of billing requirements when creating rezepts, you can notice recording deficiencies and concurrent-billing errors. Ideally, document creation such as home-visit care plans and billing management are connected on the same foundation.
Protecting Home-Care Billing with AI Karte
Pottech's AI Karte can handle visit schedule management, clinical records, and integrated-rececon billing on a single foundation. By making use of visit-record data and having the AI rezept check inspect billing content, it helps prevent omissions in billing home-care management fees, including the home-care management fee. It also supports automatic creation of documents such as visit plans and connects seamlessly from the field to the office on multiple devices. Designed in compliance with the Three Ministries' Two Guidelines, it reliably supports the complex billing work of home care.
In Closing
The home-care management fee is an important management fee that influences the management of home care, and it is an area prone to billing omissions due to its complex requirements. Because points and requirements change with revisions, be sure to check the latest conditions in official information such as from the MHLW, and then use EMR-based billing support to build a billing system with no missed catches.
Through providing AI Karte, Pottech serves as the optimal business partner for clinics, supporting not only the improvement of working conditions for doctors, nurses, and medical clerical staff but also the fullest possible realization of what each clinic wants to achieve.
For details, please feel free to contact us.