Attachment_J-7,_Special_Healthcare_Payment_Conditions.docx

Section J Attachment J-7 Special Healthcare Payment Conditions - Japan

Due to cultural differences in the delivery of health care overseas, health care providers and facilities in Japan may separately itemize for certain healthcare charges and other items that are attendant to the delivery of health care in that country. This practice is acceptable and such claims may be payable by TRICARE if they are identified on this list and they are determined, by the TRICARE Overseas Program Office (TOPO) to be reasonable and customary for the specific location. Due to the dynamic nature of health care, this list may not be all-inclusive and the TOP Contractor will notify the Government if providers or facilities in Japan claim reimbursement for separately-itemized charges that are not included on this list:

Potentially payable charges:

· Meals and meal fees associated with an inpatient admission

· Sundries such as gloves, masks, alcohol swabs, pajamas, linens, personal items, OB sets, diapers, and baby formula when associated with an inpatient admission

· Syringes and needles (disposable)

· Injections (the actual service provided by a health care worker, not an injectable drug which should be coded and reimbursed according to existing guidelines for injectables)

· Placenta disposal

· Patient teaching/medical management fees (applies to both inpatient and outpatient services) associated with medical guidance, illness treatment, or other medical management fees attendant to the delivery of services for a specific illness

· Assessment Letters to update the medical record (number of words not limited)

· Referral Letters (used to request the services of other specialists in a patient's care, or for the

· Primary Physician for continuity of care

· Medical Discharge Certificate (issued for the Primary Physician for continuity of care)

· Non-Referral Fees associated with consultation charges

· Rehabilitation associated with an inpatient admission (inpatient physiotherapy, occupational therapy or respiratory therapy)

· Charges for services received outside normal business hours

· Outside insurance fee (fee for handling other than Japan National Health Insurance)

· Charges associated with the Japan Obstetrics Compensation System for Cerebral Palsy

The following charges are NOT considered payable as a separately-itemized charge for Japan providers or facilities:

· Interpreter’s Fee

· Fees associated with birth certificates

· Fees associated with accessing a refrigerator

· Cancellation Fees

· Invoices for any item that would be considered deluxe, luxury, immaterial, or nonessential to the delivery of health care

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