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Condition Code 43 and Home Health Discharges

When Does the Hospital Earn the Full MS-DRG?

When a Medicare inpatient is discharged with home health services planned, the hospital’s payment may depend on something that happens after the patient leaves: when the first home health service is actually furnished.

If related home health services begin within three days of discharge, Medicare’s post-acute care transfer policy may reduce the hospital’s payment from the full MS-DRG to a graduated per-diem amount. But when no related home health service is furnished within that three-day window, Condition Code 43 may allow the hospital to receive the full MS-DRG payment.

Whether you work in Revenue Cycle, Case Management, Physician Advisory Services, CDI, Compliance, Finance, Utilization Review, or Hospital Leadership, you'll leave with practical ideas to help your organization prepare for what's coming.

Join us LIVE on Friday, July 17, 2026 at 1:00 PM ET for
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Ernie also produces and moderates another LIVE show, MONTHLY on Thursdays at https://physicianonline.org 

THIS show is all Physician Advisors, and is mostly clinical topics, going over top disease specific concerns and questions. Free to watch live! Register Now!

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CHECK OUT OUR FRIENDS AT CORE-CDI

https://www.core-cdi.com/  

Core CDI offers several resources to help you address your Revenue Cycle and CDI needs. You can find Word documents, PowerPoints, videos, links and more that focus on the "How to" and "Why?" questions that invariably arise.

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Revised Medicare Appeals Process

Learn the Key Changes No Part of the Regulations, including Limits on Precedential Decisions, Attorney Adjudicators & CMS Contractors.

Free 1-hour webinar. Another exceptional presentation by Jessica Gustafson, a founding Partner at The Health Law Partners.

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