Condition Code 43, One Week Later

The Questions, the Cases, and the Missing Information

A hospital can make the right home-health referral and still have the wrong claim outcome. 

That is because the critical question is not simply whether home health was planned at discharge. It is whether related home-health services were actually furnished within the applicable window—and whether your organization can prove what happened.

In last week’s Finally Friday! LIVE discussion, attendees raised the questions that expose the operational gap between discharge planning, patient care, coding, billing, revenue integrity, and compliance. This follow-up session is where we answer them.

You will leave with a clearer way to separate:

• A referral from a furnished service

• Relatedness from delayed care

• A discharge plan from the evidence needed to support a claim

• A one-off exception from a broken closed-loop process

What we will cover

• The 90-second refresher: why actual home-health service dates matter

• Status 06, Condition Code 42, and Condition Code 43—without blending them together

• How to approach delayed home-health starts, including starts on day seven or eight

• What to do when a patient refuses every visit or no service is ever furnished

• Whether an assessment, start-of-care record, or visit establishes the first furnished service

• Five practical case studies your team can use to test its current workflow

• The evidence ladder: referral, agency confirmation, patient outreach, claim-line dates, and auditable proof

• Who should own the exception review and correction pathway

• A focused 30-day diagnostic to identify where the information loop breaks

This discussion is designed for hospital case managers, physician advisors, utilization management leaders, CDI professionals, coders, billers, revenue-integrity teams, compliance professionals, and leaders responsible for accurate reimbursement and safer transitions of care.

Register now for free live attendance. Bring your questions—and bring the cases that have made your team wonder what really happened after discharge.

Educational discussion only; not legal advice. Apply current CMS guidance, MAC instructions, and your organization’s compliance policies.

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.

Registration is FREE.

Even if you cannot attend live, register today and we'll provide access to the on-demand recording.

Who Should Watch:
• Utilization Management
• Utilization Review
• Physician Advisors
• Healthcare Information Mgmt.
• Anyone else involved in 
healthcare operations roles