Reason Code C7800


Description
Claim has been Rejected due to the beneficiary began a home health episode within three days of discharge from inpatient care.

Resolution
When an inpatient hospital discharges a patient to be under the care of a Home Health Agency (HHA) within 72 hours of discharge; a patient status code 06 is billed on the claim to Medicare.

Condition Code 42 may be used to indicate that the care provided by the HHA is not related to the Hospital Care and therefore, will result in payment based on the MS-DRG and not a per diem payment.

Condition Code 43 may be used to indicate that Home Care was started more than three days after discharge from the Hospital and therefore payment will be based on the MS-DRG and not a per diem payment.

Resource

  • SE1411 (PDF, 786 KB) - Clarification of Patient Discharge Status Codes and Hospital Transfer Policies
  • Resolution Tips for Overlapping Claims (JJA, JMA)




Last Updated: 12/01/2020