If you're running a home health or hospice agency, you know that Medicare compliance is critical to your financial health. But did you know that failing to participate in required patient experience surveys could cost your agency thousands in lost reimbursements?
Medicare requires all qualifying home health and hospice agencies to take part in CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys. These surveys collect standardized patient and caregiver feedback and directly impact your Medicare reimbursements.
If you fail to meet CAHPS requirements, your agency could face penalties of 2%-4% of your Medicare Annual Payment Update (APU). This major financial hit could lead to agency closure.
In this article, we’ll break down:
- What CAHPS is and why it matters
- The financial impact of non-compliance
- Who must participate (and who qualifies for an exemption)
- CAHPS survey requirements and deadlines
- How to avoid costly compliance mistakes
By the end, you’ll have a clear roadmap to ensure your agency stays compliant with CAHPS and protects its Medicare revenue.
What Is CAHPS?
CAHPS is a national survey program designed to measure patient and caregiver experiences with healthcare providers. CAHPS surveys are not to be mistaken for surveys conducted by accrediting organizations, state health departments, or complaint investigations. CAHPS surveys are questionnaires designed to assess patient experiences and satisfaction with care.
Home health and in-home hospice, though similar services, have their own kinds of CAHPS.
- Home Health CAHPS (HHCAHPS): Surveys patients who receive skilled home health services.
- Hospice CAHPS: Surveys caregivers of patients who received hospice services before passing away.
CAHPS surveys can be conducted via mailed questionnaires, telephone calls, or both. It’s up to your agency and your CAHPS vendor to decide which option will be best for your agency.
Both HHCAHPS and hospice CAHPS surveys collect feedback on:
- Communication
- Care quality
- Overall experience
Medicare uses these results to evaluate agency performance and determine future payment updates.
But CAHPS isn’t only important because it affects your bottom line. It also provides direct and invaluable feedback from your clientele. Feedback from your patients is valuable for a number of reasons:
- Positive CAHPS Data Can Bring in More Patients: CAHPS data is public. If your agency has shining reviews, you’re more likely to make an impression on potential clients.
- Potential Risks or Lapses in Compliance Are Identified: Obviously you want to have systems in place that catch lapses in compliance before your CAHPS questionnaires start. However, it’s common for things to slip through the cracks. By establishing a line of patient-agency feedback, you stay up-to-date on issues as they arise, and not during a survey.
What Kinds of Questions Are Asked for HHCAHPS & Hospice CAHPS?
Because home health care and hospice care are different services, they will have different questions on their CAHPS questionnaires. Below you’ll find a few examples of what CAHPS questions can look like for both home health and hospice
Examples of Home Health CAHPS Survey Questions:
- When you first started getting home health care from this agency, did someone from the agency talk with you about how to set up your home so you can move around safely?
- In the last 2 months of care, did home health providers from this agency talk with you about the purpose for taking your new or changed prescription medicines?
- In the last 2 months of care, did you have any problems with the care you got through this agency?
Examples of Hospice CAHPS Questions:
- While your family member was in hospice care, how often did you take part in or oversee care for them?
- How often did your family member get the help they needed from the hospice team for feelings of anxiety or sadness?
- In the weeks after your family member died, how much emotional support did you get from the hospice team?
What Are the CAHPS Penalties and Payment Reductions?
Your agency’s participation in HHCAHPS or Hospice CAHPS isn’t optional. It directly impacts your Medicare reimbursement. Non-compliance can lead to significant penalties:
- Home Health Agencies: Failing to submit HHCAHPS survey data results in a 2% reduction in your Annual Payment Update (APU).
- Hospice Agencies: As of Fiscal Year 2024, the penalty for failing to report Hospice CAHPS data has doubled to 4% of the APU.
These penalties don’t just affect a single claim—they reduce your entire Medicare payment for the year. In an industry where every dollar counts, losing 2–4% of your revenue can be a major setback.
Who Is Required to Participate in CAHPS? How to Know If Your Home Health or Hospice Qualifies for an Exemption
While participation in CAHPS is non-negotiable, some agencies may qualify for an exemption. Medicare has set size-based exemptions for agencies that serve a small number of patients:
- Home Health Agencies: If your agency had 59 or fewer eligible patients in a year, you can apply for an HHCAHPS size exemption for that year.
- Hospice Agencies: If your agency served fewer than 50 eligible family members or other caregivers in the prior year, you can request a Hospice CAHPS exemption.
Don’t forget! CAHPS exemptions only last for one year. If your agency still meets exemption requirements the following year, you will need to re-apply.
What Are the CAHPS Survey Requirements?
If you don’t qualify for an exemption, you will need to hire a vendor to survey your patients or caregivers. CMS has strict requirements about how these surveys are conducted and by whom:
- You must hire an approved CAHPS survey vendor. Medicare does not allow agencies to conduct CAHPS surveys in-house.
- Surveys must be conducted in English or the patient’s preferred language. Your vendor will have multilingual options.
- Survey responses are confidential. Your agency won’t see individual responses—just aggregated results.
- Submission deadlines are quarterly. You must submit census data on time to your CAHPS vendor to ensure compliance.
How Are HHCAHPS and Hospice CAHPS Different?
While both HHCAHPS and Hospice CAHPS measure patient experience, they focus on different aspects of care:
4 Common CAHPS Compliance Mistakes (And How to Avoid Them)
There are a few frequently made mistakes regarding CAHPS. However it's essential to be aware of and avoid them. By doing so, you safeguard your agency from Medicare Payment Reductions.
1. Failing to Hire a CMS-Approved Survey Vendor
- Medicare does not allow agencies to conduct surveys in-house to satisfy this requirement. Only CMS-approved vendors can administer HHCAHPS and Hospice CAHPS surveys.
- How to fix it: Use the approved vendor lists linked above to choose your vendor.
2. Missing CAHPS Submission Deadlines
- Medicare requires agencies to follow strict timelines for data submission. Late reports result in automatic Medicare payment reductions (up to 2 % or 4%).
- How to fix it: Know when the deadlines are. Work with your vendor to ensure data is submitted on time.
HHCAHPS & Hospice CAHPS Submission Deadlines
Below, you’ll find charts displaying the most up-to-date CAHPS deadlines for home health and hospice agencies.
3. Not Educating Patients & Caregivers on Surveys
- Participation is voluntary, but higher response rates improve your agency’s public ratings.
- How to fix it: Explain the survey process during patient admission and discharge.
4. Influencing Survey Responses
- Medicare prohibits agencies from coaching, pressuring, or guiding patients and caregivers on how to answer survey questions. Even subtle suggestions can lead to compliance violations. Agencies are also not permitted to assist in completing the survey or filling out responses on behalf of the patient. Violations can result in steep financial penalties.
- How to fix it: Train staff to provide neutral, factual information about the survey without leading patients in any way. Emphasize that participation is entirely voluntary and that responses should reflect each patient’s genuine experience with your agency.
5. Ignoring CAHPS Exemption Rules
- If you qualify for a size-based exemption but don’t file the required CMS form, you’ll still be penalized as non-compliant.
- How to fix it: Submit your exemption request before the deadline.
How to File a Hospice CAHPS or HHCAHPS Exemption (If You Qualify)
If your agency serves a small number of patients, you may qualify for an exemption from CAHPS reporting. Here’s how to apply:
1. Determine eligibility: Check if your agency served:
Determine eligibility. Check if your agency served:-
- Home Health: 59 or fewer home health patients in the prior year
- Hospice: Fewer than 50 hospice patients in the prior year
2. Locate the exemption form. Forms are available on the CAHPS websites:
3. Submit the form before the deadline. There are specific annual deadlines for exemption requests. Below you will find the upcoming exemption request deadlines:
-
- Home Health Exemption Request Deadline: 11:59 PM Eastern Time, March 31, 2025
- Hospice Exemption Request Deadline: December 31st, 2025
4. Keep a copy for your records. If CMS audits your agency, you’ll need proof that you submitted your exemption request.
Need Help Staying on Top of CAHPS?
Now that you understand the importance of CAHPS compliance, you have the knowledge to avoid penalties and maximize your Medicare reimbursements.
Failing to submit CAHPS survey data can cost your agency up to 2-4% of your annual Medicare payments—a major financial hit. But by hiring an approved survey vendor, meeting deadlines, and educating but not overeducating patients, you can stay compliant.
If you're unsure about CAHPS requirements, exemptions, or vendor selection, don't wait until it's too late. Staying proactive is the key to avoiding penalties.
Remember, the information in this article is accurate at the time of publishing, but always be sure to check official CAHPS websites for the most up-to-date information.
At The Home Health Consultant, we help you stay on top of CAHPS reporting deadlines and so much more. To learn more about what else can cause Medicare payment reductions, check out the article below.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
