For many agency administrators, hiring a Quality Assurance (QA) professional feels like a gamble. You post the job, review resumés, and interview candidates who seem knowledgeable. But once they start, you’re still left wondering: Can they actually catch what surveyors or auditors will?
It’s one of the most frustrating hiring decisions in home health and hospice. You need someone who understands clinical charting, knows how to protect you during audits and surveys, and can communicate clearly with your team. The worst part? Most agency owners won’t even know if they’ve made the wrong decision until an issue is flagged at survey or during an ADR.
At The Home Health Consultant, we help Medicare-certified agencies build systems and teams that stay survey-ready year-round. We’ve seen what works, and what doesn’t, when it comes to hiring QAs.
This article breaks down:
- Why hiring a QA for a home health or hospice agency is so difficult
- What red flags to avoid when hiring a QA for your agency
- What to look for when hiring a QA for your home health or hospice agency
By the end of this article, you’ll have a better understanding of the hiring process for a QA and know how to avoid common mistakes.
*This article was written in consultation with Mariam Treystman.
What Makes Hiring a QA for Home Health & Hospice So Difficult in the First Place?
Hiring a QA for your Medicare-certified home health or hospice agency is difficult because the role itself requires a very high and specific level of expertise.
Most administrators and HR staff don’t come from a clinical background. And that’s okay, that’s part of the reason why you’re looking to hire a QA in the first place. But, lack of clinical experience can make evaluating a potential QA’s charting skills feel like trying to read a language you don’t speak.
As our co-founder Mariam Treystman explains:
“If you can’t read a chart properly, it’s hard to know if somebody else can read a chart properly.”
A QA’s primary job is to review charts for missing elements, inconsistencies, and clinical logic. If they can’t interpret documentation at that level, surveyors will. The problem is that even a small knowledge gap can make a candidate seem more qualified than they really are.
How Can You Tell If a QA Candidate Really Knows What They’re Doing?
Unfortunately, there’s no single test that guarantees a perfect hire (that would be lovely though). Regardless, there are clear signs that separate strong QAs from those who may not be ready for the role.
A good QA knows how to identify compliance issues before surveyors or auditors do. When you interview candidates, focus less on how long they’ve “worked in quality assurance,” and more on how they approach documentation problems.
When speaking with a candidate, ask open-ended questions like:
- “How do you identify documentation gaps in a chart?”
- “What process do you follow when you find an issue in a chart?”
- “What’s your approach to preparing for a survey?”
If the candidate’s answers are vague or rely heavily on buzzwords like “HIPAA,” that’s a red flag. For example, HIPAA governs patient privacy, not chart quality. You want a seasoned QA candidate that will talk about things like chart completeness, care plan accuracy, and meeting timeframes.
What Are the Red Flags When Interviewing a Home Health or Hospice QA?
It can be hard to spot red flags in the QA hiring process if you’re unfamiliar with clinical details. But, a few behaviors can reveal a lack of real experience even if you’re not exactly sure what to look for:
- They Misuse Terminology.
We get it. Wrapping your head around all of the different terminology used in this industry is no easy feat. There’s a reason we wrote an article decoding home health and hospice acronyms!
But, a QA is such a detail oriented, hyper-clinical position, that they need to understand exactly what they’re talking about to a T. If they don’t understand frequencies, episodes, or benefit periods, for starters, they’re definitely not the best choice.
- They ask to review charts that have already passed survey.
A good QA won’t want to waste time checking charts that have already passed, *unless they’re specifically worried about ADRs. But most good QAs should want to evaluate imperfect charts to show how they problem-solve.
- They bad-mouth others.
Skilled professionals focus on process, not people. A QA who immediately criticizes former teams or “the last person who did this job,” may be covering for gaps in their own knowledge.
What Basic Knowledge Should Every Home Health or Hospice QA Be Able to Demonstrate?
Even if you aren’t clinical, you can still check for foundational knowledge. A qualified QA should easily explain:
- What makes a complete medication order
- How to reconcile medications and check for interactions
- How often aide supervisory visits and/or IDG meetings must occur
- What elements belong in a care plan or discharge note
- The different disciplines in home health and hospice and what documentation is required for each
- What is the home health or hospice eligibility criteria?
If a candidate can’t answer those questions without hesitation, they may not have the depth your agency needs.
Are Clinicians Automatically Qualified to Do Quality Assurance Work in Home Health & Hospice?
Being an excellent clinician doesn’t always translate to being an excellent documenter.
Some of the best QAs have never provided bedside care, but they understand chart structure, compliance timelines, discipline-specific requirements and survey expectations inside and out. Likewise, some RNs who are exceptional in patient care need significant guidance to meet documentation standards.
That’s why your Director of Patient Care Services (DPCS) should participate in interviews, but not be the only evaluator. Clinical expertise helps, but QA requires a different kind of precision and patience.
Q&A: How Do I Hire a Home Health or Hospice QA?
Q: How can I test a QA’s skills if I don’t have a clinical background?
A: Give them a mock chart with known documentation gaps. You can create the chart with your DPCS, or a clinician you know has especially strong charting. See if they can identify missing elements and explain why those issues matter.
Q: What’s one mistake agencies make when hiring QAs?
A: Hiring based on confidence instead of competence. Someone who “talks compliance” isn’t always someone who knows compliance.
Q: Can home health and hospice QA work be done remotely?
A: Absolutely (if your company charts completely online). Chart review is often done after hours or off-site. If you’re in a rural area or have limited local candidates, expanding your search to regions with larger home health and hospice networks (like California or Texas) can open up your options.
Q: Where should I start looking when hiring a home health or hospice QA?
A: The best QAs are rarely on the job market, they’re already employed. That means your search process has to be intentional. Don’t be afraid to network. Many agencies find their QAs through industry contacts, not job boards.
And if you have a strong compliance foundation internally, consider hiring someone with the right mindset and training them for the role. Great QAs can start with curiosity and grow into expertise.
What’s the Long-Term Value of Finding the Right QA?
Hiring a QA protects your agency’s reputation, revenue, and license. The right QA prevents small errors from becoming survey deficiencies or payment denials.
As our co-founder Mariam Treystman puts it:
“Finding the right professionals is one of the hardest parts of running a home health or hospice agency. But when you do, it changes everything.”
If you need help strengthening your compliance program beyond a QA, check out the article below for the importance and best practices of compliance maintenance.
*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.
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