If you're managing a Home Health or Hospice Care agency, you're likely overwhelmed, confused, and worried about the varying types of surveys and what happens if you don't pass. Failing one could put your entire business at risk. Ultimately, you may be wondering how you’re going to tackle this on your own.
At The Home Health Consultant, we’ve seen the toll prepping for surveys takes on agencies when they’re already stretched thin. Just last year alone, we helped prepare and liaise over 200 surveys. The THC team specializes in helping agencies like yours navigate every kind of survey, because we’ve been there before.
In this article, you'll learn about the six types of surveys and the differences between each one. By reviewing this information and educating yourself, you’ll take the first step to make sure your agency stays compliant, thriving, and profitable.
What Is A Survey?
A survey occurs when a government entity visits your agency’s office in person and, at times, may also visit patients' homes, to conduct an inspection. The primary purpose of the survey is to review your agency’s documents and procedures. However, each type of survey has specific nuances.
According to regulations set by the Centers for Medicare and Medicaid Services (CMS), upon entering your agency for any kind of survey, the surveyor will:
- Present identification
- Introduce the survey team to the administrator or designee
- Explain the purpose of the survey they are conducting
- Provide the estimated length of surveys
Announced vs. Unannounced Surveys
While there are many types of surveys, there is one consistent difference between all of them: whether they are announced or unannounced.
Announced surveys are scheduled in advance with the agency. For example, the California Licensure survey is an announced survey.
Unannounced Surveys are "surprise" surveys, where the agency knows the range of possible dates (the survey window) but not the exact date. The purpose is to observe the agency’s typical operations without allowing time for last-minute adjustments. Examples include initial enrollment accreditation surveys, focus surveys, and triennial surveys.
1. What Is a California Licensure Survey?
Every Home Health or Hospice Care Agency will experience a California Licensure survey when starting. These surveys are conducted by one of three national accreditors:
- Accreditation Commission for Health Care (ACHC)
- Community Health Accreditation Program (CHAP)
- The Joint Commission (TJC)
Surveys used to be conducted solely by government entities. However, as the industry has grown, the number of applications, and therefore surveys, has increased. This led the California Department of Public Health (CDPH) to outsource surveying to these three national accreditors.
Why is a California licensure survey important?
Your California licensure survey is critical because you cannot start seeing patients until you have your license.
What do surveyors look for in a California licensure survey?
Each state has different requirements for surveys. California specifically requires a paperwork-based survey for California Licensure. For this survey, your agency administrator, alternate administrator, Director of Patient Care Services (DCPS), or Alternate DCPS must be present. In a California Licensure survey, the state will review all Human Resources (HR) files to ensure your staff is qualified. This survey aims to prove that your agency is following all policies and procedures regarding record-keeping and has all the documents, processes and staff in place to provide safe patient care.
Is a California licensure survey announced or unannounced?
A California Licensure survey is announced. This means you can schedule exactly when this survey will take place.
How much does a California licensure survey cost?
To get a California Licensure survey, you will pay a fee of approximately $5,000. This fee is charged by one of the three national accreditors (ACHC, CHAP, or TJC) mentioned above.
What happens when I pass a California licensure survey?
Once you pass your survey, the California Department of Public Health (CDPH) will issue your agency a license. This gives your agency the ability to accept and treat patients, and move onto the next steps in the Medicare enrollment process.
2. What Is a Site Visit Survey?
A site visit is the quickest type of survey you will undergo, but that doesn’t mean it’s absent of its own nuances.
Why is a site visit survey important?
A Site Visit is conducted to prevent fraud, abuse, and patient confidentiality breaches at Home Health and Hospice Care offices. This survey is one of the mandatory requirements to apply for the accreditation survey.
What do surveyors look for at a site visit survey?
During a Site Visit, the surveyor ensures that your agency is legitimate. This means checking in to make sure no other business or activities are being conducted at your office location.
However, during a site visit, the surveyor will not review any of your agency’s work. The surveyor will visit the office and take photos of the front door, and sometimes the inside of your office. It’s more of a check-in to make sure your office is brick and mortar and where you said it is.
Is a site visit survey announced or unannounced?
A Site Visit is unannounced, meaning you cannot schedule exactly when this survey occurs. In some cases, you may not even know a site visit has occurred. Sometimes, surveyors simply check the entrance to your office without even entering. There's a chance your site visit occurred, and you had no clue.
However, it remains essential that you have at least one person in the office when the surveyor comes. If you don’t, you risk survey failure, which can add months to your Medicare accreditation process.
How much does a site visit survey cost?
A site visit survey is free, as it is conducted by The Centers for Medicare and Medicaid Services (CMS).
What happens when if I fail a site visit survey?
The site visit survey is essentially a pre-survey to make sure you qualify for whatever you are applying for. For example, if you’re applying for accreditation, you will undergo numerous Site Visit surveys throughout the accreditation process. Failure to pass multiple site visit surveys will result in your application being rejected. In this case, you would have to start the accreditation process from scratch.
3. What Is an Accreditation Survey?
The next survey agencies typically undergo is an Accreditation survey. An Accreditation survey is similar to a California Licensure survey. However, the Accreditation survey differs for a few reasons.
Why is an accreditation important?
A large chunk of your patients will likely be on Medicare. Medicare is federal health insurance provided for anyone over the age of 65. Because a large number of patients in Hospice and Home Health Care are 65 or over, it’s important to make sure you qualify for Medicare Accreditation to be able to accept a wider variety of patients.
Additionally, most insurance companies require Medicare accreditation as a condition of contracting. While agencies that are only licensed (not accredited) can legally service patients with private insurance, it will be impossible for them to get ‘in-network’ with insurance companies, thus being paid a much lower rate.
What do surveyors look for in an accreditation survey?
The accreditation survey inspects the agency’s patient care, human resources, and administrative processes. To qualify for the Medicare program, your agency must meet all Medicare Conditions of Participation (COPs). These regulations are determined by the Centers for Medicare and Medicaid Services (CMS).
At an accreditation survey, surveyors will:
- inspect your office
- confirm the agency has serviced 3 discharged and 7 active patients
- review records
- visit patient homes
- interview staff
While surveyors will primarily focus on Medicare COPs, each national accreditor has their own regulations as well. An Accreditation survey is generally on the longer side, spanning over two to three days. The more patients you have, the longer surveys tend to be.
If you fail your first Accreditation survey, don’t worry, the world isn’t falling apart! If your agency is not compliant with Medicare COPs, you will not pass, but you can redo the survey. However, you will have to pay to try the survey again, so avoid failing at all costs! It is often cheaper to hire consultants to help agencies pass, than to undergo this process multiple times.
If your agency is not compliant with the accreditor’s regulations, you must write, submit, and receive approval on a plan to fix your agency’s deficiencies. This plan is commonly called a ‘Plan of Corrections,’ or POC for short. If your POC is approved, you will officially have your accreditation, and in tandem Medicare enrollment, approved.
Is an accreditation survey announced or unannounced?
An Accreditation survey is unannounced, meaning you cannot schedule an exact day and time. This is why once you apply for Medicare Accreditation, keeping your office staffed over the following weeks or months is essential. Surveyors who arrive at an empty office will cancel the survey and the agency will have to pay the cancellation fee.
How much does an accreditation survey cost?
As mentioned above, the accreditation survey is conducted by one of the three national accreditors (ACHC, CHAP, or TJC). To get an accreditation survey, you pay one of the three national accreditors anywhere from $7000-$9000. This covers the accreditor’s cost of sending an out-of-state surveyor for 2-3 days to conduct the survey.
What happens when I pass an accreditation survey?
The provider application process typically takes between 3 to 9 months to complete, depending on the current backlog. Once the agency is found compliant with all Conditions of Participation (COPs), it can begin accepting Medicare for patient services from that date forward. Following this approval, the agency may also start pursuing contracts with private insurance providers if they choose.
4. What Is a Triennial Survey?
You’ve officially passed your initial surveys, congratulations! You’re now set, at least survey-wise, to start accepting patients, including those on Medicare. But don’t get too ahead of yourself, surveys are an aspect of owning and operating home health and hospice agencies that never go away. The next survey agencies typically face is a Triennial survey.
Why is a triennial survey important?
A Triennial survey, as you may have guessed, occurs three years after your accreditation certificate and Medicare enrollment become valid. Unfortunately, once you pass the accreditation survey for the first time, you will inevitably have to undergo your triennial survey to renew your accreditation every 3 years, forever, as long as you want to continue billing Medicare.
What do surveyors look for in a triennial survey?
Over two to three days, one of three national accreditors will return to your agency to conduct another full accreditation survey. There are a few additional details the surveyors will want to look into now that your agency has been up and running for at least three years. For example, the accreditor will review your agency’s administrative programs, such as your
- QAPI’s
- fall programs
- medication management program
- mergency management programs
and more, in much more detail since there are now 3 years of data and procedure to observe. On top of this, you will also have to meet all Medicare Conditions of Participation (COPs) again.
Similar to the surveys above, a Triennial survey is also conducted by one of three national accreditors. Most agencies stick with their initial accreditor, as it’s easier to avoid updating all documentation, employee files, patient charts, and more.
Is a triennial survey announced or unannounced?
A triennial survey is unannounced, meaning you will not have the ability to schedule the survey. However, a triennial survey must occur within 6 months before the three-year expiration. This gives you more control over the period your triennial survey will take place.
How much does a triennial survey cost?
For your triennial survey, you will pay your national accreditor approximately $9,000-$15,000. Some accreditors charge less for this survey, but have an annual fee that will add up to this fee range. The cost of your survey will depend on your patient census, which will dictate how many days the agency will be surveyed.
What happens when I pass the triennial survey?
When you successfully pass your triennial survey, your accreditation and enrollment with Medicare are renewed for another 3 years. This allows you to continue accepting patients on and billing Medicare.
5. What Is a Focus Survey?
A focus survey is applicable when your agency makes any major changes to ownership or location. If you have no changes to the ownership or location of your agency, you do not need to worry about a focus survey.
Why is a focus survey important?
A Focus survey is important because it ensures your agency maintains and upholds Medicare Conditions of Participation (COPs), staffing needs, patient care, and more amid leadership or location changes. You will need a Focus survey in three situations:
- A Change of Ownership (CHOW)
- A Change Change of Location (CHOL) that is more than 20 miles from your approved office location
- OR a combination of a CHOW and CHOL (regardless of the distance)
What do surveyors look for in a focus survey?
Like most Home Health and Hospice Care surveys, Focus surveys are conducted by one of three national accrediting organizations. When undergoing a Focus survey for CHOW (Change of Ownership), the new buyers must undergo a background check.
In addition, your agency must report the change of ownership to government entities and the accreditors within a specific time frame. If you do not check all these boxes when undergoing a CHOW, you violate the Medicare Conditions of Participation (COPs) and your agency’s provider could be terminated.
If your agency is undergoing a CHOL (Change of Location), you must also report this to all government entities within a specified time frame. However, you actually may not be required to undergo a Focus survey.
If your agency’s new location is within a 20-mile radius of your previous location, the Focus survey will be waived because there is no significant change to the agency’s general services or patient population. However, if your agency moves, and also changes ownership, you will need to undergo a Focus survey.
In a Focus survey for a CHOW or a CHOL, the national accreditor will look at key elements of the change, patient charts, and Human Resource files that occurred after the effective date of the change. Focus surveys occur after the change applications are approved, so there should be months of work built up for surveying, by the time the survey occurs.
Is a focus survey announced or unannounced?
A Focus survey is unannounced, meaning you cannot schedule exactly when your Focus survey occurs.
How much does a focus survey cost?
A focus survey is conducted by one of three national accreditors. You can expect to pay over $4,000 for the survey, which will occur over one day.
What happens when I pass a focus survey?
When you successfully complete your focus survey, your CHOW or CHOL will be approved. In passing the survey, you’ve proved that despite leadership or location changes, your agency has continued to deliver quality care.
6. What Is a Complaint Survey?
No home health or hospice agency wants to deal with a complaint survey. However, maintaining top-tier patient care can be challenging, and sometimes, issues arise. Complaint surveys are the most unique of all six surveys, making understanding the differences crucial to your agency’s success.
Why is a complaint survey important?
The three national accreditors do not conduct a complaint survey. Instead, the California Department of Public Health (CDPH) conducts complaint surveys. CDPH will typically show up at your agency 2-7 days after a complaint has been filed. Often, agency personnel are not aware of complaints received at CDPH, and are blindsided by this type of survey altogether.
This is a scenario you want to avoid at all costs, as it can quickly lead to provider termination, or the end of your Medicare enrollment. If you’re concerned about the possibility of a complaint survey, see our article on the importance of QAPI and how you can prevent issues at your agency from growing into bigger, and potentially business-ending, problems.
What do surveyors look for in a complaint survey?
During a complaint survey, the CDPH could look at anything concerning the complaint filed against your agency. This is why it is paramount to establish a healthy relationship with your patients and workflow for addressing deficiencies before a situation escalates to a complaint.
Is a complaint survey announced or unannounced?
A complaint survey is unannounced. The surveyor will not tell you what complaint was filed, nor who made it to prevent retaliatory situations or attempts at a quick fix.
How much does a complaint survey cost?
A complaint survey does not cost your agency anything, other than the stress of being approached by a, typically less friendly, CDPH surveyor.
What happens when I pass a complaint survey?
If you are lucky enough to pass a complaint survey, all restrictions and repercussions against your agency will be lifted.
What If I Need More Help Navigating Surveys?
So now you finally understand why there are so many surveys, their differences, and the costs. But if you still find yourself drowning in an ocean of survey questions and concerns, that’s where The Home Health Consultant can help.
At THC we provide consulting through all types of surveys, and provide remote survey support to help quell any stress or anxiety regarding the process.
We get it. It’s complicated. That’s why the team at THC has been helping Home Health and Hospice Care agencies navigate the survey process for over 20 years. For a free consultation, you can schedule a call with us now.
*This article was written in consultation with Mariam Treystman & Sarah Allen.
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