Running a home health or hospice agency is like juggling a dozen balls in the air. Each one represents a critical piece of compliance, care, and administration. For agencies with limited staff and resources, consulting can be a lifesaver.
The Home Health Consultant is a trusted partner with over 20 years of experience supporting home health and hospice agencies. We specialize in navigating complex regulations, improving operational efficiency, and addressing common challenges in agency management.
In this article, you’ll discover a clear, timeline-based guide to determine
- when seeking outside expertise makes sense
- ensuring your agency stays compliant, efficient,
- and focused on delivering quality care.
By the end of this article, you will know exactly when and why consulting can keep your agency compliant and thriving.
1. Agency Opening: Navigating Start-Up Challenges
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Starting a home health or hospice agency is exciting but riddled with complex processes. It starts with organizational registration. This includes setting up a corporation, Tax ID, NPI, and submitting state and Medicare enrollment applications.
You’ll also have to submit applications for key staff members. These key staff members include your administrator, DPCS, and if you’re a hospice, medical director.
Hidden internal policies and unwritten requirements often complicate this process. Consulting services can help new owners address these challenges head-on, ensuring proper compliance, limited costly mistakes and a strong foundation for growth.
2. Licensure and Medicare Accreditation
Once your agency has registered in all the required places and locked down key staff, now you can move to licensure. From establishing policies to recruiting the right talent, the setup phase sets the tone for long-term success.
At this point, consulting services can help new owners navigate initial licensure requirements. They can also guide agencies through Medicare enrollment, and even compliance basics.
Some agency owners, especially first-timers, recognize the steep learning curve and partner with consultants immediately. Others attempt to DIY, only to realize within the first few months that external support is crucial.
When it’s time to secure a Medicare provider number, agencies must go through an accreditation survey. This involves demonstrating compliance with Medicare Conditions of Participation (COPs). The process is rigorous—requiring
- fully documented policies,
- a minimum number of serviced patients,
- and staff ready to meet high standards.
The survey itself takes about 2-3 days, depending on the surveying body and industry (HH or HSP). Many agencies choose to hire a consultant at this time to assist with survey preparation and guidance. This takes a large chunk of stress off the agency owner so they don’t have to go in blind.
3. Accepting Patients & Starting Work After Licensure & Accreditation
Many agency owners come in with the impression that after they receive their Medicare provider number, the hard part of owning an agency is over. Unfortunately, this is not the case.
Believe it or not, immediately after receiving their provider number is one of the most common times an agency seeks a consultant.
There are about 4 to 9 months between your accreditation survey and when you receive your provider number. What that means for you, is 4 to 9 months where your agency is in a sort of limbo. You’ve passed your survey, but you cannot bill Medicare yet. At this time, you’re likely not considering taking new patients.
This limbo leaves too much time for your agency to fall out of practice or routine. Many agencies find that when they do finally receive their provider number, it feels like they’re starting from scratch.
Agencies often underestimate the leap from passing a survey with five to ten patients to managing a growing, complex patient census.
This is when maintaining compliance and balancing billing regulations becomes a challenge, leading many to seek consulting. Consultants provide a framework to keep agencies compliant while managing increasing operational demands.
3. Hiring and Staffing Complexities
As the agency grows, so does the complexity of staffing. Field clinicians often work per diem, managing their own geographic preferences. This system, while flexible, can create administrative headaches—especially when assigning patients across a large geographic service area (GSA).
Consultants can step in to streamline HR policies, ensure all staff meet Medicare and state requirements, and create scalable processes that work for both part-time and full-time employees.
4. Triennial Surveys: The Three-Year Check-In
Medicare requires agencies to undergo a survey every three years to maintain their provider numbers. These are make-or-break moments where every aspect of compliance is scrutinized.
Whether preparing for a triennial survey or recovering from a failed one, agencies often turn to consultants. With their expertise, consultants can help agencies identify weak points, prepare the necessary documentation, and stay compliant.
5. Failed Surveys and Immediate Jeopardy
Sometimes, things don’t go as planned. A failed survey or an immediate jeopardy situation—a severe breach of compliance that threatens patient health—can put an agency’s operations at risk.
These high-stakes moments often unearth other vulnerabilities. Consultants help agencies rebuild, providing the support needed to correct deficiencies and prevent recurrence. Their fresh perspective can also help agencies develop robust Quality Assurance and Performance Improvement (QAPI) programs to address systemic issues.
6. Ownership Changes
A change of ownership (CHOW) is a pivotal moment for any agency. Medicare regulations for CHOWs are notoriously intricate, and mistakes in reporting ownership changes can lead to provider termination.
New owners also inherit the agency’s compliance history—good or bad. Many bring in consultants during this transition to ensure all systems are up to code and to identify any hidden compliance risks.
7. Leadership Transitions
The departure or arrival of an administrator or Director of Patient Care Services (DPCS) is another crucial transition. These positions are essential for maintaining compliance, yet changes in leadership often lead to gaps in processes and workflows.
Consultants provide stability during these periods, ensuring continuity in compliance and operations while new leadership gets up to speed. A consultant can also make sure staff change applications are completed accurately and promptly. This saves you from delays and potential compliance issues. Ultimately it ensures smooth transitions without compromising quality of care.
To read more about our compliance services, check out our article on ‘The Administrative Compliance Program Explained.’
8. When Things Go Sideways: Complaints, Staff Changes, and Beyond
Unexpected events—such as a complaint survey or a wave of staff departures—can throw an agency into chaos. Complaint surveys, which are unannounced, give surveyors a candid snapshot of your operations. Even minor oversights can escalate into major compliance issues.
In these situations, knowing you have a well-documented compliance program can make all the difference. At THC, we offer an Administrative Compliance Program (ACP). The goal of ACP is to tackle your agency’s administrative compliance tasks routinely, instead of right before a major event or survey. Our consultants offer ongoing support, so no matter what kind of question you have, we’re here to help.
Making the Call: Is It Time for Consulting?
Ultimately, the decision to bring in a consultant depends on your agency’s specific needs. The only person who can decide whether or not your agency needs a consultant is you.
Whether you’re preparing for a major milestone or recovering from a setback, the right consulting partner can make all the difference in guiding agencies through these challenges, ensuring you stay compliant, confident, and patient-focused. Understanding the potential value of a consultant can help you make informed decisions about when and if you need a helping hand.
If you think you’re ready to work with a consultant, let’s talk—because running a home health or hospice agency doesn’t have to feel overwhelming.
*This article was written in consultation with Mariam Treystman.
