Few things are more stressful for an agency owner or administrator than sitting through a survey and hearing the dreaded words: “We found a deficiency.” It doesn’t matter if your clinicians are working long hours, your patients are satisfied, or your documentation is improving, deficiencies still sting. They can feel personal, unfair, and threatening to your agency’s reputation and certification.
In the moment, the natural reaction is to fight back. But should you? The truth is, not every deficiency is worth disputing. In fact, some disputes can make things harder by straining relationships with surveyors.
*This article was written in consultation with Mariam Treystman.
At The Home Health Consultant, we’ve guided hundreds of Medicare-certified home health and hospice agencies through surveys, corrective actions, and appeal processes. We know what surveyors expect, how accreditor standards differ from CMS Conditions of Participation (COPs), and when it’s smarter to accept a citation versus push back.
By the end of this article, you’ll know:
- the questions to ask before disputing a deficiency
- the risks and benefits of disputing
- how to approach surveyors in a way that protects both compliance and your agency’s reputation
Now let’s look at the first step, what to ask yourself before even considering a dispute.
What Questions Should Agencies Ask Before Disputing a Deficiency?
Before deciding whether to dispute, step back and ask three simple but critical questions:
- Will this deficiency fail the survey?
- If no, it usually isn’t worth the fight.
- If yes, you may need to dispute, but carefully.
- Is this deficiency a pattern across your agency?
- One-off issues (like a missing signature in one record) may not fail a survey.
- Widespread patterns (e.g., late documentation across multiple charts) make the deficiency more serious.
- Is the deficiency valid?
- If it’s valid, disputing usually won’t succeed.
- If it’s based on a misunderstanding, missing documentation, or misinterpretation, a dispute may be warranted.
This filter helps you avoid reacting emotionally and instead make strategic decisions.
Once you’ve asked these questions, the next step is understanding which deficiencies are usually better left undisputed.
What Types of Deficiencies Usually Don’t Warrant a Dispute?
Not every deficiency is worth contesting. In fact, disputing minor issues can sometimes do more harm than good.
- Accreditor-only standards: These don’t automatically fail your survey. Fighting them usually just creates unnecessary friction.
- Single-instance COP issues: A one-time mistake often doesn’t lead to survey failure unless it reveals a systemic problem or safety issue.
Example: If a nurse missed documenting a vital sign for one visit, that’s not the same as every visit in every chart showing the same omission. Surveyors recognize the difference.
There are times when a deficiency is serious enough to dispute, let’s look at when that might be.
When Might It Be Worth Disputing a Deficiency?
Some deficiencies are worth challenging, especially if they put your agency at risk of failure.
- Survey failure is on the line. If a deficiency ties directly to whether your agency passes or fails, you may need to act.
- Multiple elements of a COP are cited. When surveyors expand findings to multiple requirements, the stakes are higher.
- Surveyor misunderstanding. If documentation exists but wasn’t presented clearly, provide it.
- Regulatory misinterpretation. Occasionally, surveyors apply state-specific expectations or misread CMS regulations. In these cases, a respectful clarification can protect your agency.
Knowing when to dispute is one thing, but how you handle the process is just as important.
How Should Agencies Approach Disputing a Deficiency During a Survey?
If you decide to dispute, the approach matters as much as the facts.
- Ask for the regulation number. Don’t rely on surveyor summaries. Always read the cited regulation yourself.
- Clarify if it’s a COP vs. accreditor standard. The stakes are very different.
- Provide documentation quickly. If you can produce missing notes or signatures in real time, do it.
- Stay collaborative. Frame disputes as clarifications, not confrontations. Example: “Could you walk me through how CMS interprets this standard so we can make sure we’re aligned?”
*Important Nuance: Surveyors are people. If you come across as combative, they may double down. If you ask for guidance, you’re more likely to get cooperation.
This ties directly into the next challenge: how human factors and perception can influence survey outcomes.
What Role Do Surveyor Perceptions and Human Factors Play?
It’s important to acknowledge the human side of surveys. While most surveyors are lovely and well-meaning, some may bring ego, pressure, or personal interpretations into their work. Arguing too aggressively can feel like a challenge to their authority.
Instead of positioning disputes as battles, approach them as opportunities to learn. Say things like:
- “We want to make sure we’re meeting expectations. Can you share how you’d recommend handling this?”
- “Here’s the documentation we located. Can we review it together to see if it meets the requirement?”
This way, even if the deficiency stands, you’ve turned the interaction into education rather than conflict.
How Should Agencies Decide Whether to Dispute Survey Deficiencies?
Not every deficiency should be disputed. Use the three-question filter to guide your decision:
- Will it fail?
- Is it patterned?
- Is it valid?
One of the best ways to avoid the stress of deciding whether to dispute is to prevent deficiencies in the first place.
The key? Staying survey-ready year-round.
You can read about our approach to survey preparation and how we help keep agencies like yours compliant in the article below.
*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.
