Preparing for a home health or hospice audit or survey shouldn’t begin when an external request arrives. Ongoing audit and survey readiness gives agencies a more practical way to understand whether documentation, workflows, operational controls, and supporting records are working as intended and whether the organization can demonstrate that when asked.
That’s especially important in home-based care, where readiness can span clinical documentation, billing processes, regulatory requirements, technology, and operations. Rather than preparing for one specific type of review, agencies can build a repeatable process for identifying exceptions, addressing risk, and strengthening their overall control environment.
Use this abbreviated home health and hospice audit readiness checklist as a recurring internal readiness tool. It is intentionally organized around the control environment rather than a single type of external review.
1. Governance and ownership
☐ Executive sponsor designated.
☐ Cross-functional readiness team established.
☐ Survey, audit, and ADR response ownership documented.
☐ Clinical, compliance, revenue-cycle, operational, and IT responsibilities defined.
☐ Legal escalation criteria established.
☐ External-review deadlines and requests centrally tracked.
☐ Executive and governing-body reporting cadence defined.
The HCHB executive audit-readiness guide recommends an executive sponsor, cross-functional readiness team, and clear decision rights across compliance, operations, clinical leadership, finance, revenue cycle, IT, and legal.
2. Patient-record integrity
For sampled records:
☐ Referral and admission information align.
☐ Eligibility is supported.
☐ Required assessments are complete and timely.
☐ Certifications and recertifications are complete and supported where applicable.
☐ Required face-to-face documentation is available.
☐ Plan of care reflects assessed needs.
☐ Orders support services delivered.
☐ Visit documentation aligns with the plan of care and patient condition.
☐ Changes in condition are appropriately documented and addressed.
☐ Transfer, discharge, revocation, or other transitions are supported.
☐ Services billed are supported by the record.
Executive Check:
Could someone unfamiliar with the patient follow the record and understand why the patient qualified, what was planned, what occurred and why?
3. Home health-specific readiness
☐ Referral-to-admission processes are consistent.
☐ Acceptance-to-service decisions follow established policy.
☐ Start-of-care timeliness and exceptions are monitored.
☐ OASIS processes and submissions are monitored.
☐ Certification and plan-of-care documentation support the episode.
☐ Orders and signatures are tracked and resolved.
☐ Visit utilization and discipline mix are monitored in clinical context.
☐ LUPA patterns are reviewed without using payment thresholds to drive clinically unnecessary care.
☐ Recertification, transfer, and discharge trends are monitored.
☐ Claims have complete, retrievable supporting documentation.
This checklist closely follows the home health and hospice readiness priorities identified in HCHB’s Survey-Ready Every Day report. Leaders can download the report to gather insights on what regulatory changes agencies should take into account.
4. Hospice-specific readiness
☐ Election documentation is complete.
☐ Terminal illness eligibility is supported by the clinical record.
☐ CTIs and narratives meet applicable requirements.
☐ Recertifications and face-to-face encounters are tracked and completed when required.
☐ HOPE assessments, HUVs, and applicable symptom follow-up workflows are monitored.
☐ IDG documentation and plans of care reflect patient-specific needs.
☐ Orders and visit documentation align with care delivered.
☐ Levels of care are clinically supported.
☐ Live discharge and revocation patterns are reviewed.
☐ Length-of-stay and utilization patterns are understood in clinical context.
☐ Claims have complete, retrievable supporting documentation.
5. Documentation and billing controls
☐ Late and incomplete documentation is visible.
☐ Aging orders and missing signatures are tracked.
☐ Eligibility and authorization exceptions have assigned owners.
☐ Billing holds are categorized by reason.
☐ High-volume or recurring exception categories are reviewed for root causes.
☐ Appropriate documentation issues are resolved before billing.
☐ Overrides or exceptions follow defined processes.
☐ Denial trends feed back into clinical, compliance, and operational review when appropriate.
6. Analytics and exception visibility
☐ Leadership can view important indicators below the enterprise level.
☐ Documentation exceptions can be reviewed by branch/team.
☐ Order aging can be reviewed by branch/team.
☐ Billing holds and exceptions can be analyzed by cause.
☐ Home health SOC, LUPA, recertification, discharge, transfer, and visit patterns are visible.
☐ Hospice live discharge, revocation, and length-of-stay patterns are visible.
☐ Outliers trigger investigation rather than automatic conclusions.
☐ Recently acquired or integrated locations are evaluated against enterprise processes.
7. Self-survey and QAPI
☐ Focused self-surveys occur throughout the year.
☐ Samples include routine records and selected higher-risk records.
☐ Staff interviews test understanding of actual workflows.
☐ Reviewers compare policy, practice, and evidence.
☐ Findings receive accountable owners and completion dates.
☐ Significant or systemic findings enter QAPI or another formal corrective process.
☐ Corrective actions are validated through resampling or performance measurement.
☐ Lessons from one branch are evaluated for broader application.
8. Technology controls
☐ High-risk workflows have appropriate prompts, alerts, or guardrails.
☐ Alerts have defined owners and expected responses.
☐ Managers can see unresolved exceptions.
☐ Required workflow steps cannot be unintentionally bypassed where stronger controls are appropriate.
☐ Audit trails show relevant creation, modification, review, and approval activity.
☐ Clinical and billing workflows share necessary information.
☐ AI-supported clinical documentation maintains appropriate clinician review and control.
☐ Technology controls are periodically tested rather than assumed to be working.
9. Record retrieval
Run the 24-hour audit packet challenge using recent home health and hospice claims.
10. Executive readiness check
Before closing the review, leadership should be able to answer:
☐ Do we know our highest-risk processes?
☐ Do we know which branches have the highest exception rates?
☐ Can we identify problems before billing where appropriate?
☐ Can we explain significant operational variation?
☐ Do we know which corrective actions are overdue?
☐ Can we demonstrate whether corrective actions worked?
☐ Can we produce supporting records quickly?
☐ Are current training priorities informed by actual findings and exception data?
☐ Are upcoming regulatory changes assigned to accountable owners?
☐ Could we explain our control environment clearly to a surveyor, auditor, payer or board?
Final reminder
These tools are designed to help agencies organize and test readiness, not determine legal compliance or replace current CMS, state, payer or accrediting-organization requirements. Agencies should validate requirements against the guidance applicable to the specific survey, audit, review or reporting program they are preparing for.
