Essential Documentation Checklist for a Home Health Agency Survey
Ensure your home health agency is prepared for a successful survey. Learn what documentation to provide, including patient records, employee lists, and compliance logs.
5/26/20252 min read
Preparing for a standard or extended home health survey is crucial for maintaining compliance with Medicare Conditions of Participation and ensuring continued operation. Whether you're operating as a parent agency or managing branch locations, having the right documentation readily available for surveyors is essential. Below is a detailed breakdown of the documentation and information your Home Health Agency (HHA) should prepare in advance.
Required Documentation for a Standard Home Health Survey
During a standard survey, surveyors will request specific documentation to evaluate your agency’s compliance with regulatory standards. Be prepared to present the following:
1. Annual Skilled Care Admission Data
Provide the total number of unduplicated skilled care admissions from the previous 12 months. This figure must include all payer types and all operational sites (parent and branches). Ensure each patient is only counted once, regardless of multiple episodes of care.
2. Current Active Skilled Patient List
Prepare a comprehensive list of active patients receiving skilled care services, including:
Full name of the patient
Certification dates (start/resumption of care)
Primary admitting diagnosis
Services provided, categorized by discipline (e.g., skilled nursing, PT, OT, SLP, social work)
Indications of any complex treatments, such as infusion therapy, pediatric services, wound care, tracheostomy or ventilator support, anticoagulation management, or pressure ulcer treatment
3. Home Visit Schedule
Submit a calendar or visit schedule showing all home visits occurring during the survey window, covering all agency locations.
4. List of Recently Discharged Patients
Compile a list of patients discharged within the past six months. For each patient, include:
Start of care and discharge dates
Diagnoses
Services rendered
Final disposition (e.g., transferred, deceased, completed care)
Additional Required Information
Surveyors will also request administrative and personnel documentation. Prepare the following:
Employee Roster – Include all direct and contracted staff with their job titles and dates of hire.
Outpatient Therapy Information – Indicate whether outpatient therapy services are offered and at which locations. If applicable, notify the State Agency (SA) for survey coordination.
Updated CMS-1572 Form – Submit the most recent version of the Home Health Agency Survey Report by the end of Day 1.
Organizational Chart – Provide the structure of both parent and branch offices.
Admission Packet – Share a copy of your standard admission documentation for review.
Complaint Log – Present a log of all patient or caregiver complaints.
Abuse Log (if maintained) – Submit records tracking any allegations or incidents of abuse.
Additional Documents for an Extended Survey
If an extended survey is initiated (either planned or triggered by findings), surveyors may request more detailed operational documentation, such as:
Home Health Aide Training & Competency Records – Include orientation, skills assessments, and in-service education files.
Administrator Authorization – Provide written documentation designating the individual authorized to act on behalf of the administrator.
CLIA Certificate of Waiver – Show certification for lab-related services, including any external lab licenses.
QAPI Program Details – Submit evidence of Quality Assurance and Performance Improvement activities, including infection prevention initiatives.
Emergency Preparedness Plan – Ensure your agency’s comprehensive emergency procedures are available for review.
🏥 Be Survey-Ready, Stay Compliant
Efficiently gathering and organizing these records ensures a smooth survey process and positions your home health agency as compliant, prepared, and professional. Staying proactive not only helps you pass regulatory audits but also strengthens your internal quality management.
For ongoing compliance and survey readiness, consider conducting mock surveys and routine internal audits to keep your documentation up to date.
Need help preparing for your next home health survey?
Let our experts guide you through the survey process and ensure your agency is always compliant. Contact us today to schedule a compliance consultation.


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