Understanding Hospice Survey Types: A Comprehensive Guide for Providers

Hospice agencies participating in Medicare are required to undergo rigorous surveys to ensure compliance with the Conditions of Participation (CoPs). These surveys, governed by federal regulations, are vital to protecting patients’ rights, upholding care standards, and maintaining operational integrity. For hospice providers, understanding the different types of surveys and their purposes can make the difference between successful certification and serious compliance consequences.

At SummitRidge, we specialize in guiding hospice agencies through these complex regulatory processes. Below is a detailed breakdown of the six primary types of hospice surveys—each designed to evaluate a different aspect of hospice operations. This article is intentionally structured to provide clarity without referencing the exact federal forms, ensuring agencies rely on expert support for successful navigation.

1. Initial Certification Survey

This foundational survey is conducted before a hospice is officially certified to participate in Medicare. It’s only scheduled once the agency confirms its operational readiness and meets certain baseline thresholds, such as having a specific number of patients under active care.

Key elements reviewed include:

• The operational status of all clinical and administrative functions.

• Ability to deliver a full spectrum of hospice services.

• Compliance with federal hospice care standards across all CoPs.

Surveyors assess whether the hospice is genuinely capable of providing quality, interdisciplinary, end-of-life care. If any area is unprepared or non-compliant, certification can be delayed or denied.

2. Standard (Recertification) Survey

Once certified, hospices are subject to a full recertification survey approximately every three years. These unannounced visits evaluate all aspects of care delivery and operations, from patient care coordination to infection control practices.

Highlights of this survey include:

• Comprehensive review of current and past patient records.

• Evaluation of staff qualifications and service delivery consistency.

• Home visit observations and interviews with patients and caregivers.

• Examination of interdisciplinary care plans and their implementation.

If the agency has multiple service locations, surveyors may visit those with higher patient volumes to ensure consistency in care.

3. Complaint (Investigative) Survey

Complaint surveys are triggered by specific allegations or concerns raised by patients, caregivers, staff, or the public. These surveys are often narrower in scope, focusing only on the area of concern—although the scope may widen if systemic issues are uncovered.

Examples include:

• Allegations of abuse, neglect, or substandard care.

• Issues with medication administration or hospice aide performance.

• Breaches of patient rights or privacy.

If serious issues (condition-level deficiencies) are identified, this survey may evolve into a broader investigation.

4. Post-Survey Revisit (Follow-Up Survey)

When deficiencies are found during a previous survey, the hospice is required to submit a plan to correct them. The revisit survey is designed to confirm whether those corrections have been made and whether the hospice is now in compliance.

This type of survey may include:

• On-site verification of revised processes or documentation.

• Interviews with staff regarding new protocols or training.

• Direct observation of changes implemented.

Follow-up surveys are critical; unresolved deficiencies can lead to enforcement actions or Medicare termination.

5. Change of Ownership (CHOW) Survey

When a hospice undergoes a change in ownership, the regulatory body may require a survey to verify that new ownership meets all applicable standards and that continuity of care is not disrupted.

This review may assess:

• Leadership and administrative competency under the new owner.

• Maintenance of existing staff, policies, and patient care practices.

• Updated operational documents and service agreements.

Not all CHOWs trigger on-site surveys, but they may require desk audits or other verification steps.

6. Validation Survey for Deemed Status Hospices

Hospices accredited by national organizations may be subject to a validation survey conducted by government agencies to ensure that the accrediting body’s standards align with federal requirements.

This type of survey ensures:

• Accuracy and integrity of third-party accreditation findings.

• Continuous adherence to Medicare CoPs despite deemed status.

• Resolution of any gaps between accrediting standards and federal regulations.

Validation surveys are part of CMS’s quality oversight process and are typically unannounced.

Survey Scope: Full vs. Abbreviated

It’s important to understand the distinction between full and abbreviated surveys:

• Full Surveys evaluate compliance with all Conditions of Participation and are typically used in initial and recertification processes.

• Abbreviated Surveys, such as those related to complaints or follow-ups, are focused and specific—though they can expand into full surveys based on surveyor findings.

Preparation Tips for Providers

To navigate these surveys successfully, hospice providers should focus on the following:

• Maintain updated documentation across all services and patient care activities.

• Train staff regularly on policies, protocols, and patient rights.

• Implement a robust quality improvement program that identifies and addresses issues proactively.

• Engage in mock surveys to simulate real-world survey conditions and identify gaps ahead of time.

• Ensure interdisciplinary coordination so that care plans are current, patient-centered, and implemented correctly.

How SummitRidge Can Help

Survey readiness is not a one-time effort—it’s a culture of ongoing compliance and improvement. At SummitRidge, we provide expert consulting and tailored documentation support to ensure your hospice is always prepared for any type of survey. From guiding your team through pre-survey readiness to assisting with post-survey corrections, our services are designed to ensure continuous compliance and operational excellence.

Whether you're preparing for your first certification or addressing a complaint-driven survey, SummitRidge offers the strategic expertise and regulatory insight you need.

Contact SummitRidge today to ensure your hospice not only survives surveys, but thrives because of them.