What to Expect During a Hospice Medicare Survey: Real Questions and Forms Requested

Every hospice agency certified under Medicare will eventually undergo a CMS survey—a detailed compliance evaluation to verify adherence to the Medicare Conditions of Participation (CoPs) outlined in 42 CFR Part 418.
Surveys may be routine (recertification), initial (for new providers), or triggered by complaints or data indicators such as quality scores or adverse events.

Understanding what surveyors look for, which forms they request, and what questions they ask your staff can mean the difference between a smooth survey and a stressful corrective process.

This guide provides a complete breakdown of the hospice Medicare survey process, the real questions surveyors ask, and the common forms and records requested—so your agency can stay confident, compliant, and always ready.

Purpose of the Hospice Medicare Survey

The primary goal of a hospice Medicare survey is not to penalize, but to verify that the hospice delivers safe, high-quality, patient-centered care consistent with the Conditions of Participation.

Surveyors assess how your agency:

• Provides and documents care to patients and families

• Coordinates services through the interdisciplinary group (IDG)

• Ensures continuity of care and proper medication management

• Honors patient rights and informed consent

• Maintains staff qualifications, competencies, and ongoing education

• Monitors performance through QAPI (Quality Assessment and Performance Improvement)

• Complies with infection control, emergency preparedness, and governance requirements

The survey process focuses on patient outcomes and compliance evidence, not just paperwork. However, proper documentation is the foundation for demonstrating that compliance.

How Hospice Medicare Surveys Are Conducted

Hospice surveys are typically unannounced. Surveyors may arrive at any time during business hours and will begin by presenting identification and a written notice of survey.

The survey typically includes:

1. Entrance Conference – Introduction, explanation of purpose, and initial document requests.

2. Administrative Review – Review of policies, governing body records, personnel files, QAPI, and emergency preparedness.

3. Clinical Record Review – Sampling of active and discharged patient charts for accuracy, timeliness, and compliance.

4. Home Visits – Observation of patient care and staff-patient interactions.

5. Interviews – Discussions with staff, patients, caregivers, and leadership.

6. Exit Conference – Summary of findings, potential deficiencies, and instructions for any Plan of Correction (POC).
   

What Surveyors Ask: Real Questions from Hospice Surveys

Surveyors use open-ended questions to evaluate staff knowledge, compliance awareness, and real-life application of agency policies. The following are actual questions frequently reported during Medicare hospice surveys:

Questions for Nursing Staff

• “How do you verify physician orders before providing care?”

• “Where do you document medication administration?”

• “Describe how you manage a patient’s pain and symptom control.”

• “What steps do you take if a patient’s condition changes?”

• “How do you ensure medication reconciliation after a hospital stay?”

• “How do you handle controlled substances in the home after a patient’s death?”

• “Can you show where patient rights are documented in the chart?”
  

Questions for Hospice Aides (CHHAs)

• “How do you know which tasks you are allowed to perform for each patient?”

• “Who gives you your assignment sheet and how is it updated?”

• “What do you do if a patient refuses care or shows a new skin issue?”

• “Where do you document your care?”

• “When do you report a change to the nurse?”
  

Questions for Social Workers and Chaplains

• “How often do you visit each patient?”

• “Describe how you assess psychosocial or spiritual needs.”

• “How do you coordinate with the interdisciplinary team?”

• “Where are your visits documented and how are outcomes measured?”
  

Questions for the Interdisciplinary Group (IDG)

• “How are IDG meetings scheduled and documented?”

• “Who participates in care plan updates?”

• “How do you ensure that physician orders align with the plan of care?”

• “When was the last IDG review for this patient?”
  

Questions for the Medical Director

• “How do you review and approve patient admissions?”

• “How do you determine hospice eligibility?”

• “How do you coordinate with attending physicians?”

• “Describe your involvement in IDG meetings.”
  

Questions for Administrators and Compliance Officers

• “Describe how your QAPI program identifies and tracks performance indicators.”

• “How often does the governing body meet, and what is reviewed?”

• “Can you explain how your emergency preparedness plan is tested annually?”

• “How do you ensure staff training and competency evaluations are current?”

• “What steps are taken when deficiencies are identified internally?”

Surveyors expect staff to answer confidently and consistently, demonstrating that the agency’s policies are not just written, but actively followed in daily practice.

Common Forms and Records Requested During Hospice Surveys

Surveyors review both administrative and clinical records to verify compliance with all relevant CoPs. Below is a list of real forms and documents most often requested:

Administrative and Governance Documents

• Current Medicare Certification and license

• Organizational chart and list of key personnel

• Governing body meeting minutes (last 12 months)

• Contracts and service agreements (DME, pharmacy, lab, nursing, therapy)

• Policy and procedure manuals (with revision logs and approval dates)

• Emergency preparedness plan, including risk assessment and annual drill reports

• Infection control program and logs

• Personnel roster with credentials and hire dates
  

Human Resources Files

• Current licenses and certifications (RN, LVN, MSW, Chaplain, Aide)

• Orientation checklist and initial competency assessments

• Annual evaluations and in-service training logs

• Health screening, TB testing, and immunization documentation

• Job descriptions signed by staff
  

Clinical Records

Surveyors select both active and discharged patient charts (typically 10–12) and review for:

• Admission consents and election of benefit forms

• Face-to-face (F2F) encounter documentation

• Physician certifications and recertifications

• Initial and comprehensive assessments

• Plan of care (POC) and updates

• IDG meeting notes with revisions and physician signatures

• Nursing, aide, and interdisciplinary visit notes

• Medication reconciliation and physician orders

• Volunteer services documentation (meeting the 5% rule)

• Bereavement follow-up notes

• Discharge or death summaries
  

Quality Assurance and Performance Improvement (QAPI)

• QAPI policy and annual plan

• Quarterly meeting minutes

• Performance indicator data and improvement projects

• Evidence of corrective actions and follow-up results
  

Volunteer Program Files

Under §418.78(e), hospices must demonstrate that volunteers provide at least 5% of total patient care hours. Surveyors often request:

• Volunteer service logs

• Orientation and training records

• Background checks

• Job descriptions and supervision notes
  

Clinical Coordination and Communication

• IDG meeting minutes for the last two cycles

• Evidence of physician communication and order verification

• Patient/family education materials

• HHA/Hospice Coordination forms (if joint patient)
  

Medication Management

• Medication profiles and reconciliation logs

• Controlled substance tracking and disposal records

• Pharmacy consults or medication reviews

• Documentation of patient/caregiver education
  

How Surveyors Evaluate Hospice Documentation

Documentation is the backbone of hospice compliance. Surveyors look for consistency, completeness, and clinical accuracy. Each section of the chart must tell a clear, chronological story: the patient’s decline, goals, symptom management, and interdisciplinary coordination.

Common areas where hospices receive citations include:

• Missing or incomplete face-to-face encounter documentation

• Outdated or unsigned plan of care

• Lack of documentation for IDG coordination

• Inconsistent visit frequencies

• Missing bereavement follow-up

• Inadequate volunteer documentation

• Incomplete infection control logs
  

Surveyors also pay attention to timeliness—for instance, whether recertifications and IDG updates are completed within required intervals (15 days before the new benefit period, per §418.22).

What Surveyors Look for During Home and Facility Visits

Surveyors often conduct home or facility visits to observe care delivery and validate chart documentation. Expect them to:

• Observe the nurse’s or aide’s visit and communication with the patient/family

• Review medication storage and labeling in the home

• Verify that PPE is available and infection control practices are followed

• Ask the caregiver if they received education and feel supported

• Observe privacy, dignity, and compassionate care interactions
  

Observations must align with the patient’s documented plan of care. Any inconsistency—such as a nurse performing an intervention not listed on the POC—can raise compliance concerns.

Common Hospice Survey Citations

Based on national survey trends, the following areas frequently lead to citations:

1. §418.56(c) – Care planning and coordination failures

2. §418.54 – Incomplete comprehensive assessments

3. §418.100 – Inadequate personnel qualification documentation

4. §418.58 – Weak or inactive QAPI program

5. §418.76(h) – Missing hospice aide supervision documentation

6. §418.78(e) – Volunteer hours not properly calculated

7. §418.60 – Incomplete medication administration or disposal records

8. §418.110 – Missing patient rights acknowledgment
   

Each deficiency can be corrected with a Plan of Correction (POC), but proactive readiness prevents them altogether.

Preparing Your Staff for Survey Interviews

One of the most revealing parts of any hospice survey is how staff respond to surveyor questions. To prepare your team:

• Conduct mock interviews using the real questions above.

• Train staff on citing the corresponding CoP section during responses.

• Ensure all team members know how to locate key documents—policies, patient rights, and forms.

• Review recent internal audits or QAPI findings so staff can discuss ongoing improvements.

• Encourage calm, honest, and professional communication—surveyors appreciate transparency.
  

Confidence and consistency among your staff demonstrate a culture of compliance and quality care.

How to Stay Ready Year-Round

Continuous readiness is the hallmark of a compliant hospice. Implement these best practices:

• Conduct quarterly chart audits using CMS survey standards.

• Keep all staff files, licenses, and competencies current.

• Hold mock surveys at least twice per year.

• Review and update QAPI goals and track data outcomes.

• Maintain documentation binders for emergency preparedness, infection control, and volunteer activities.

• Ensure all policies are reviewed annually and signed by the governing body.
  

Integrating compliance into daily workflow prevents panic when the surveyor walks in the door.

After the Survey: Responding to Findings

At the exit conference, surveyors will review preliminary findings and potential deficiencies. Shortly after, your agency will receive a Form CMS-2567 Statement of Deficiencies outlining each citation.

You must submit a Plan of Correction (POC) within the required timeframe (usually 10 calendar days). Each response should include:

• The corrective action taken

• Who is responsible

• Completion dates

• Monitoring and verification plans
  

CMS or your accrediting organization (ACHC, CHAP, or Joint Commission) will review your POC and may conduct follow-up visits to confirm compliance.

Remember, the best approach is prevention—through ongoing internal audits, staff training, and documentation excellence.

Partnering with Experts for Survey Readiness

Navigating a hospice Medicare survey can be complex and time-consuming, especially with frequent regulatory updates.

SummitRidge Consulting specializes in helping hospices achieve full compliance with Medicare’s Conditions of Participation (CoPs).
Our services include:

• Comprehensive mock surveys replicating CMS protocols

• Policy and procedure development aligned with 42 CFR §418

• Staff training and competency validation

• QAPI and performance improvement program design

• Chart audit and documentation compliance

• Plan of Correction (POC) preparation and follow-up guidance
  

With SummitRidge Consulting, your hospice gains a proactive compliance partner dedicated to helping you maintain quality care and pass any survey with confidence.

Final Thoughts

A hospice Medicare survey can feel daunting, but preparation and consistency turn it into an opportunity to showcase your agency’s quality, compassion, and commitment to excellence.

By understanding what surveyors ask, which forms they review, and how they evaluate compliance, you can empower your team to perform confidently and professionally.

Continuous readiness—supported by solid policies, complete documentation, and strong interdisciplinary collaboration—ensures your hospice not only meets but exceeds CMS expectations.

When you’re ready to elevate your compliance standards, strengthen your survey readiness, and maintain a culture of excellence, partner with SummitRidge Consulting—your trusted resource for hospice compliance, training, and survey management solutions.