How to prepare for a home care audit

how to prepare for a home care audit

How to prepare for a home care audit

If you operate a home care or community-based services agency, getting notice that you will undergo a home care audit – especially if it is your first time – is likely to make you feel anxious and scared.

But don’t panic. Pavillio gives you access to the  necessary information and makes it available right at your finger tips. We’ve seen many agencies go through the home care audit process and our team is ready to support you through each step. Open a ticket right away with our support team so we’re aware and can standby to assist. 

Here are the 5 tips to prepare for a home care audit. 

1. Closely review the communication for what is being requested. The most common areas of concern include: 

  • Comparing visit records for home care and community-based services delivered and billed. 
  • Description of activities provided during visits compared to assessed need.
  • Duplicated or over billing (very important to not bill or rebill outside of Pavillio).


 2. Ensure you have a clearly defined and documented home care compliance program. 

Home care and community-based services agencies must review their compliance policies and procedures regularly to ensure home care compliance with current regulations and to “support ethical and lawful conduct.” 

Continually train and retrain employees on the requirements for approved and necessary home care and community-based services. 

Regularly run checks on Service Agreement expiration dates. Pavillio makes this easy with Compliance Reporting tools, including the ability to run Service Agreements expiring within 90-60-30 days.

And documentation is key. Administrators should record all of the agency’s efforts, evaluate internal policies and procedures and implement process changes when needed. It is also recommended to perform random, periodic audits of client records – use internal resources or hire outside consultants to review your practices. 

 3. Know these Pavillio compliance features to gather and prepare all of your home care audit data. 

  • Date Compliance features throughout Pavillio keep you on track. Client onboard date, employee joining date, hospitalization dates, and discharge dates are used when validating records for billing.
  • Service Agreement/Care Delivery Compliance. Active service agreement and a fully integrated care delivery allow you to ensure the correct service code is billed and that the activities performed align directly with the assessed needs of your clients.
  • 45 Validations. Prior to billing, there are over 45 system validations to ensure that clean data is going out to the payor. Pavillio will hold records in Failed if the record already exists for that date of service, client ineligible, or if there’s no service agreement or care delivery.
  • Reports > Compliance. Access the reports here to review and confirm data: Clients with no attendance, Clients without Active Service Agreements, Clients without time record and Service Agreement (SA) that expire within 90-60-30 days. 


 4. Locate the Employee Service Records with signatures for each client. 

 You can do this under Reports > Audit. 

 5. Review your claims management for the audited time period. 

You want to ensure that each claim submitted has followed the approval path and compliance protocol prior to submission. Pavillio’s enforced workflow, claims processed and managed within the system follow compliance protocols when sent to the payor. You also want to validate its current status of paid, pending or rejected. 

 You can do this through Financials > Claims Management and couple that with reporting and data through Financials > Invoicing. 

 And if you need help at any point along the way, please reach out at [email protected]. While all of your data needed for the home care audit is at your fingertips in Pavillio, we can also help with additional requests as needed and with questions during this stressful time. 

Interested in learning more? 

Register here for our September 27 webinar at 1 pm.