How to Set Up Your Home Health Agency's QA Process

By Ashlee Oliver (CEO, JWO Home Health Consultants) and Zach Rosen (CEO, Brellium)

Introduction

In this guide, we'll outline how to most efficiently set up your quality assurance (QA) process for your home health agency, based on learnings from working with dozens of home health clinician groups.

Ashlee Oliver is the CEO of JWO Home Health Consultants, a full-service home health consulting and quality assurance organization servicing agencies of all sizes across the country. Ashlee has assisted over 100 home health agencies in streamlining their quality assurance processes.

Zach Rosen is the CEO of Brellium, which helps home health agencies across the country automate their chart review with AI.

Why QA is Important

1. To ensure your patients are being treated correctly and according to your clinical standards.
2. To ensure that every dollar your payers pay you stays in your pocket, instead of being clawed back.

Step 1: Setting Up Your Note Template

A strong visit note template dramatically reduces the time you spend on auditing. The key is to balance preset, automated options with well-structured free text sections.

Recommendations for Automation

Use your EMR to auto-populate and structure as much as possible:

• Session info should be populated by your EMR:
• Clinician name
• Patient demographics
• Visit date/time
• Visit location
• Structured clinical sections should be encoded into checkboxes or short required form fields, such as:
• Wound status
• Interventions performed
• Vital signs and other routine measures
• Template logic and flow:
• Make sure your note template has a clear “plan” for how it should be filled out.
• Group related items together (assessment, interventions, education, response, plan).
• Use required fields for true “must-haves” tied to compliance and payment.

Recommendations for Free Text

Use free text where clinical nuance and judgment matter most:

• Session narrative

An excellent narrative should include:

• Summary of the visit
• Physical assessment summary
• Psychosocial assessment summary
• Overall clinical picture
• Justification for homebound status
• Justification for need for skilled services
• Additional notes

Reserve this for:

• Extraordinary or unusual cases
• Exacerbating circumstances
• Safety concerns or social issues not captured elsewhere

Example narrative:

“Mr. Smith is an 80 yr old male patient requiring home health services for a recent CHF exacerbation. Mr. Smith was sitting in his recliner when SN arrived. He is alert and oriented with periods of forgetfulness. He has 2+ pitting edema to his BLE with SOB upon exertion.”

Step 2: Outlining Clear Rules for Your Clinicians

Your QA process is roughly:

• 50% building a great visit note template, and
• 50% training your staff to use it correctly and consistently.

Key Elements

• Designate a go-to QA resource

Have a clearly identified person within your organization that clinicians can bring documentation questions to.

• QA team lead qualifications

Your QA lead should:

• Understand the Conditions of Participation (CoPs) for home health.
• Be comfortable interpreting payer requirements.
• Be able to translate regulations into practical documentation rules.
• Use examples, not just corrections

When documentation is incomplete or incorrect:

• Don’t just send notes back with “fix this” comments.
• Reach out directly (email, call, or message) to explain the error.
• Provide a good example of what the documentation should look like.
• Standardize expectations for free text

For each free text section (e.g., narrative, additional notes), clearly outline:

• What must be included every time.
• What should be added when certain conditions are present (e.g., new wound, medication change, fall, hospitalization).

Step 3: Setting Up Your Audit Requirements

Your audit criteria should be tightly aligned with actual payer and policy requirements, not just preferences.

Building Your Criteria

• Start with must-haves

Identify items that are required for:

• Conditions of Participation
• Payer coverage and payment
• Medical necessity and homebound status
• Layer in patient-specific elements

Include criteria that ensure the note reflects:

• The patient’s specific diagnoses and comorbidities
• The individualized plan of care
• Changes in condition and response to treatment
• Keep criteria current

Regularly update your audit checklist based on:

• Payer feedback and denials
• Changes to Conditions of Participation
• OASIS updates
• Best practice and clinical guideline changes

Step 4: Setting Up Your Auditing Team (and Using Brellium)

The most effective QA teams are usually built around clinicians who have transitioned into operations and understand both sides of the agency.

Building Your QA Team

• Ideal QA team lead:
• Strong clinical background
• Solid understanding of agency operations and billing
• Comfortable with data, trends, and training
• Role of Brellium:
• Automates the manual chart review process.
• Flags documentation issues so your QA team can focus on:
• Coaching clinicians
• Improving documentation quality
• Elevating standard of care

Manual Audit Tips

If you are auditing manually (or in combination with automation):

• Simple status labels:
• Use “X” to mark passed audits.
• Use “Contacting Clinician” for failed audits that need correction.
• Use conditional formatting:
• Highlight failed audits or missing elements in red or yellow.
• Quickly see patterns by clinician, discipline, or visit type.
• Track error frequency per clinician:
• Create a VLOOKUP/INDEXMATCH tab (or similar lookup) to:
• Count error instances per clinician.
• Identify training needs and trends.

Step 5: How to Have Clinicians Fix Errors

Close the loop on audits with a clear, consistent correction process.

• Daily communication:
• At the end of each auditor’s day, send an individual email to each clinician.
• Include:
• Patient name (as allowed by your privacy policies)
• Note date and time
• Exactly what needs to be fixed and why
• Visual tracking in your log:
• Mark “Notification Sent” cells as orange once the clinician has been notified.
• When the clinician completes the correction and the note is re-verified, mark the cell green.

This gives you a quick visual of:

• Outstanding corrections
• Clinicians who are behind on fixes
• Overall QA backlog

Step 6: Responding to Payer Audits (ADRs)

When you receive an Additional Documentation Request (ADR), your priority is accuracy, completeness, and organization.

If You’re Manually Auditing

• Refocus your QA efforts:
• For 1–2 weeks, have your QA team focus only on the patients and dates requested by the payer.
• Document export and packaging:
• Export each requested document from your EMR/PMS.
• Compile everything into one large PDF per ADR packet, if allowed.
• Follow payer instructions exactly:
• Ensure all notes are:
• In the correct format (PDF, etc.).
• In the exact order requested by the payer.
• Many ADRs are denied simply because documentation is incomplete or out of order.

Using Brellium for ADRs

• Brellium provides a clawback guarantee.
• You can export all notes for the audit period in just a few clicks.
• This reduces manual work and helps ensure you submit a complete, well-organized packet.

By combining a strong note template, clear clinician rules, well-defined audit criteria, a capable QA team, and the right automation tools, your home health agency can protect revenue, improve patient care, and reduce the day-to-day burden of documentation review.