Reduce HOPE-Related Audit Risk: 3 Common HOPE Assessment Errors (and How to Avoid Them)
- 4compliancelady
- Dec 26, 2025
- 4 min read
The HOPE (Hospice Outcomes & Patient Evaluation) tool has transformed how hospices approach patient assessment and quality reporting. While this standardized system offers real benefits, it also introduces new compliance challenges that can trigger Medicare scrutiny when workflows aren’t set up correctly.
Since HOPE’s implementation, auditors have identified recurring patterns of errors that consistently raise red flags during reviews. Understanding these mistakes—and building simple systems to prevent them—can help protect reimbursement, reduce staff rework, and keep your team focused on patient care.
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Error #1: Timing and Submission Failures
The most common HOPE-related audit trigger involves timing violations. This includes both documentation deadlines and submission requirements that can be difficult to meet consistently without a clear system.
The documentation deadline challenge
Symptom-Focused Visits (SFVs) must be documented within 48 hours of identifying new or worsening symptoms. That tight timeframe can catch teams off guard—especially if they were used to more flexible documentation expectations under prior processes.
In addition, HOPE assessments (Admission, HUV1, HUV2, and Discharge) must be submitted to CMS within 30 calendar days of completion. That 30-day clock starts when the assessment is completed—not when it’s entered into the EMR.
The 90% submission rate requirement
Many hospices also struggle to maintain the required 90% on-time submission rate. Falling below this threshold can result in a 4% Annual Payment Update (APU) reduction, which can significantly impact reimbursement.
Solutions that work
Configure your EMR with automatic alerts for approaching deadlines
Trigger documentation workflows immediately when symptoms are identified
Assign a specific owner to monitor overdue assessments and submissions
Review at 24 hours (not 48) to create a buffer
Track submission rates daily (not monthly)
Error #2: Improper Visit Structuring and Combination
The second major audit trigger involves incorrectly structuring or combining different types of visits and assessments. This error often stems from confusion about how SFVs relate to other HOPE assessments.
The SFV combination confusion
A frequent mistake is combining SFV visits with Admission or HUV assessments. While SFV data is documented within the triggering HOPE record for submission purposes, the SFV visit itself cannot be combined with other assessment visits. These must remain separate encounters.
When visits are improperly combined, it can trigger audit flags related to visit frequency, assessment timing, and reimbursement calculations.
Solutions that work
Create a one-page visual guide for when each HOPE assessment type is required
Build simple flowcharts to help staff choose the correct assessment in real scenarios
Configure your EMR to prevent improper combinations
Implement quick QA checks before submission to catch errors early
If any of these errors sound familiar, let’s fix the workflow—not just the symptoms.
Most HOPE issues aren’t a “staff problem.” They’re aprocess + EMR + deadline tracking problem. In a 60-minute phone consult, we’ll identify exactly where things are breaking down and how to tighten it up before it becomes an ADR.
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Error #3: Missing Required Assessments Based on Length of Stay
The third common audit trigger involves failing to complete all required assessments based on a patient’s length of stay. This often happens when teams don’t have a reliable system to track timing windows—or when patient trajectories change unexpectedly.
Understanding HUV requirements
HUV1 is required if the patient remains on service throughdays 6–15.
HUV2 is required if the patient remains on service throughdays 16–30.
Missing these assessments due to oversight creates immediate audit vulnerability.
Solutions that work
Use admission-date-based alerts and dashboards to track upcoming requirements
Run automated reports to identify patients approaching assessment windows
Train staff to anticipate varying patient trajectories and adjust plans accordingly
Use clear decision trees for assessment requirements
Build a Comprehensive HOPE Compliance Strategy
Preventing HOPE-related errors requires more than fixing individual mistakes. It takes a repeatable approach that integrates people, process, and technology.
Staff education and ongoing training
Regular education helps your team understand not only what to do, but why the requirements matter. Consider monthly HOPE-focused refreshers using real-world scenarios and common pitfalls.
Technology integration
Your EMR should support HOPE compliance, not hinder it. Ensure your system is configured to flag deadlines, prevent improper combinations, and make required assessments easy to track.
Quality assurance programs
Internal audits and spot checks can reveal patterns before they become audit findings. A consistent QA rhythm helps you catch issues early and reduce rework.
HOPE Assessment FAQ (Hospice Compliance)
What is the HOPE assessment in hospice?
HOPE (Hospice Outcomes & Patient Evaluation) is a standardized assessment and reporting tool designed to support quality measurement and consistent patient evaluation. Because it impacts reporting and compliance, errors can increase audit risk.
When are HUV1 and HUV2 required?
HUV1 is required when a patient remains on service through days 6–15, and HUV2 is required when the patient remains on service through days 16–30. A reliable tracking system is essential to avoid missed assessments.
Can an SFV be combined with an admission or HUV visit?
No. While SFV data may be documented within the triggering HOPE record for submission, the SFV visit itself must remain a separate encounter from Admission or HUV assessment visits.
What is the HOPE submission deadline to CMS?
HOPE assessments must be submitted within 30 calendar days of completion. The countdown begins when the assessment is completed—not when it’s entered into the EMR.
What happens if a hospice misses the 90% submission rate requirement?
Falling below the 90% on-time submission threshold can lead to a 4% Annual Payment Update (APU) reduction, which can impact overall reimbursement.
Ready to reduce HOPE-related audit risk?
Don’t wait for an ADR to confirm there’s a gap. Book a $95, 60-minute phone consultation and walk away with a clear, prioritized action plan to strengthen HOPE compliance and protect reimbursement.
Book the $95 Phone Consultation:
Prefer self-paced training? Explore the HOPE for HOPE course: https://www.adrpreventionforyou.com/product-page/hope-for-hope
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