Survey risk
A bad survey means deficiencies, a plan of correction, and sometimes a hold on revenue. Much of what a surveyor cites can be seen in your own charts well before the survey, if somebody is looking.
Get ready for your next survey before the surveyor shows up.
We help home care, home health, and hospice agencies in Illinois and Kentucky find the problems in their charts, billing, and paperwork before a surveyor or a payer does. Mock surveys, ADR response support, denial and takeback help, ongoing QAPI work, and fractional administrator, operations, and QA RN coverage while you hire, all for a fixed fee we put in writing first.
Run by people who have worked in home care, home health, and hospice, with backgrounds in operations, sales, and billing. Your agency stays responsible for its own records, coding, and claims.
Where agencies usually get hurt
Most owners we talk to already work hard. What they’re missing is a system for one of these three things.
ADRs, denials, and takebacks
Medicare and commercial payers ask for records, deny claims, and take money back after the fact. A late or incomplete ADR response can mean a denial, and denials nobody reworks turn into write-offs. When we trace the pattern, it usually goes back to documentation.
Referral follow-through
Referral sources rarely tell you they’re leaving. They just start calling another agency. Good care helps, but it won’t make up for a follow-up routine that doesn’t exist.
How we work with agencies
Every project is a fixed fee, and ongoing support is a fixed monthly fee, agreed in writing before work starts. Our fees are never based on a percentage of what’s paid, billed, or recovered. The written scope lists what’s included, what isn’t, and when you’ll receive each deliverable. We quote after a discovery call.
Survey readiness
Find what a surveyor would find, before they do.
We go through your charts, policies, and QAPI the way a state surveyor or accreditor would, using the Medicare Conditions of Participation and the Illinois and Kentucky rules. Then you get a fix list ordered by risk, so you can correct things on your own timeline.
- A health check across compliance, operations, referrals, and billing
- Remote chart audits, or a full mock survey on site
- For hospices, a review of your election statement addendum workflow
- A prioritized fix list with a 90-day plan
Fixed fee, with the scope in writing.
ADR response support
Answer every request on time, with the complete record.
An ADR starts a clock. For Medicare reviews by a MAC, you generally have 45 days from the date of the request, and a late or incomplete response can mean a denial. We help you set up a routine and respond to Medicare, Medicare Advantage, and commercial payer requests for records. Medicare Advantage and commercial plans set their own timelines, so we read the letter and your contract first.
- Every ADR logged the day it arrives, with the due date tracked until you’ve confirmed it was received
- The records the request actually asks for, pulled and organized: orders, certifications, plans of care, and signed, dated visit notes
- An RN review of the record before it goes out, on engagements where clinical review is scoped in
- One response per request, with a cover sheet and an index for each claim
- Appeal support if a claim denies, including Medicare redetermination, which is due within 120 days
- A process fix and the education your team needs, so the same gap is less likely to come back
We never create, change, or backdate records. Your agency submits the response and stays responsible for what’s in it.
Denial and takeback recovery
Work the denials that can still be appealed, and cut down on repeat ones.
We look for the patterns behind your denials, work through the backlog that can still be appealed, and tighten the front end so fewer of the same denials come back. We can’t promise any particular result. Every appeal is decided by the payer.
- Denial analysis by root cause
- Overpayment and takeback (recoupment) review, with an appeal plan that follows Medicare’s five-level process and your commercial contracts
- A push on the appealable backlog, then a routine your team can run
Fixed fee, with the scope in writing.
QAPI and compliance support
A QAPI program that keeps running between surveys.
Ongoing help for agencies that don’t have a full-time compliance director: monthly chart audits, QAPI meetings we help run, and a readiness cycle that doesn’t lapse.
- Monthly chart audits with written findings
- Quarterly QAPI meetings and tracking of your improvement projects
- A yearly readiness review, staff education, and someone to call when questions come up
Fixed fee, with the scope in writing.
Fractional administrator, operations, and QA RN
Keep the work covered while you find the right person.
An open administrator, operations, or QA nurse role doesn’t pause the work. We can step in part time while you search for the right candidate. The duties, hours, and who we report to are written down first, and each role has to meet Medicare and state requirements before anyone starts.
- Fractional administrator: interim or part-time administrator support, with the duties and authority written into the agreement
- Fractional operations support: intake and admissions workflow, scheduling oversight, policies and procedures, and day-to-day systems
- Fractional QA RN: chart audits, QAPI work, and clinical documentation review, with no direct patient care
- A written hand-off, so the person you hire can pick up where we leave off
Fixed monthly fee, with the duties in writing. Coverage ends when your hire starts.
Clinical findings get a clinician’s sign-off
We run the engagement, but clinical judgment belongs to a clinician. When an engagement includes chart-level clinical review, a licensed RN is brought in and scoped as part of the engagement, and signs off on every clinical finding before it gets to you. Our tools flag charts worth a look. The RN decides what they mean.
- RN review of clinical findings, scoped per engagement
- Care plan and documentation review
- Clinical findings in writing
What we do and don’t do
In audits, reviews, and advisory work, we advise and review. We don’t submit claims, sign certifications or attestations, or make coding or clinical decisions for you, and we don’t create or change patient records. In a fractional role, the duties, the authority, and who we report to are written into the agreement, and your governing body stays responsible for the agency. Your clinicians, physicians, and billing staff stay responsible for the care, the records, and the claims. We can’t guarantee any survey result, payment, or audit or appeal outcome.
Organic growth support, done clean
We help agencies build ethical liaison systems: regular source check-ins, follow-up rhythms, and responsive intake, so referral relationships stay steady on the strength of the work. We never promise patient volume, and nothing we do ties fees to referrals. We also help build software and tools that help your processes and save time on documentation, scoped the same way: in writing, after a discovery call.
How it works
Three steps. You know the scope and the timeline before anything starts.
Discovery call
30 minutes, no charge. Tell us what’s going on and we’ll tell you if we can help, and how. If we’re not a good fit, we’ll say so.
Written scope
You get a document with numbered deliverables, what’s excluded, milestones, and one fixed fee. You’re signing a scope, not a promise.
The work
Most one-time projects wrap up in 2 to 6 weeks. You end up with a findings report, a fix list, and a team that knows how to keep it going. ADR work follows the payer’s deadline, so we start as soon as you call.
Book by December 31 for priority booking in 2027
We keep next year’s calendar open for the agencies that plan ahead. Sign a written scope with us between October 1 and December 31, 2026 for work in 2027, and you go on our priority booking list. It’s a place in line, not a discount, and it doesn’t change your scope or your fee.
Ask about 2027 bookingPriority booking means
- First pick of 2027 start dates for new projects
- First pick of 2027 mock survey dates
- Follow-up calls and added work scheduled ahead of clients who sign after December 31
Within the list, dates go in the order written scopes are signed. Priority booking doesn’t guarantee a particular start date, deadline, or result. We work open ADRs against their deadlines, whichever list you’re on.
About Kosurv
Kosurv Consulting is run by people who have worked in home care, home health, and hospice, on the operations side, in sales and marketing, and in revenue cycle, including denial review and takeback defense. That mix matters, because the person who can spot your survey risk can also read your accounts receivable.
We also help build software and tools that fit into your processes and save your staff time on documentation, so fixes stick instead of piling more work on your team. The tools we use speed up our chart audits and reports. A person still signs off on every clinical finding.
What we are not: operators are not legal counsel, and clinical judgment doesn’t rest with us. Chart-level clinical review is signed off by a licensed RN brought in as part of the engagement, and anything that becomes legal interpretation goes to a healthcare attorney. You’ll always know which hat we’re wearing.
Founder
Administrator and consultant
Background in operations, sales and marketing, and revenue cycle. Leads every engagement and helps build the software and tools we use.
Clinical QA
Licensed RN, engaged per project
When an engagement needs chart-level clinical review, we bring in a licensed RN to review flagged charts and sign off on clinical findings, scoped in writing like everything else. That call should come from a clinician.
Support
Healthcare virtual assistant
Engaged per project to keep audits, reports, and follow-ups moving so jobs finish in weeks.
Free download
9 Things Surveyors Check First: Illinois & Kentucky Edition
A free self-check we hand to agency owners. It covers the nine areas surveyors look at first, plus the Illinois (IDPH) and Kentucky (CHFS) checks that sit on top of the federal ones. Run it every quarter. It takes an afternoon.
- Aide supervision visits, every 14 days, documented
- Care plan reviews that show progress or decline
- Comprehensive assessments completed on time
- QAPI that exists on paper and in practice
- Infection control observed in the home
- Patient rights, admission packet through discharge
- Denial and billing patterns nobody’s watching
- Emergency preparedness: plan, communication, testing
- Home care (non-medical) service plans
Plus state sections: Illinois checks under 77 Ill. Adm. Code 245 (IDPH) and Kentucky checks under 902 KAR 20:081 / 907 KAR 1:030 (CHFS).
Get your copy
Put in your name and the checklist PDF downloads right away.
Your checklist is downloading
Try running it every quarter with your leadership team. If more than a couple of boxes come up unchecked, the quickest next step is a 30-minute call. We’ll tell you straight whether we can help.
Book a discovery callDidn’t get the file? Download it again.
New for hospices, October 2026
Hospice Election Statement Addendum: Readiness Playbook
CMS is using enforcement discretion on the new mandatory election statement addendum from October 1 through December 31, 2026. Claims won’t be denied solely because the addendum is missing or incomplete during that window, but the requirement itself hasn’t gone away. This one-pager is the quickest way for a small hospice to get the workflow into its EMR before January 1.
- Use the CMS model election statement & addendum language
- Give the addendum in writing at election, and document that you did
- Re-issue within 3 days when a plan-of-care change affects what’s covered
- Make it available to the beneficiary, non-hospice providers & your MAC on request
- Build the trigger, owner & audit trail into your EMR workflow
- Train admissions and IDG staff, then run a 2-week internal audit before Jan 1
References: 42 CFR §418.24 (Election of hospice care); CMS enforcement-discretion report: McKnight’s Home Care, Oct 2026; LeadingAge summary of the Oct 1–Dec 31, 2026 window. This is operational guidance, not legal advice. Check it against current CMS guidance with healthcare counsel.
Get the one-pager
Put in your name and the playbook PDF downloads right away. Good for this week’s admissions huddle.
Your playbook is downloading
Try the six checks this week while the grace period is open. Want another set of eyes on your EMR workflow before January? That’s a 30-minute call.
Book a discovery callDidn’t get the file? Download it again.
Questions owners usually ask first
Anything from a brand-new agency to a multi-team operation. We size the scope to you. A young agency gets an audit and a fix list it can actually act on, not an enterprise program it can’t staff.
Both. We work with Illinois non-medical Home Services agencies, Medicare-certified home health, and hospice. The survey and documentation problems are different in each, so the scope changes depending on which one you are.
Three ways. Every job is a fixed fee with a written scope, not open-ended hourly billing. We’re built for small and growing agencies, not only big ones. And because of the tools we use, chart audits and reports usually come back in days.
An ADR, or additional documentation request, is a letter from a Medicare contractor or a health plan asking for the records behind a claim. For Medicare reviews by a MAC, the window is generally 45 days from the date of the request, and if the records don’t arrive in time, the claim can be denied. Medicare Advantage and commercial plans set their own windows. Check the date and instructions on every letter, and call us as soon as you have one open.
All three. The rules and timelines are different for each, so we start by reading the request letter and, for plans, your contract. Medicare appeals follow a set five-level process. Plan appeals follow the plan’s own rules.
We start by looking at what the request asks for and what documentation is missing. If it’s in the record, we walk you through how to find it and make the case for it in your response. If it isn’t, we tell you what the record does and doesn’t show, and your response goes out with what’s there. We never create, change, or backdate records. After that, we help you put the right process in place and point you to the education, training, and corrective steps your team needs, so it’s less likely to happen again. Any correction or late entry has to follow your policy and CMS rules, and it’s made by the person who provided the care, clearly marked and dated when it’s written.
No. We help with compliance and operations. In our advisory and audit work, we also don’t submit claims, sign certifications, or make coding or clinical decisions for you. If a question turns into legal interpretation, we’ll tell you and send you to a healthcare attorney. We don’t guess at the law.
Yes, part time and for a fixed monthly fee. We can step in as a fractional administrator, operations lead, or QA RN while you look for the right person. We write down the duties, hours, and who we report to first, and the role has to meet Medicare and state requirements before anyone starts. Fractional QA RN work is chart and quality review only, with no direct patient care. Coverage ends when your hire starts, and we hand off in writing.
A licensed RN. We lead the engagement and the operational review, and a licensed RN, brought in and scoped as part of the engagement, reviews and signs off on every chart-level clinical finding before you see it. You won’t have to wonder which findings are clinical.
We help build software and tools into the processes your agency already runs, like chart pre-screening, report drafting, and documentation checks. That saves your staff time and keeps audits quicker and cheaper. Because this work can touch PHI, we set it up with that in mind. We sign a BAA before any PHI is shared, limit access to the minimum necessary, and follow the HIPAA Privacy and Security Rules, including encryption and activity logs. The tools flag and draft, and people decide. Your team reviews the findings, and a licensed RN, brought in as part of the engagement, signs off on anything clinical before it reaches you.
Yes. CMS is using enforcement discretion through December 31, 2026, so now is a good time to get the workflow right without denials hanging over you. Start with the free Readiness Playbook above. If you want us to check it, the addendum workflow review is part of a Survey Readiness scope for hospices, with written findings and nurse sign-off where charts are involved.
Illinois and Kentucky. Audits and ongoing support are mostly remote. We come on site for mock surveys and kickoffs, where being in the building matters.
Book a discovery call
Thirty minutes, no slide deck. Tell us what’s going on and we’ll work out together whether we can help. If you can, send over a recent survey result, a denial report, an ADR letter, or just your questions beforehand, and we’ll read it before we talk. Have an ADR open? Deadlines run from the date on the letter, so call as soon as you can.
Email
Service area
Illinois and Kentucky
