Can You Outsource Triage and Still Meet CMS Requirements? Yes – Here’s What You Need to Know.

One of the first questions we’re asked by home health and hospice leaders, especially those serving smaller regions or managing an average daily census of 200 of less, is: Can we outsource triage and still stay compliant with CMS Conditions of Participation (CoPs)?

The short answer is: Yes, you can.

CMS does allow triage to be outsourced – but with clear expectations around clinical quality, coordination, and accountability. And those expectations apply no matter who answers the phone: your team or a triage partner, like CareXM.

Here’s what CMS requires, whether triage is internal or outsourced:

1. Hospice CoPs (§418.64): The hospice must ensure that all services, including contracted ones, meet professional standards and are coordinated to support the interdisciplinary group plan of care. If triage is outsourced, the hospice remains fully responsible for the quality and documentation of that care.

2. Home Health CoPs (§484.75): For skilled services, including nurse triage, CMS emphasizes communication, documentation, and patient-centered planning. Any contracted services must be integrated into the overall plan of care, and the home health agency must ensure the personnel meet qualifications and the service outcomes align with care goals.

3. Accountability for Subcontracted Services (§§418.100, §484.105): Whether triage is in-house or outsourced, the organization must maintain oversight, ensure timely and accurate documentation, and demonstrate that the care supports patient needs and regulatory standards.

The bottom line is what matters most to CMS isn’t who performs triage – it’s how that care is delivered. Is it clinically sound and performed by a licensed nurse? Is it well-documented? Is it fully coordinated with the rest of the patient’s care? If you’re outsourcing, your triage partner must function as a direct extension of your clinical team.

That’s where CareXM stands apart. We’ve helped hundreds of home health and hospice organizations of all sizes confidently meet triage requirements for while improving the patient and staff experience. Our triage nurses are licensed, experienced, and trained to deliver triage based on organization-specific protocols, escalate accurately, and document in a way that supports audits and integrates with your EMR platform.

While others may stop at basic symptom managing or call logging, CareXM goes further:

• We follow each call to resolution – whether that means a scheduled visit, follow-up call, or coordination with your team. We won’t just take a message and escalate it back to your team to handle.

• We offer the best available experience for EMR-integrated, outsourced triage. Documentation is accurate and feeds back into your EMR in real time.

• We provide analytics that help you manage triage performance, like call volume trends, call handle performance, escalation patterns, and coordination performance.

So, yes, you can outsource triage – and with CareXM, you can do it with confidence. We’re here to help reduce the burden on your nurses, and we offer the most reliable path to fully resolving patient needs.