CMS-10097 CMS-10097.Sample Cognitive Interview Protocol

ATTACHMENT 4

SAMPLE COGNITIVE INTERVIEW PROTOCOL

Introduction
Hello, my name is (NAME). I am from Westat, a research organization that is working with the Division of Provider Relations and
Evaluation (DPRE). The reason we would like to talk with you is to get your feedback on the Medicare Contractor Provider
Satisfaction Survey (MCPSS). In preparation for the 2007 survey, we’d like to talk to review the survey with you to make sure the
questions work, whether providers like you understand them as they are intended and which questions providers feel are key to
evaluating the performance of their contractor.
I want to make sure you're aware of a couple of things. First, I assure you that everything we cover in the interview will be treated as
confidential. Only a small number of people working on the project will have access to the information you share with us, and we
won't use your name in any reports of the results.
Second, there are a two other people listening to our discussion. NAME is from Westat and she is helping to take notes. NAME is
from CMS and she is interested in listening to what you have to say about the questionnaire.
The interview should take about an hour (or less) and I’d like to record our conversation to make sure I don’t miss anything that you
say. Is that OK with you?
[TURN ON TAPE RECORDER IF RESPONDENT SAYS THAT IT IS OK]
Before we start, I’d just like to get a little information about your contractor.
First, I just want to confirm that you got a copy of the survey and that you have it in front of you. Is that right? (IF NOT, THEN
SEND COPY EITHER BY E-MAIL OR FAX).
Next, can you tell me the name of your contractor?

Have you been working with CONTRACTOR for the last 12 months? That is, since March of 2006?
Yes

______

No

______

Go to instructions on interviewing procedures

When did you first start working with CONTRACTOR?

___ ____ ____

ii

OK, let me briefly explain what we will be doing. As I said before, we are very interested in getting your feedback on the 2007
survey. Our primary concerns are whether people understand the questions that are being asked and which questions they feel are
important when evaluating their contractor.
So the way this will work is, I’m going to read the questions to you as if it were the actual survey and I would just like you to answer
the questions as best you can. We're very interested in what you're thinking as you answer the questions, because this helps us
evaluate whether the questions are working. So I'd like you to try to think aloud as much as possible: just verbalize for us whatever it
is you're thinking about as you're coming up with your answer. And occasionally, after you've answered a question, I'll ask you to tell
me what a word in the question means to you, or something like that, just so I'll understand how you interpreted it. And finally, if you
don't understand any of the questions I ask, please don't be embarrassed to say so, because that's just the sort of thing we're trying to
find out here. There are no right or wrong answers --- we are really just interested in how you are interpreting the questions. Your
feedback will give us important information on the types of changes we might need to make to the questionnaire.
Do you have any questions?

iii

Sample Cognitive Interview Protocol
The attached MCPSS survey instrument includes the following seven key areas of the interface between you
and your contractor, [CONTRACTOR NAME]:
Section A: Provider Inquiries
Section B: Provider Communications
Section C: Claims Processing
Section D: Appeals
{Section E: Provider Enrollment}
{Section F: Medical Review}
{Section G: Provider Audit and
Reimbursement}
Most of the key areas pertain to your facility’s interaction with your Medicare Contractor.
For each main section of the survey, you will have at least two choices:
•
Complete the section yourself
•
Forward the section to the person at your facility who interacts on a regular basis with your Medicare
Contractor
Once complete, please mail the survey directly to:
Joshua Rubin
Westat
1650 Research Boulevard
Rm # RA 1153
Rockville, MD 20850
OR
Fax the completed survey instrument to Westat at 1-888-748-5820
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0915. The time required
to complete this information collection is estimated to average 16-21 minutes per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information collection. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security
Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Introduction
Medicare is listening! CMS has selected your facility to participate in a satisfaction survey. We know
that your time is valuable and greatly appreciate your willingness to participate in this very important study to
assess your satisfaction with your Contractor.
Your Office Manager or staff in the Billing Department might be the appropriate staff to complete the survey.
Please note that your participation is voluntary. Responses to this data collection will be used only for statistical
purposes. The reports prepared for this study will summarize findings across the sample and will not associate
responses with a specific individual. We will not provide information that identifies you to anyone outside the
study team, except as required by law. Thank you in advance for taking the time to complete the Medicare
Contractor Provider Satisfaction Survey.
If you have any questions or concerns, please call the MCPSS Provider Helpline at 1-888-863-3561 or send an
email to [email protected]

About Your Facility
Q1. Approximately how long have you been a Medicare Provider?
 Less than 6 months
 6 to 12 months
 1-2 years
 2-5 years
 5 years or more

Overall Satisfaction with Your Contractor
Q1. {CONTRACTOR}, your Contractor, provides a number of services on behalf of Medicare to Medicare
Providers in your area. Thinking about ALL your interactions with your Contractor, {CONTRACTOR},
*Global change* {in the last six months/ since {new contractor} became your contractor}, how satisfied have
you been with the with your Contractor’s performance overall.
Please rate your level of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.”








1
NOT AT ALL SATISFIED
2
3
4
5
6
COMPLETELY SATISFIED
Don’t Know

Please continue to Section A

2

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section A: Provider Inquiries
[Contractor] has Provider Inquiry staff to answer questions from Providers via telephone, written
correspondence or modem. You might use a toll-free number to call the Contractor’s Provider Inquiries staff or
use a “Call Center” or “Provider Hotline/ Help Line.” Please note that Provider Inquiry activities related to this
section of the survey instrument are NOT related to your “Provider Rep” or “Ombudsman” if you have one. For
the purposes of this survey instrument, your “Contractor’s Provider Inquiries performance” includes the
activities and interactions that you have with [Contractor] related to asking questions and receiving answers
from their Inquiries staff.
It should take you approximately two (2) minutes to complete this section.

INSTRUCTIONS FOR SECTION A

You have two choices for Section A: Provider Inquiries:
•

Complete Section A yourself ---PROCEED TO QUESTION A1 on PAGE A-2

•

Forward Section A to the person at your facility who interacts on a regular basis with [CONTRACTOR
NAME]---PROCEED TO SECTION B on PAGE B-1

3

Your Ratings of [CONTRACTOR]’S
Performance of PROVIDER INQUIRIES
While answering the following questions, please think about your experiences in the last six (6) months involving Provider Inquiries
you make to your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument).

In the last six months, how satisfied have
you been with
A1.

How quickly you can reach a
representative to make a Provider
Inquiry by telephone

A3.

Receiving the correct information

For each of the following items in the Provider Inquiries section, please rate your level
of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.” Please circle the relevant number.
Completely
Not at all
Satisfied
Satisfied
Don’t
Not
2
3
4
5
6
1
Know
Applicable

1
A5.

A6.

The consistency of responses that you
get from different Provider Inquiries
representatives

Completely
Satisfied

Not at all
Satisfied
2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

6

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

The knowledge of your Contractor’s
Provider Inquiries staff
What does this question mean to
you?

What is the difference between this
and question A3?
A8.

The effort your Contractor makes to
make the Provider Inquiries process
as easy as possible for you
What were you thinking about
when you answered this question?

A9.

The mechanisms that your Contractor
offers for exchanging information
with them about your Inquiries
What does “mechanisms” mean to
you in this question?

A10. The professionalism and courtesy of
your Contractor’s representatives
throughout Provider Inquiries
activities

Completely
Satisfied

Not at all
Satisfied

1

2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

6

Completely
Satisfied

Not at all
Satisfied
1

6

2

3

Proposed New Questions

4

4

5

6

NEW A12. Your Contractor’s ability to
fully resolve problems without you having to
make multiple inquiries
What does this question mean to
you?
Were you thinking about a
specific set of inquries? Can you
describe one?

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

What if I asked about inquiries for the last 12 months, rather than the last 6 months. Would that be a problem when trying to
answer these questions? Would it be hard for you to remember back that far?

Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?

NEW A13. {In the last six months/Since {New Contractor} became your contractor} which method(s) have you used to
communicate with your Contractor? (Mark all that apply)
 Telephone call with a Contractor representitive
 Automated telephone system
 Web
 Mail
 Fax
 Other (specify).

NEW A14. {In the last six months/ Since {New Contractor} became your contractor} which method have you used most often to
communicate with your Contractor?
 Telephone call with a Contractor representative
 Automated telephone system
 Web
 Mail
 Fax
 Other (specify).

5

NEW A15. How many inquires have you made {In the last six months/ Since {New Contractor} became your contractor}?
 1-2
 3-5
 6-10
 11-50
 51- or more

How did you come up with your answer to this question?

What about the categories used here? Do these fit for the number of inquiries you typically make over this period?

NEW A16. Do you use the internet to get any of the following? (Mark all that apply)
 CMS Program updates
 Contractor updates
 Training
 Billing Regulations
 Other (Please specify) _________________________________

6

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section B: Provider Communication (Education and Training)
[Contractor] offers Providers Education and Training in a variety of ways including seminars, on-site
training, demonstrations, CD’s, videos, newsletters, emails, reference materials, bulletins, website, web-based
training, etc. Your organization might also have a “Provider Rep” that acts as a liaison for education issues or as
an actual trainer. For the purposes of this survey instrument, your “Contractor’s Education and Training
performance” includes all of these ways that [Contractor] provides training and education to your organization.
It should take you approximately two (2) minutes to complete this section.

INSTRUCTIONS FOR SECTION B
You have two choices for Section B: Provider Communication (Education and Training):
•

Complete Section B yourself ---PROCEED TO QUESTION B_1A BELOW

•

Forward Section B to the person at your facility who interacts on a regular basis with your
[CONTRACTOR NAME]---PROCEED TO SECTION C on PAGE C-1

7

Your Ratings of [CONTRACTOR]’S
Performance of PROVIDER COMMUNICATION
(Formerly EDUCATION AND TRAINING)
While answering the following questions, please think about your experiences in the last six (6) months involving the types of training
resources provided by your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument). These resources
include seminars, on-site training, demonstrations, CD’s, videos, newsletters, emails, reference materials, bulletins, website, webbased training, etc.
In the last six months, how satisfied have
you been with

B1.

The amount of training and
educational resources available from
your Contractor

B3.

The detail in which topics are
covered.

For each of the following items in the Provider Communication (Education and
Training) section, please rate your level of satisfaction on a scale of 1 to 6, where 1 is
“Not at all Satisfied” and 6 is “Completely Satisfied.” Please circle the relevant
number.
Completely
Not at all
Satisfied
Satisfied
Don’t
Not
6
Know
Applicable
1
2
3
4
5

What were you thinking about
when you answered this question

How did you come up with your
answer?
B5.

1

3

4

5

6

The tailoring of training or education
at a level you can understand

B8a. The topics of the training and
education materials are up-to-date

NEW B8b. The topics of the training and
education materials are relevant to
your organizations needs.

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

B9.

2

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

The quality of the education and
training materials that you regularly
use
What type of education and
training materials were you
thinking about?

B6.

Completely
Satisfied

Not at all
Satisfied

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

Not at all
Satisfied

2

3

4

5

Completely
Satisfied

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

1

6

Not at all
Satisfied

Completely
Satisfied

The accessibility of education and
training resources from your
Contractor
What were you thinking about
when you answered this question

How did you come up with your
answer?
B10. The expertise of your Contractor’s
provider education and training staff
during in-person trainings

1

2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

6

2

3
8

4

5

6

In the last six months, how satisfied have
you been with

B11. Your contractor’s communication
with you about changes that have
been or are being made to Medicare
policies and regulations
What did “communication with
you” mean to you?
B13. The professionalism and courtesy of
your Contractor’s training and
education representatives

For each of the following items in the Provider Communication (Education and
Training) section, please rate your level of satisfaction on a scale of 1 to 6, where 1 is
“Not at all Satisfied” and 6 is “Completely Satisfied.” Please circle the relevant
number.

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

6

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Proposed New Questions
NEW B15. The training and education
resources were helpful.

1
NEW B16. The availability of education and
training resources on the web

Completely
Satisfied

Not at all
Satisfied
2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

6

2

3

4

5

6

Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?

New B17. {In the last six months/ Since {New Contractor} became your contractor} what mode of education and training have you
used?
 Web-based Training
 Online Resources
 In-person training / Workshops
 Hard copy manuals
 Other (specify)

9

New B18. For which of the following topics would you like to see more training and education material (mark all that apply)?
 Online claims processing
 Paper claims processing
 NPI
 Enrollment
 Appeals
 Medical Review
 Audit and reimbursement
 Other (specify)
What if I asked about inquiries for the last 12 months, rather than the last 6 months. Would that be a problem when trying to
answer these questions? Would it be hard for you to remember back that far?

10

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section C: Claims Processing
[Contractor] has procedures and regulations and statutes associated with how they receive, process and
pay claims that Providers submit. For the purposes of this survey instrument, your “Contractor’s Claims
Processing performance” includes the activities and interactions that you have with [Contractor] throughout the
lifecycle of a claim submission to payment or denial. It should take you approximately three (3) minutes to
complete this section.

INSTRUCTIONS FOR SECTION C
You have two choices for Section C: Claims Processing:
•

Complete Section C yourself ---PROCEED TO QUESTION C1 on PAGE C-2

•

Forward Section C to the person at your facility who interacts on a regular basis with your
[CONTRACTOR NAME]---PROCEED TO SECTION D on PAGE D-1

11

Your Ratings of [CONTRACTOR]’S
Performance of CLAIMS PROCESSING
While answering the following questions, please think about your experiences in the last six (6) months involving Claims Processing
activities with your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument).

In the last six months, how satisfied have
you been with
C4.

For each of the following items in the Claims Processing section, please rate your
level of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.” Please circle the relevant number.

The accuracy of your Contractor’s
claims editing
Could you repeat this question in
your own words?
What does “accuracy” mean to
you?
What does “claims editing” mean to
you?

1
C5.

Completely
Satisfied

Not at all
Satisfied
2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

The timeliness of notification from
your Contractor that a claim will not
be paid, including denied, returned or
unprocessed claims
What were you thinking about
when you answered this question

How did you come up with your
answer?

Did you base your answer on any
specific notification? (if so) When
did this (these) notification(s)
occur?
C6.

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

The accuracy of remittance advices
received from your Contractor
What does “accuracy” mean to you
in this question?

Were you thinking about a specific
remittal when you answered?
When was this?
C7.

The ease of submitting electronic
claims

Completely
Satisfied
1

The availability of your Contractor’s
representatives to address claimsrelated issues

3

4

5

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

6
Completely
Satisfied

Not at all
Satisfied
1

C8.

2

2

3

12

4

5

6

In the last six months, how satisfied have
you been with
C9.

Your Contractor’s claims information
being up-to-date (e.g., codes and
billing instructions)

For each of the following items in the Claims Processing section, please rate your
level of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.” Please circle the relevant number.
Completely
Not at all
Satisfied
Satisfied
Don’t
Not
Know
Applicable
2
3
4
5
6
1

C11. Your Contractor’s handling of
claims-related documentation
What does this question mean to
you?
What does “handling of claims
related documentation” mean to
you?

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

Proposed New Questions
Completely
Satisfied

New C13.
The clarity of remittance
advices you receive from your
Contractor

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

New C14.
The ease of correcting
claims, including correcting claims
online and asking for a change over
the phone

Not at all
Satisfied

2

3

4

5

Completely
Satisfied

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

6

1

What were you thinking about
when you answered this question

How did you come up with your
answer?

Was there a specific experience or
set of experiences you thought of
when answering this question? (if
yes) When did these happen?
New C15.
Your Contractor provides
adequate training and educational
material on claims processing

Not at all
Satisfied

2

3

4

5

Completely
Satisfied
6

1

How did you come up with your
answer to this question?
Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?
New C16. {In the last six months/ Since {New Contractor} became your contractor} how have you submitted claims?




Paper
Electronic
Both

What if I asked about inquiries for the last 12 months, rather than the last 6 months. Would that be a problem when trying to
answer these questions? Would it be hard for you to remember back that far?
13

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section D: Appeals
[Contractor] has procedures and regulations associated with how and when it addresses Appeals, makes

determinations about Appeals and communicates with Providers about Appeals decisions. For the purposes of
this survey instrument, your “Contractor’s Appeals performance” includes the activities and interactions that
you have with [Contractor] throughout the lifecycle of a first-level Appeal—from when you first receive a
denial of a claim to when [Contractor] states its decision to reverse or uphold its decision about paying the
claim. It should take you approximately two (2) minutes to complete this section.

INSTRUCTIONS FOR SECTION D
You have two choices for Section D: Appeals:
•

Complete Section D yourself ---PROCEED TO QUESTION D_1A BELOW

•

Forward Section D to the person at your facility who interacts on a regular basis with your
[CONTRACTOR NAME]---PROCEED TO SECTION E on PAGE E-1

New. {In the last one year/ Since {New contractor} became your contractor} has your facility had a first
level appeal?


Yes--- PROCEED TO QUESTION D1 on PAGE D-2



No---PROCEED TO SECTION E on PAGE E-1

14

Your Ratings of [CONTRACTOR]’S
Performance of APPEALS
While answering the following questions, please think about your experiences in the last one year involving first level Appeals
activities with your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument).
In the last one year, how satisfied have
you been with
D3.

The accuracy of your Contractor’s
reasons for their first-level appeals
decisions

For each of the following items in the Appeals section, please rate your level of
satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is “Completely
Satisfied.” Please circle the relevant number.

1
D4.

The consistency of your Contractor’s
decisions about first-level appeals for
claims that have been denied
How did you come up with your
answer?

D5.

D6.

Your Contractor’s communication
with you about changes that have
been made to Medicare policies or
regulations

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

6

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Your Contractor’s responsiveness,
attentiveness, and availability during
the process of first-level

Could you repeat this in your own
words?
D8.

2

The mechanisms that your Contractor
offers for exchanging information
with them about first-level appeals

What does “mechanisms …for
exchanging information” mean to
you? Can you give me examples?
D7.

Completely
Satisfied

Not at all
Satisfied

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

The professionalism and courtesy of
your Contractor’s representatives
during the appeals process
Can you tell me the difference
between this question and “D7”.
What did you think about when
answering these two items?

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Proposed New Questions
New D10.
The explanations for an
appeal decisions are made clear by
your Contractor
What does this question mean to
you?
What types of “explanations” do
you think this is referring to?

Completely
Satisfied

Not at all
Satisfied
1

2

3
15

4

5

6

New D11.Your Contractor provides
adequate training and educational
material on appeals process

Not at all
Satisfied

2

3

4

5

Completely
Satisfied

Don’t
Know

Not
Applicable

6

1

What if I asked about inquiries for the last 12 months, rather than the last 6 months. Would that be a problem when trying to
answer these questions? Would it be hard for you to remember back that far?
Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?

16

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section E: Provider Enrollment
[Contractor] has procedures and regulations associated with how and when they require and make
determinations about applications for Provider Enrollment in the Medicare program. Providers new to Medicare
since 1997, as well as established Providers with new changes in their qualifications or in payment assignments
since 1997 (as in mergers or acquisitions), are required to submit the appropriate CMS 855 Enrollment Application to their
Medicare contractor. For the purposes of this survey instrument, your “Contractor’s Provider Enrollment

performance” includes the activities and interactions that you have with [Contractor] regarding enrolling your
organization as a Provider with the Medicare program. This includes all of your interaction with the Medicare
contractor including initial enrollment and updates to enrollment information — from the first contact you made
with [Contractor] since 1997 through your assignment of a Provider number. It should take you approximately
one (1) minute to complete this section.

INSTRUCTIONS FOR SECTION E
You have two choices for Section E: Provider Enrollment:
•

Complete Section E yourself ---PROCEED TO QUESTION E_1A BELOW

•

Forward Section E to the person at your facility who interacts on a regular basis with your
[CONTRACTOR NAME]---PROCEED TO SECTION F on PAGE F-1

E_1A. Have you enrolled as a Medicare provider in the last one year?


Yes--- PROCEED TO QUESTION E1 on PAGE E-2



No--- (Go to NPI SECTION)

17

Your Ratings of [CONTRACTOR]’S
Performance of PROVIDER ENROLLMENT
While answering the following questions, please think about your experiences in the last yearinvolving Provider Enrollment activities
with your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument).
In the last year, how satisfied have you been
with
E1.

The instructions and guidance your
Contractor provided to you to complete
and submit the 855 form.
What were you thinking about when
you answered this question
How did you come up with your
answer?

E2.

For each of the following items in the Provider Enrollment section, please rate your
level of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.” Please circle the relevant number.

The ability of your Contractor’s
representatives to answer your
questions about the Form 855
application

1

The consistency of your Contractor’s
responses or decisions
What is the difference between this
question and E1?

E6.

The professionalism and courtesy of
your Contractor’s representatives
during the Provider Enrollment process

2

3

4

5

2

3

4

5

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

6
Completely
Satisfied

Not at all
Satisfied
1

6

Completely
Satisfied

Not at all
Satisfied
1

E3.

Completely
Satisfied

Not at all
Satisfied

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Proposed New Questions
New E8. Your Contractor’s responsiveness,
attentiveness, and availability during
the process of enrollment
In your own words, what do you
think this question is asking?
New E9. Your Contractor’s ability to answer
questions specific to your situation or
specialty.

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

Not at all
Satisfied

2

3

4

5

Completely
Satisfied

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

6

1

In your own words, what do you
think this question is asking?
What does the phrase “questions
specific to your situation or
specialty” mean to you?
New E10. Once you were enrolled, the
quality and thoroughness of the
information from your contractor to get
started (e.g., PPN, how to submit info,
etc.).

Not at all
Satisfied

2

3

4

5

Completely
Satisfied
6

1

What does “information from your
contractor to get started” mean to
you?
18

New E11.
Your contractor provides
adequate training and educational
material on the enrollment process

Not at all
Satisfied

2

3

4

5

Completely
Satisfied

Don’t
Know

Not
Applicable

6

1

When did you enroll?

Was it difficult to remember what happened to answer these questions?
Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?

19

NPI Supplement

New NPI1. Your contractor made you aware
of the need to obtain a NPI.”

1
New NPI2. “Your contractor provided
education and training to prepare you to
obtain a NPI.”

2

3

4

5

2

3

4

5

6

Completely
Satisfied

Not at all
Satisfied
1

6

Completely
Satisfied

Not at all
Satisfied
1

New NPI3. Your Contractor’s responsiveness,
attentiveness, and availability during the NPI
process

Completely
Satisfied

Not at all
Satisfied

2

20

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section F: Medical Review

[Contractor] has procedures and regulations that require them to sometimes perform Medical Review of
Providers’ records. For the purposes of this survey instrument, your “Contractor’s Medical Review
performance” includes the activities and interactions that you have with [Contractor] during Pre-Pay and/or
Post-Pay Medical Review. Please note that Medical Review activities in this section of the survey instrument
are NOT related to fraud investigations, overpayments, or appeals. It should take you approximately three (3)
minutes to complete this section.

INSTRUCTIONS FOR SECTION F
You have two choices for Section F: Medical Review:
•

Complete Section F yourself ---PROCEED TO QUESTION F_1A BELOW

•

Forward Section F to the person at your facility who interacts on a regular basis with your
[CONTRACTOR NAME]---PROCEED TO SECTION G on PAGE G-1

Change to : {In the last one year/ Since {New contractor} has been your contractor} have you had a
medical review ?


Yes---PROCEED TO QUESTION F1 on PAGE F-2



No---PROCEED TO SECTION G on PAGE G-1

21

Your Ratings of [CONTRACTOR]’S
Performance of MEDICAL REVIEW
While answering the following questions, think about your experiences in the past one year involving Medical Review activities with
your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument).
In the last one year, how satisfied have
you been with
F1.

F3.

The clarity of the notification (letter,
phone call, etc.) from your Contractor
that your claims were selected for
Medical Review

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Your Contractor’s handling of
documentation during Medical
Review
What does this question mean to
you?
What does “handling of
documentation” mean to you?

F5.

For each of the following items in the Medical Review section, please rate your level
of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.” Please circle the relevant number.

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

The clarity of the explanations of your
Contractor’s Medical Review
decisions
What were you thinking about
when you answered this question
How did you come up with your
answer?

1
F6.

F8.

Receiving timely local Medical
Review policy changes and updates
that affect your organization from
your Contractor

2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

6

2

3

4

5

6

The follow through that your
Contractor provided after Medical
Review decisions
What does this question mean to
you?
What does “follow through” mean
to you?

F9.

Completely
Satisfied

Not at all
Satisfied

The knowledge of your Contractor’s
Medical Reviewers

1

2

3

4

5

2

3

4

5

6
Completely
Satisfied

Not at all
Satisfied
1

6
Completely
Satisfied

Not at all
Satisfied
1

F10. How well your Contractor makes an
effort to make things as easy and as
fair as possible for you

Completely
Satisfied

Not at all
Satisfied

2

3

22

4

5

6

In the last one year, how satisfied have
you been with

For each of the following items in the Medical Review section, please rate your level
of satisfaction on a scale of 1 to 6, where 1 is “Not at all Satisfied” and 6 is
“Completely Satisfied.” Please circle the relevant number.

F11. The consistency of your Contractor’s
Medical Review decisions and
answers to your questions
What were you thinking about
when you answered this question
How did you come up with your
answer?
F12. The professionalism and courtesy of
your Contractor representatives
throughout the medical review
process

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

Completely
Satisfied

Not at all
Satisfied
1

6

2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Proposed New Questions
New F14.
Your Contractor provides
adequate training and educational
material on the medical review
process

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

What period were you thinking about? When you answered these questions, which medical reviews were you thinking about?
When did they happen?

What do you think about asking someone to remember back for 12 months?
Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?

MEDICARE CONTRACTOR PROVIDER SATISFACTION SURVEY

Section G: Provider Audit and Reimbursement
[Contractor] has procedures and regulations that require them to work with Providers who are paid on
either a cost reimbursement or prospective payment basis for treating Medicare patients. For the purposes of
this survey instrument, your “Contractor’s Provider Audit and Reimbursement activities” includes all
interactions with [Contractor] related to how they decide and make adjustments to what Medicare has paid or is
supposed to pay your organization, cost report audit activities you may participate in each year, and interim
payments you receive. Please note that Audit and Provider Reimbursement activities in this section of the
survey instrument are NOT related to the direct payment or denial of claims or to appeals activities related to
claims. It should take you approximately three (3) minutes to complete this section.

INSTRUCTIONS FOR SECTION G
23

You have two choices for Section G: Provider Audit and Reimbursement:
•

Complete Section G yourself ---PROCEED TO QUESTION G_1A BELOW

•

Forward Section G to the person at your facility who interacts on a regular basis with your
[CONTRACTOR NAME]

G_1A. In the last one year, have you submitted a cost report to {Contractor}?


Yes--- PROCEED TO QUESTION G1 on PAGE G-2 When was the last time?



No---THANK YOU FOR COMPLETING THE MCPSS SURVEY INSTRUMENT. PLEASE
REFER THE LAST PAGE FOR INSTRUCTIONS FOR SUBMITTING YOUR COMPLETED
SURVEY.

24

Your Ratings of [CONTRACTOR]’S
Performance of PROVIDER AUDIT AND REIMBURSEMENT
While answering the following questions, think about your experiences in the last one year involving Audit and Reimbursement
activities with your Contractor, [Contractor] ONLY (called “your Contractor” in the survey instrument).
In the last one year, how satisfied have you For each of the following items in the Provider Audit and Reimbursement section,
been with
please rate your level of satisfaction on a scale of 1 to 6, where 1 is “Not at all
Satisfied” and 6 is “Completely Satisfied.” Please circle the relevant number.
G1.

G2.

G3.

Availability of timely updates from
your Contractor on Medicare policy
(regulations, manuals and other
instructions) that affect Provider
Audit and Reimbursement
The responsiveness of your
Contractor to your reimbursement
and other questions throughout all
Provider Audit and Reimbursement
activities.

Not at all
Satisfied
1

Completely
Satisfied
2

3

4

5

Not at all
Satisfied
1

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Completely
Satisfied
2

3

4

5

6

The consistency of your
Contractor’s answers to your
questions throughout all Provider
Audit and Reimbursement
activities.
What does “consistency” mean to
you?
How did you come up with your
answer to this question?

Not at all
Satisfied
1

G4.

G5.

The professionalism and courtesy of
your Contractor representatives
throughout all Provider Audit and
Reimbursement activities.

3

4

5

Not at all
Satisfied
1

6
Completely
Satisfied

2

3

4

5

Not at all
Satisfied
1

G7.

2

6

How well your Contractor makes an
effort to make things as easy and as
fair as possible for you during Cost
Report settlement activities.
How does this question differ
from G2?

G6.

Completely
Satisfied

Your Contractor’s interpretations of
CMS’ rules for Cost Report and
payment policies.

The knowledge of your Contractor’s
Cost Report Auditors

Completely
Satisfied
2

3

4

5

Not at all
Satisfied
1

6
Completely
Satisfied

2

3

4

5

6

Not at all
Satisfied

Completely
Satisfied

1

6

2

3

25

4

5

In the last one year, how satisfied have you For each of the following items in the Provider Audit and Reimbursement section,
been with
please rate your level of satisfaction on a scale of 1 to 6, where 1 is “Not at all
Satisfied” and 6 is “Completely Satisfied.” Please circle the relevant number.
G8.

The appropriateness of your
Contractor’s responses if/when you
requested assistance in completing
a Cost Report
In your own words, can you tell
me what you think this question
is asking?

Not at all
Satisfied
1

G9.

Completely
Satisfied
2

3

4

5

6

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

The reasonableness of your
Contractor’s requests during the
Cost Report audit, including the
time you are given to submit
documentation and the methods
you are given for submitting those
documents
In your own words, can you tell
me what you think this question
is asking?
What does “reasonableness of
requests” mean to you?

Not at all
Satisfied
1

Completely
Satisfied
2

3

4

5

6

G10. The timeliness of your Contractor’s
audit of your Cost Report, if one is
conducted, and the final settlement.
In your own words, can you tell
me what you think this question
is asking?
What does “reasonableness of
requests” mean to you?
G11. The overall communication between
you and your Contractor about
adjustments and Cost Reports/ Cost
Report Audits
How does this question differ
from G9?

Not at all
Satisfied
1

Completely
Satisfied
2

3

4

5

Not at all
Satisfied
1

6

Completely
Satisfied
2

3

4

5

6

The next few questions are about Interim Payments you receive from Your Contractor
G12. The clarity of your Contractor’s
instructions for the process of
requesting a review and
adjustment to your Interim
Payments

Completely
Satisfied

Not at all
Satisfied
1

2

3

26

4

5

6

In the last one year, how satisfied have you For each of the following items in the Provider Audit and Reimbursement section,
been with
please rate your level of satisfaction on a scale of 1 to 6, where 1 is “Not at all
Satisfied” and 6 is “Completely Satisfied.” Please circle the relevant number.
G13. The reasonableness of your
Contractor’s requests during their
consideration of an adjustment to
your Interim Payments, including
the time you are given to submit
documentation and the methods
you are given for submitting those
documents
What were you thinking about when
you answered this question
How did you come up with your
answer?
G14. The clarity of your Contractor’s
explanations for decisions about
adjustments to your Interim
Payments
G15. The timeliness of your Contractor’s
decisions about adjustments to
your Interim Payments

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

2

3

4

5

Not at all
Satisfied
1

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Don’t
Know

Not
Applicable

Completely
Satisfied

Not at all
Satisfied
1

6

6
Completely
Satisfied

2

3

4

5

6

Proposed New Questions
New G17.
Your contractor provides
adequate training and educational
material on preparing cost reports.

Completely
Satisfied

Not at all
Satisfied
1

2

3

4

5

6

What period were you thinking about? When did you have your last Audit and Reimbursement? Were you thinking about
this time when you answered all of the above questions?
What do you think about asking someone to remember back for 12 months?
Take a look at each of the questions that are in this section. Which ones seem to ask about the issues that you are most
concerned about when you evaluate (CONTRACTOR)?

Now I’d like you to look over each of the different sections. Which sections do you think are most important for
you when you are evaluating (CONTRACTOR)?

Finally, is there anything else you would like to tell us about the survey? About what you think would be
important to ask providers when evaluating the contractor?

27