524 CMS Palmetto Railroad 4-6-12.xlsx

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Overview

Current Model Qsts
Current Custom Qsts

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Sheet 1: Current Model Qsts

Model Instance Name:
Palmetto GBA Railroad
MID:	1hFtg1IgIw1FtdpQ1shZog==
Date:	10/19/2011
Palmetto GBA Railroad MODEL QUESTION LIST
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Content (1=Poor, 10=Excellent, Don't Know)		Satisfaction (1=Poor, 10=Excellent)		Likelihood to Return (1=Not Very Likely, 10=Very Likely)
1	Please rate the accuracy of information on this site.	21	What is your overall satisfaction with this site?	24	How likely are you to return to this site?
2	Please rate the quality of information on this site.	22	How well does this site meet your expectations?
3	Please rate the freshness of content on this site.	23	How does this site compare to your idea of an ideal website?		Recommend (1=Not Very Likely, 10=Very Likely)
	Functionality (1=Poor, 10=Excellent, Don't Know)			25	How likely are you to recommend this site to someone else?
4	Please rate the usefulness of the services provided on this site.
5	Please rate the convenience of the services on this site.				Primary Resource (1=Not Very Likely, 10=Very Likely)
6	Please rate the ability to accomplish what you wanted to on this site.			26	How likely are you to use this site as your primary resource for getting information on Medicare?
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
7	Please rate the ease of reading this site.
8	Please rate the clarity of site organization.
9	Please rate the clean layout of this site.
	Navigation (1=Poor, 10=Excellent, Don't Know)
10	Please rate the degree to which the number of steps it took to get where you want is acceptable.
11	Please rate the ability to find information you want on this site.
12	Please rate the clarity of the site map/directory.
13	Please rate the ease of navigation on this site.
	Site Performance (1=Poor, 10=Excellent, Don't Know)
14	Please rate the speed of loading the page on this site.
15	Please rate the consistency of speed on this site.
16	Please rate the reliability of site performance on this site.
	Search (1=Poor, 10=Excellent, Don't Know)
17	Please rate the usefulness of search results on this site.
18	Please rate how this site provides comprehensive search results.
19	Please rate the organization of search results on this site.
20	Please rate how the search feature helps you to narrow the results to find the information you want.

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Sheet 2: Current Custom Qsts

Model Instance Name:

red & strike-through: DELETE

Palmetto GBA Railroad

underlined & italicized: RE-ORDER

MID:

1hFtg1IgIw1FtdpQ1shZog==

pink: ADDITION

Date:

4/5/2012

blue + -->: REWORDING

Palmetto GBA Railroad CUSTOM QUESTION LIST

CQID

Skip Logic Label

Question Text

Answer IDs (DOT ONLY)

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

Special Instructions

Short Name

51958

Which best describes you?

Provider of medical services

Radio buttons

Single

Y

OPS Group

Supplier of medical equipment or supplies

Staff of provider/supplier working primarily with billing/insurance

Administrative staff of a provider/supplier

Other staff of a provider/supplier

Consultant or attorney

Billing service

Other (please specify)

A

7000003

A

Other - which best describes you?

Text field, <100 char

Single

N

OPS Group

51960

What is your primary reason for visiting this site today?

Download forms

Radio buttons

Single

Y

OPS Group

51960A002

Access claim status and/or beneficiary eligibility

Learn of, or register for, workshops, seminars or other training events

Find contact information

Find general Medicare program information

Research a specific question on Medicare policy or billing

Find information on fees or fee schedules

Find out about a Local Coverage Determination (LCD)

Read Medicare publications such as newsletters, articles, etc.

Find enrollment information

Take an on-line training course

Other (please specify)

B

7000004

B

Other - primary reason?

Text field, <100 char

Single

N

OPS Group

DEZ10180

Did you find what you were looking for?

Yes

Radio button, one-up vertical

Single

Y

OPS Group

Looking For

No, I was looking for:

D

DEZ10181

D

No, I was looking for:

Text field, <100 char

Single

N

OPS Group

Didn't Find

ACQOsl0003347

Did you use the site-wide search feature on this site? (open text box in the upper right)

ACQOsl0003347A01

Yes

2A, 2F

Radio button, one-up vertical

Single

Yes

Skip Group

Use Search

ACQOsl0003347A02

No

ACQOsl0003348

2A

How would you rate the helpfulness of the site-wide search?

ACQOsl0003348A001

Very helpful

Radio button, one-up vertical

Single

No

Skip Group

Rate Search

ACQOsl0003348A002

Somewhat helpful

ACQOsl0003348A003

Fair

ACQOsl0003348A004

Somewhat unhelpful

2B

ACQOsl0003348A005

Very unhelpful

2B

ACQOsl0003349

2B

Which of the following describes your experience with the site-wide search?

ACQOsl0003349A001

Search difficult to use

Radio button, one-up vertical

Single

No

Skip Group

Search Experience

ACQOsl0003349A002

Received too few results

2C

ACQOsl0003349A003

Received too many results

ACQOsl0003349A004

Search results were not what I was looking for

2D

ACQOsl0003349A005

Could not sort or refine results

ACQOsl0003349A006

Other

2E

ACQOsl0003370

2C

What search term(s) did you use?

Text area, no char limit

Single

No

Skip Group

Terms - Too Few

ACQOsl0003371

2D

What search term(s) did you use?

Text area, no char limit

Single

No

Skip Group

Terms - Not What Look For

ACQOsl0003372

2E

Please briefly explain your experience with the site-wide search.

Text area, no char limit

Single

No

Skip Group

Other_Search Experience

ACQOsl0003373

2F

What one improvement to the site-wide search feature would be most beneficial?

Text area, no char limit

Single

No

Skip Group

Other-Search Improvement

ACQwil0012030

Do you use E-mail Updates (listserv)?

ACQwil0012030A01

Yes

Radio button, one-up vertical

Single

N

Use Listserv

ACQwil0012030A02

No, but please show me the link to sign up after I submit this survey

51957

In the last 30 days, how many times have you visited this website?

This is my first time

Radio button, one-up vertical

Single

Y

Once or twice

Three or four times

More than once per week but not every day

Every day

AML001061

How do we rate in comparison to other companies that offer the same products on the following criteria? Amount of Content

1=Poor

Radio button, scale, no don't know

Single

Yes

Matrix

Amount of Content

2

3

4

5

6

7

8

9

Excellent=10

AML001062

Ease of Use

1=Poor

Radio button, scale, no don't know

Single

Yes

Matrix

Ease of Use

2

3

4

5

6

7

8

9

Excellent=10

AML001063

Ability to find what you are looking for

1=Poor

Radio button, scale, no don't know

Single

Yes

Matrix

Ability to find what you are looking for

2

3

4

5

6

7

8

9

Excellent=10

KFB07032

If you could change anything about our site, what would it be?

Text area, no char limit

Single

No

Change Anything

ACQLiv0008477

If you are over the age of 18 and would like to be contacted by Palmetto GBA Railroad Medicare regarding your feedback, please provide your e-mail address and phone number.

Text area, no char limit

Single

No

Email Address