| Model Instance Name: |
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This is a CMS measure!
USE MODEL #410 |
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| CMS - Cahaba J10 MAC |
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| MID: |
FRkpwtNoQ0NxZVwZQcNs0A== |
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| Date: |
4/23/2009 |
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| CMS - Cahaba J10 MAC MODEL QUESTION LIST |
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| Model questions utilize the ACSI methodology to determine scores and impacts |
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ELEMENTS (drivers of satisfaction) |
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CUSTOMER SATISFACTION |
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FUTURE BEHAVIORS |
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Content |
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Satisfaction |
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Primary Resource |
| 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 use this site as your primary resource for getting information on Medicare? |
| 2 |
Please rate the quality of information on this site. |
22 |
How well does this site meet your expectations? |
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Recommend |
| 3 |
Please rate the freshness of content on this site. |
23 |
How does this site compare to your idea of an ideal website? |
25 |
How likely are you to recommend this site to someone else? |
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Functionality |
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Return |
| 4 |
Please rate the usefulness of the services provided on this site. |
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26 |
How likely are you to return to this site? |
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Please rate the convenience of the services on this site. |
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| 6 |
Please rate the ability to accomplish what you wanted to on this site. |
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Look and Feel |
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| 7 |
Please rate the ease of reading this site. |
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| 8 |
Please rate the clarity of site organization. |
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Please rate the clean layout of this site. |
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Navigation |
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Please rate the degree to which the number of steps it took to get where you want is acceptable. |
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| 11 |
Please rate the ability to find information you want on this site. |
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| 12 |
Please rate the clarity of the site map/directory. |
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| 13 |
Please rate the ease of navigation on this site. |
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Search |
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| 14 |
Please rate the usefulness of search results on this site. |
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| 15 |
Please rate how this site provides comprehensive search results. |
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| 16 |
Please rate the organization of search results on this site. |
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| 17 |
Please rate how the search feature helps you to narrow the results to find the information you want. |
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Site Performance |
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| 18 |
Please rate the speed of loading the page on this site. |
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| 19 |
Please rate the consistency of speed on this site. |
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| 20 |
Please rate the reliability of site performance on this site. |
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| Model Instance Name: |
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red & strike-through: DELETE |
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| CMS - Cahaba J10 MAC |
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underlined & italicized: RE-ORDER |
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| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
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pink: ADDITION |
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| Date: |
10/1/2009 |
blue + -->: REWORDING |
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| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
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QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
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| AED08187 |
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What is your Medicare line of business? |
Alabama Part A |
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Drop down, select one |
Single |
Y |
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Medicare line |
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Alabama Part B |
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Georgia Part A |
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Georgia Part B |
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Mississippi Part B |
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Tennessee Part A |
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Tennessee Part B |
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HH&H |
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ESRD |
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Religious Non-medical Health Care Institution (RNHC) |
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Independent Organ Procurement Organization |
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Histocompatibility Lab |
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None of the above |
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| 51958 |
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Which best describes you? |
Provider of medical services |
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Radio button, one-up vertical |
Single |
Y |
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Role |
Required by CMS |
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| Supplier of medical equipment or supplies |
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Staff of provider/supplier working primarily with billing/insurance |
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| Administrative staff of a provider/supplier |
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| Other staff of a provider/supplier |
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| Consultant or attorney |
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| Billing service |
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| Other (please specify) |
SKIP A |
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| 7000003 |
SKIP A |
Other - which best describes you? |
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Text field, <100 char |
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Y |
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OE_Role |
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| C51960 |
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What is your primary reason for visiting this site today? |
Download forms |
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Radio button, one-up vertical |
Single |
Y |
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Primary Visit Reason |
Required by CMS |
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| Learn of, or register for, workshops, seminars or other training events |
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| Find contact information |
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| Find general Medicare program information |
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| Research a specific question on Medicare policy or billing |
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| Find information on fees or fee schedules |
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| Find out about a Local Coverage Determination (LCD) |
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| Read Medicare publications such as newsletters, articles,etc. |
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| Find enrollment information |
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| Take an on-line training course |
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| Other (please specify) |
SKIP B |
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| C7000004 |
SKIP B |
Other - primary reason? |
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Text field, <100 char |
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OE_Reason |
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| C51957 |
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In the last 30 days, how many times have you visited this website? |
This is my first time |
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Radio button, one-up vertical |
Single |
Y |
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Visit Frequency |
Required by CMS |
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| Once or twice |
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| Three or four times |
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| More than once per week but not every day |
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| Every day |
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| CWS01706 |
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Did you find what you were looking for? |
Yes - I found what I was looking for |
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Drop down, select one |
Single |
Y |
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Found Info |
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No - I did not find what I was looking for |
C/H |
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I don't know yet; I am still looking |
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I wasn't looking for anything in particular |
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| CWS01707 |
H |
Please tell us exactly what you were looking for. |
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Text area, no char limit |
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T |
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Looking For |
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| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
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Radio button, one-up vertical |
Single |
Y |
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Do Next |
Recommended by CMS |
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Call the Cahaba call center |
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Return to the Cahaba website later and try again |
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Send an email |
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Write a letter |
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Other (please specify) |
D |
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| CWS01709 |
D |
Please describe what you will do next. |
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Text area, no char limit |
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Y |
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OE_Do Next |
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| CWS01710 |
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Which areas of the site did you primarily use today? |
News |
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Radio button, one-up vertical |
Single |
Y |
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Area Used |
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Calendar of events |
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Transition schedule |
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Local Coverage Determinations (LCDs) |
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Frequently Asked Questions (FAQs) |
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Past Correspondences/Communications |
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Contact Information |
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Other (please specify) |
E |
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| CWS01711 |
E |
Other Area Used |
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Text field, <100 char |
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Y |
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OE_Area Used |
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| EDO05180 |
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In addition to the currently used communication tools (example: Internet, email lists), would you be interested in receiving Cahaba Medicare Services related information through the following Social Media outlets: (Please select all that apply) |
Facebook |
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Checkbox, one-up vertical |
Multi |
Y |
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Twitter |
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YouTube |
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RSS Feed |
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Podcast |
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LinkedIn |
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None |
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Other (please specify) |
A |
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| EDO05181 |
A |
Please list the other social media outlet: |
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Text area, no char limit |
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| EDO05182 |
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Does your place of business allow you to access social media outlets for work-related information during work hours? (i.e. Facebook, YouTube etc.) |
Yes |
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Radio button, one-up vertical |
Single |
Y |
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No |
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| EDO05183 |
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Would you access Cahaba Medicare Services social media outlets for information during off/non-business hours? |
Yes |
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Radio button, one-up vertical |
Single |
Y |
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No |
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| ACQLiv0010428 |
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Did you use the search feature during your visit today? |
Yes |
F |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Search Usage |
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No |
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Don't recall |
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| ACQLiv0010429 |
F |
Please tell us about your experience with the site's search feature today. (Please select all that apply.) |
The search feature met my needs today. |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Experience |
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I had issues with the basic search process (how to use it, terms to enter). |
A |
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I had issues with the visual display of the search results (text size, images). |
B |
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I had issues with the search results I received. |
C |
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I had issues with sorting, filtering, advanced search or lack of these options. |
D |
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I had technical issues with the search feature. |
E |
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The search tips were not useful |
F |
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None of these |
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| ACQLiv0010430 |
A |
What were your issues with the basic search process? (Please select all that apply.) |
It was not clear to me how to use the search feature |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Process |
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I did not know what terms to use to get the results I wanted |
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There were too many steps or refinements to get to what I wanted |
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None of these |
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| ACQLiv0010431 |
B |
What were your issues with the visual display of the search results? (Please select all that apply.) |
I could not see enough of the description to decide which link to choose |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Display |
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The text was too small |
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The page was too crowded |
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I could not see much difference between the listings/items |
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None of these |
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| ACQLiv0010432 |
C |
What were your issues with the search results? (Please select all that apply.) |
Results were not relevant/not what I wanted |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Results |
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There were not enough results |
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There were NO results |
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There were too many results |
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There was too little information in the results to decide what to choose |
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Many of the search results looked the same |
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I had other issues with the search results |
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| ACQLiv0010433 |
D |
What were your issues with sorting, filtering, or advanced search? (Please select all that apply.) |
The results were not sorted in a helpful way |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Sorting |
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I want advanced search options |
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I want the following sorting/filtering/advanced option: |
D1 |
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I had a different sorting/filtering issue: |
D2 |
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| ACQLiv0010434 |
D1 |
Sorting/filtering/advanced option: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Filter1 |
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| ACQLiv0010435 |
D2 |
My issue was: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Filter2 |
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| ACQLiv0010436 |
E |
What were your technical issues with the search feature? (Please select all that apply.) |
Error message(s) |
E1 |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Technical |
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Search speed was too slow |
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| ACQLiv0010437 |
E1 |
What error message did you receive: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Technical |
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| ACQLiv0010438 |
F |
What were you issues with the search tips? (Please select all that apply.) |
The search tips were not helpful |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Tips |
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Displays no results |
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Too much information returned when using the search tips function |
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Not enough results are shown when using the search tips function |
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| ACQLiv0010439 |
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How did you look for information/navigate the site today? (Please select all that apply.) |
Search feature |
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Checkbox, one-up vertical |
Multi |
Y |
OPS Group |
Look for Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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Other (please specify): |
A |
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| ACQLiv0010440 |
A |
Other way I looked for information: |
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Text area, no char limit |
Single |
N |
OPS Group |
OE_Look for Info |
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| ACQLiv0010441 |
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Which of these method(s) led you to the information you were looking for? |
Search feature |
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Radio button, one-up vertical |
Single |
Y |
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Method Found Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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None of these |
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Don't recall |
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| ACQLiv0010442 |
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How would you describe your experience browsing/looking for information on this site today? (Please select all that apply.) |
I had no difficulty browsing/looking for information on this site |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Navigation Experience |
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Links often did not take me where I expected |
B |
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Had difficulty finding relevant information |
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Too many links/navigational options to choose from |
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Had technical difficulties (error messages, broken links, etc.) |
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Could not navigate back to previous information |
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I had a navigation difficulty not listed above: |
A |
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| ACQLiv0010443 |
A |
Other navigation difficulty: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Experience |
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| ACQLiv0010444 |
B |
Please describe the specific navigation links or paths that did not take you where they should have. |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Paths |
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| CWS01715 |
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Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
Y |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
Y |
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Email Sat |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
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Text area, no char limit |
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N |
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Low Rate |
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| CWS01718 |
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Where are you located? |
Alabama |
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Drop down, select one |
Single |
Y |
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Other |
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| CWS01719 |
|
If you could identify one improvement to this site, what would that improvement be? |
|
|
Text area, no char limit |
|
N |
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Improvements |
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| Model Instance Name: |
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|
red & strike-through: DELETE |
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| CMS - Cahaba J10 MAC |
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underlined & italicized: RE-ORDER |
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| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
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|
pink: ADDITION |
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| Date: |
10/1/2009 |
blue + -->: REWORDING |
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| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
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|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
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|
| AED08187 |
|
What is your Medicare line of business? |
Alabama Part A |
|
Drop down, select one |
Single |
Y |
|
Medicare line |
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Alabama Part B |
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Georgia Part A |
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Georgia Part B |
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Mississippi Part B |
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Tennessee Part A |
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Tennessee Part B |
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HH&H |
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ESRD |
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Religious Non-medical Health Care Institution (RNHC) |
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Independent Organ Procurement Organization |
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Histocompatibility Lab |
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None of the above |
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| 51958 |
|
Which best describes you? |
Provider of medical services |
|
Radio button, one-up vertical |
Single |
Y |
|
Role |
Required by CMS |
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| Supplier of medical equipment or supplies |
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Staff of provider/supplier working primarily with billing/insurance |
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| Administrative staff of a provider/supplier |
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| Other staff of a provider/supplier |
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| Consultant or attorney |
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| Billing service |
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| Other (please specify) |
SKIP A |
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| 7000003 |
SKIP A |
Other - which best describes you? |
|
|
Text field, <100 char |
|
Y |
|
OE_Role |
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| C51960 |
|
What is your primary reason for visiting this site today? |
Download forms |
|
Radio button, one-up vertical |
Single |
Y |
|
Primary Visit Reason |
Required by CMS |
|
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| Learn of, or register for, workshops, seminars or other training events |
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| Find contact information |
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| Find general Medicare program information |
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| Research a specific question on Medicare policy or billing |
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| Find information on fees or fee schedules |
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| Find out about a Local Coverage Determination (LCD) |
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| Read Medicare publications such as newsletters, articles,etc. |
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| Find enrollment information |
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| Take an on-line training course |
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| Other (please specify) |
SKIP B |
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| C7000004 |
SKIP B |
Other - primary reason? |
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Text field, <100 char |
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OE_Reason |
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| C51957 |
|
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 |
|
Visit Frequency |
Required by CMS |
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| Once or twice |
Z,Y |
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| Three or four times |
Z,Y |
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| More than once per week but not every day |
Z,Y |
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| Every day |
Z,Y |
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| ACQwil0013783 |
Z |
Please select the statement which best describes your experience with the new Cahaba site redesign: |
It is easier to find what I'm looking for |
|
Radio button, one-up vertical |
Single |
Y |
|
Site Redesign |
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It is harder to find what I'm looking for |
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My experience is no different when looking at information on the new site |
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Don't know |
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| ACQwil0013784 |
Y |
Please tell us what you think of the new Cahaba site: |
|
|
Text area, no char limit |
|
N |
|
OE_New Site |
|
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| CWS01706 |
|
Did you find what you were looking for? |
Yes - I found what I was looking for |
|
Drop down, select one |
Single |
Y |
|
Found Info |
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No - I did not find what I was looking for |
C/H |
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I don't know yet; I am still looking |
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I wasn't looking for anything in particular |
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| CWS01707 |
H |
Please tell us exactly what you were looking for. |
|
|
Text area, no char limit |
|
T |
|
Looking For |
|
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| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
|
Radio button, one-up vertical |
Single |
Y |
|
Do Next |
Recommended by CMS |
|
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Call the Cahaba call center |
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Return to the Cahaba website later and try again |
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Send an email |
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Write a letter |
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Other (please specify) |
D |
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| CWS01709 |
D |
Please describe what you will do next. |
|
|
Text area, no char limit |
|
Y |
|
OE_Do Next |
|
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| CWS01710 |
|
Which areas of the site did you primarily use today? |
News |
|
Radio button, one-up vertical |
Single |
Y |
|
Area Used |
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Calendar of events |
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Transition schedule |
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Local Coverage Determinations (LCDs) |
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Frequently Asked Questions (FAQs) |
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Past Correspondences/Communications |
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Contact Information |
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Other (please specify) |
E |
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| CWS01711 |
E |
Other Area Used |
|
|
Text field, <100 char |
|
Y |
|
OE_Area Used |
|
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| EDO05180 |
|
In addition to the currently used communication tools (example: Internet, email lists), would you be interested in receiving Cahaba Medicare Services related information through the following Social Media outlets: (Please select all that apply) |
Facebook |
|
Checkbox, one-up vertical |
Multi |
Y |
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Twitter |
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YouTube |
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RSS Feed |
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Podcast |
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LinkedIn |
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None |
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Other (please specify) |
A |
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| EDO05181 |
A |
Please list the other social media outlet: |
|
|
Text area, no char limit |
|
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|
| EDO05182 |
|
Does your place of business allow you to access social media outlets for work-related information during work hours? (i.e. Facebook, YouTube etc.) |
Yes |
|
Radio button, one-up vertical |
Single |
Y |
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No |
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| EDO05183 |
|
Would you access Cahaba Medicare Services social media outlets for information during off/non-business hours? |
Yes |
|
Radio button, one-up vertical |
Single |
Y |
|
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No |
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|
| ACQLiv0010428 |
|
Did you use the search feature during your visit today? |
Yes |
F |
Radio button, one-up vertical |
Single |
Y |
Skip Logic Group |
Search Usage |
|
|
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|
No |
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Don't recall |
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|
| ACQLiv0010429 |
F |
Please tell us about your experience with the site's search feature today. (Please select all that apply.) |
The search feature met my needs today. |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Experience |
|
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|
|
I had issues with the basic search process (how to use it, terms to enter). |
A |
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I had issues with the visual display of the search results (text size, images). |
B |
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I had issues with the search results I received. |
C |
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I had issues with sorting, filtering, advanced search or lack of these options. |
D |
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I had technical issues with the search feature. |
E |
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The search tips were not useful |
F |
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None of these |
|
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|
|
| ACQLiv0010430 |
A |
What were your issues with the basic search process? (Please select all that apply.) |
It was not clear to me how to use the search feature |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Process |
|
|
|
|
|
|
I did not know what terms to use to get the results I wanted |
|
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|
There were too many steps or refinements to get to what I wanted |
|
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|
None of these |
|
|
|
|
|
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|
|
|
| ACQLiv0010431 |
B |
What were your issues with the visual display of the search results? (Please select all that apply.) |
I could not see enough of the description to decide which link to choose |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Display |
|
|
|
|
|
|
The text was too small |
|
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|
The page was too crowded |
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I could not see much difference between the listings/items |
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None of these |
|
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|
| ACQLiv0010432 |
C |
What were your issues with the search results? (Please select all that apply.) |
Results were not relevant/not what I wanted |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Results |
|
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|
There were not enough results |
|
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There were NO results |
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There were too many results |
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| ACQLiv0010433 |
D |
What were your issues with sorting, filtering, or advanced search? (Please select all that apply.) |
The results were not sorted in a helpful way |
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Checkbox, one-up vertical |
Multi |
Y |
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Search Sorting |
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I want advanced search options |
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I want the following sorting/filtering/advanced option: |
D1 |
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I had a different sorting/filtering issue: |
D2 |
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| ACQLiv0010434 |
D1 |
Sorting/filtering/advanced option: |
Open-ended |
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Text area, no char limit |
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OE_Search Filter1 |
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| ACQLiv0010435 |
D2 |
My issue was: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Filter2 |
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| ACQLiv0010436 |
E |
What were your technical issues with the search feature? (Please select all that apply.) |
Error message(s) |
E1 |
Checkbox, one-up vertical |
Multi |
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Skip Logic Group |
Search Technical |
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Search speed was too slow |
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| ACQLiv0010437 |
E1 |
What error message did you receive: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Technical |
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| ACQLiv0010438 |
F |
What were you issues with the search tips? (Please select all that apply.) |
The search tips were not helpful |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Tips |
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Displays no results |
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Too much information returned when using the search tips function |
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Not enough results are shown when using the search tips function |
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| ACQLiv0010439 |
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How did you look for information/navigate the site today? (Please select all that apply.) |
Search feature |
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Checkbox, one-up vertical |
Multi |
Y |
OPS Group |
Look for Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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Other (please specify): |
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| ACQLiv0010440 |
A |
Other way I looked for information: |
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Text area, no char limit |
Single |
N |
OPS Group |
OE_Look for Info |
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| ACQLiv0010441 |
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Which of these method(s) led you to the information you were looking for? |
Search feature |
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Radio button, one-up vertical |
Single |
Y |
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Method Found Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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None of these |
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Don't recall |
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| ACQLiv0010442 |
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How would you describe your experience browsing/looking for information on this site today? (Please select all that apply.) |
I had no difficulty browsing/looking for information on this site |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Navigation Experience |
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Links often did not take me where I expected |
B |
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Had difficulty finding relevant information |
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Too many links/navigational options to choose from |
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Had technical difficulties (error messages, broken links, etc.) |
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Could not navigate back to previous information |
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I had a navigation difficulty not listed above: |
A |
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| ACQLiv0010443 |
A |
Other navigation difficulty: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Experience |
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| ACQLiv0010444 |
B |
Please describe the specific navigation links or paths that did not take you where they should have. |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Paths |
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| CWS01715 |
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Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
Y |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
Y |
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Email Sat |
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2 |
G |
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9 |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
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Text area, no char limit |
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N |
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Low Rate |
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| CWS01718 |
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Where are you located? |
Alabama |
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Drop down, select one |
Single |
Y |
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Located |
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Georgia |
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Tennessee |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia (Washington DC) |
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Florida |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Rhode Island |
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South Carolina |
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South Dakota |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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Other |
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| CWS01719 |
|
If you could identify one improvement to this site, what would that improvement be? |
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|
Text area, no char limit |
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N |
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Improvements |
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| Model Instance Name: |
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|
red & strike-through: DELETE |
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| CMS - Cahaba J10 MAC |
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underlined & italicized: RE-ORDER |
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| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
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pink: ADDITION |
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| Date: |
10/1/2009 |
blue + -->: REWORDING |
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| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
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QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
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| AED08187 |
|
What is your Medicare line of business? |
Alabama Part A |
|
Drop down, select one |
Single |
Y |
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Medicare line |
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Alabama Part B |
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Georgia Part A |
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Georgia Part B |
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Mississippi Part B |
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Tennessee Part A |
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Tennessee Part B |
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HH&H |
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ESRD |
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Religious Non-medical Health Care Institution (RNHC) |
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Independent Organ Procurement Organization |
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Histocompatibility Lab |
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None of the above |
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| 51958 |
|
Which best describes you? |
Provider of medical services |
|
Radio button, one-up vertical |
Single |
Y |
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Role |
Required by CMS |
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| Supplier of medical equipment or supplies |
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Staff of provider/supplier working primarily with billing/insurance |
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| Administrative staff of a provider/supplier |
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| Other staff of a provider/supplier |
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| Consultant or attorney |
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| Billing service |
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| Other (please specify) |
SKIP A |
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| 7000003 |
SKIP A |
Other - which best describes you? |
|
|
Text field, <100 char |
|
Y |
|
OE_Role |
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| C51960 |
|
What is your primary reason for visiting this site today? |
Download forms |
|
Radio button, one-up vertical |
Single |
Y |
|
Primary Visit Reason |
Required by CMS |
|
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| Learn of, or register for, workshops, seminars or other training events |
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| Find contact information |
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| Find general Medicare program information |
|
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| Research a specific question on Medicare policy or billing |
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| Find information on fees or fee schedules |
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| Find out about a Local Coverage Determination (LCD) |
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| Read Medicare publications such as newsletters, articles,etc. |
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| Find enrollment information |
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| Take an on-line training course |
|
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| Other (please specify) |
SKIP B |
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| C7000004 |
SKIP B |
Other - primary reason? |
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Text field, <100 char |
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OE_Reason |
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| C51957 |
|
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 |
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Visit Frequency |
Required by CMS |
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| Once or twice |
Z,Y |
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| Three or four times |
Z,Y |
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| More than once per week but not every day |
Z,Y |
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| Every day |
Z,Y |
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| |
Z |
Please select the statement which best describes your experience with the new Cahaba site redesign: |
It is easier to find what I'm looking for |
|
Radio button, one-up vertical |
Single |
Y |
|
Site Redesign |
|
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It is harder to find what I'm looking for |
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My experience is no different when looking at information on the new site |
|
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Don't know |
|
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|
Y |
Please tell us what you think of the new Cahaba site: |
|
|
Text area, no char limit |
|
N |
|
OE_New Site |
|
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| CWS01706 |
|
Did you find what you were looking for? |
Yes - I found what I was looking for |
|
Drop down, select one |
Single |
Y |
|
Found Info |
|
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|
No - I did not find what I was looking for |
C/H |
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I don't know yet; I am still looking |
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I wasn't looking for anything in particular |
|
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| CWS01707 |
H |
Please tell us exactly what you were looking for. |
|
|
Text area, no char limit |
|
T |
|
Looking For |
|
|
|
| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
|
Radio button, one-up vertical |
Single |
Y |
|
Do Next |
Recommended by CMS |
|
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|
Call the Cahaba call center |
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Return to the Cahaba website later and try again |
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Send an email |
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Write a letter |
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Other (please specify) |
D |
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| CWS01709 |
D |
Please describe what you will do next. |
|
|
Text area, no char limit |
|
Y |
|
OE_Do Next |
|
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| CWS01710 |
|
Which areas of the site did you primarily use today? |
News |
|
Radio button, one-up vertical |
Single |
Y |
|
Area Used |
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Calendar of events |
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Transition schedule |
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Local Coverage Determinations (LCDs) |
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Frequently Asked Questions (FAQs) |
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Past Correspondences/Communications |
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Contact Information |
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Other (please specify) |
E |
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Other Area Used |
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OE_Area Used |
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| EDO05180 |
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In addition to the currently used communication tools (example: Internet, email lists), would you be interested in receiving Cahaba Medicare Services related information through the following Social Media outlets: (Please select all that apply) |
Facebook |
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Y |
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Twitter |
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YouTube |
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RSS Feed |
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Podcast |
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LinkedIn |
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None |
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Other (please specify) |
A |
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| EDO05181 |
A |
Please list the other social media outlet: |
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| EDO05182 |
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Does your place of business allow you to access social media outlets for work-related information during work hours? (i.e. Facebook, YouTube etc.) |
Yes |
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Y |
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No |
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| EDO05183 |
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Would you access Cahaba Medicare Services social media outlets for information during off/non-business hours? |
Yes |
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Y |
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No |
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| ACQLiv0010428 |
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Did you use the search feature during your visit today? |
Yes |
F |
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Y |
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Search Usage |
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No |
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Don't recall |
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Please tell us about your experience with the site's search feature today. (Please select all that apply.) |
The search feature met my needs today. |
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Y |
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Search Experience |
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I had issues with the basic search process (how to use it, terms to enter). |
A |
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I had issues with the visual display of the search results (text size, images). |
B |
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I had issues with the search results I received. |
C |
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I had issues with sorting, filtering, advanced search or lack of these options. |
D |
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I had technical issues with the search feature. |
E |
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The search tips were not useful |
F |
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None of these |
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| ACQLiv0010430 |
A |
What were your issues with the basic search process? (Please select all that apply.) |
It was not clear to me how to use the search feature |
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Search Process |
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I did not know what terms to use to get the results I wanted |
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There were too many steps or refinements to get to what I wanted |
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None of these |
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| ACQLiv0010431 |
B |
What were your issues with the visual display of the search results? (Please select all that apply.) |
I could not see enough of the description to decide which link to choose |
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Y |
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The text was too small |
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The page was too crowded |
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I could not see much difference between the listings/items |
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None of these |
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| ACQLiv0010432 |
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What were your issues with the search results? (Please select all that apply.) |
Results were not relevant/not what I wanted |
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Search Results |
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There were not enough results |
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There were NO results |
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There were too many results |
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There was too little information in the results to decide what to choose |
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Many of the search results looked the same |
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I had other issues with the search results |
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| ACQLiv0010433 |
D |
What were your issues with sorting, filtering, or advanced search? (Please select all that apply.) |
The results were not sorted in a helpful way |
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Multi |
Y |
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Search Sorting |
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I want advanced search options |
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I want the following sorting/filtering/advanced option: |
D1 |
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I had a different sorting/filtering issue: |
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| ACQLiv0010434 |
D1 |
Sorting/filtering/advanced option: |
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| ACQLiv0010435 |
D2 |
My issue was: |
Open-ended |
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Single |
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OE_Search Filter2 |
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| ACQLiv0010436 |
E |
What were your technical issues with the search feature? (Please select all that apply.) |
Error message(s) |
E1 |
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Search speed was too slow |
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| ACQLiv0010437 |
E1 |
What error message did you receive: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Technical |
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| ACQLiv0010438 |
F |
What were you issues with the search tips? (Please select all that apply.) |
The search tips were not helpful |
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Multi |
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Search Tips |
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Displays no results |
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Too much information returned when using the search tips function |
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Not enough results are shown when using the search tips function |
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| ACQLiv0010439 |
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How did you look for information/navigate the site today? (Please select all that apply.) |
Search feature |
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Multi |
Y |
OPS Group |
Look for Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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Other (please specify): |
A |
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| ACQLiv0010440 |
A |
Other way I looked for information: |
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Text area, no char limit |
Single |
N |
OPS Group |
OE_Look for Info |
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| ACQLiv0010441 |
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Which of these method(s) led you to the information you were looking for? |
Search feature |
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Method Found Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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None of these |
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Don't recall |
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| ACQLiv0010442 |
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How would you describe your experience browsing/looking for information on this site today? (Please select all that apply.) |
I had no difficulty browsing/looking for information on this site |
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Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Navigation Experience |
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Links often did not take me where I expected |
B |
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Had difficulty finding relevant information |
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Too many links/navigational options to choose from |
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Had technical difficulties (error messages, broken links, etc.) |
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Could not navigate back to previous information |
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I had a navigation difficulty not listed above: |
A |
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| ACQLiv0010443 |
A |
Other navigation difficulty: |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Experience |
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| ACQLiv0010444 |
B |
Please describe the specific navigation links or paths that did not take you where they should have. |
Open-ended |
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Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Paths |
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| CWS01715 |
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Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
Y |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
Y |
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Email Sat |
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2 |
G |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
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Text area, no char limit |
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N |
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Low Rate |
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| CWS01718 |
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Where are you located? |
Alabama |
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Drop down, select one |
Single |
Y |
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Located |
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Georgia |
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Tennessee |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia (Washington DC) |
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Florida |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Rhode Island |
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South Carolina |
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South Dakota |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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Other |
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| CWS01719 |
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If you could identify one improvement to this site, what would that improvement be? |
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Text area, no char limit |
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N |
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Improvements |
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| Model Instance Name: |
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red & strike-through: DELETE |
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| CMS - Cahaba J10 MAC |
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underlined & italicized: RE-ORDER |
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| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
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pink: ADDITION |
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| Date: |
10/1/2009 |
blue + -->: REWORDING |
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| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
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QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
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| AED08187 |
|
What is your Medicare line of business? |
Alabama Part A |
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Drop down, select one |
Single |
Y |
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Medicare line |
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Alabama Part B |
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Georgia Part A |
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Georgia Part B |
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Mississippi Part B |
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Tennessee Part A |
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Tennessee Part B |
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HH&H |
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ESRD |
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Religious Non-medical Health Care Institution (RNHC) |
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Independent Organ Procurement Organization |
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Histocompatibility Lab |
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None of the above |
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| 51958 |
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Which best describes you? |
Provider of medical services |
|
Radio button, one-up vertical |
Single |
Y |
|
Role |
Required by CMS |
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| Supplier of medical equipment or supplies |
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Staff of provider/supplier working primarily with billing/insurance |
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| Administrative staff of a provider/supplier |
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| Other staff of a provider/supplier |
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| Consultant or attorney |
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| Billing service |
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| Other (please specify) |
SKIP A |
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| 7000003 |
SKIP A |
Other - which best describes you? |
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Text field, <100 char |
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Y |
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OE_Role |
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| C51960 |
|
What is your primary reason for visiting this site today? |
Download forms |
|
Radio button, one-up vertical |
Single |
Y |
|
Primary Visit Reason |
Required by CMS |
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| Learn of, or register for, workshops, seminars or other training events |
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| Find contact information |
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| Find general Medicare program information |
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| Research a specific question on Medicare policy or billing |
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| Find information on fees or fee schedules |
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| Find out about a Local Coverage Determination (LCD) |
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| Read Medicare publications such as newsletters, articles,etc. |
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| Find enrollment information |
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| Take an on-line training course |
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| Other (please specify) |
SKIP B |
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| C7000004 |
SKIP B |
Other - primary reason? |
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Text field, <100 char |
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OE_Reason |
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| C51957 |
|
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 |
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Visit Frequency |
Required by CMS |
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| Once or twice |
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| Three or four times |
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| More than once per week but not every day |
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| Every day |
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| CWS01706 |
|
Did you find what you were looking for? |
Yes - I found what I was looking for |
|
Drop down, select one |
Single |
Y |
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Found Info |
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No - I did not find what I was looking for |
C/H |
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I don't know yet; I am still looking |
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I wasn't looking for anything in particular |
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| CWS01707 |
H |
Please tell us exactly what you were looking for. |
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Text area, no char limit |
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T |
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Looking For |
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| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
|
Radio button, one-up vertical |
Single |
Y |
|
Do Next |
Recommended by CMS |
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Call the Cahaba call center |
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Return to the Cahaba website later and try again |
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Send an email |
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Write a letter |
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Other (please specify) |
D |
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| CWS01709 |
D |
Please describe what you will do next. |
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Text area, no char limit |
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Y |
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OE_Do Next |
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| CWS01710 |
|
Which areas of the site did you primarily use today? |
News |
|
Radio button, one-up vertical |
Single |
Y |
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Area Used |
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Calendar of events |
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Transition schedule |
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Local Coverage Determinations (LCDs) |
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Frequently Asked Questions (FAQs) |
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Past Correspondences/Communications |
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Contact Information |
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Other (please specify) |
E |
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| CWS01711 |
E |
Other Area Used |
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Text field, <100 char |
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Y |
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OE_Area Used |
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Did you use the search feature during your visit today? |
Yes |
F |
Radio button, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Usage |
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No |
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Don't recall |
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F |
Please tell us about your experience with the site's search feature today. (Please select all that apply.) |
The search feature met my needs today. |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Experience |
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I had issues with the basic search process (how to use it, terms to enter). |
A |
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I had issues with the visual display of the search results (text size, images). |
B |
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I had issues with the search results I received. |
C |
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I had issues with sorting, filtering, advanced search or lack of these options. |
D |
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I had technical issues with the search feature. |
E |
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The search tips were not useful |
F |
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None of these |
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A |
What were your issues with the basic search process? (Please select all that apply.) |
It was not clear to me how to use the search feature |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Process |
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I did not know what terms to use to get the results I wanted |
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There were too many steps or refinements to get to what I wanted |
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None of these |
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B |
What were your issues with the visual display of the search results? (Please select all that apply.) |
I could not see enough of the description to decide which link to choose |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Display |
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The text was too small |
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The page was too crowded |
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I could not see much difference between the listings/items |
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None of these |
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C |
What were your issues with the search results? (Please select all that apply.) |
Results were not relevant/not what I wanted |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Results |
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There were not enough results |
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There were NO results |
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There were too many results |
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There was too little information in the results to decide what to choose |
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Many of the search results looked the same |
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I had other issues with the search results |
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D |
What were your issues with sorting, filtering, or advanced search? (Please select all that apply.) |
The results were not sorted in a helpful way |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Sorting |
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I want advanced search options |
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I want the following sorting/filtering/advanced option: |
D1 |
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I had a different sorting/filtering issue: |
D2 |
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D1 |
Sorting/filtering/advanced option: |
Open-ended |
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Filter1 |
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D2 |
My issue was: |
Open-ended |
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Filter2 |
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E |
What were your technical issues with the search feature? (Please select all that apply.) |
Error message(s) |
E1 |
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Technical |
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|
Search speed was too slow |
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E1 |
What error message did you receive: |
Open-ended |
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Search Technical |
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F |
What were you issues with the search tips? (Please select all that apply.) |
The search tips were not helpful |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Search Tips |
|
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Displays no results |
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Too much information returned when using the search tips function |
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Not enough results are shown when using the search tips function |
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How did you look for information/navigate the site today? (Please select all that apply.) |
Search feature |
|
Checkbox, one-up vertical |
Multi |
Y |
OPS Group |
Look for Info |
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Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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Other (please specify): |
A |
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A |
Other way I looked for information: |
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|
Text area, no char limit |
Single |
N |
OPS Group |
OE_Look for Info |
|
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|
|
Which of these method(s) led you to the information you were looking for? |
Search feature |
|
Radio button, one-up vertical |
Single |
Y |
|
Method Found Info |
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|
Advanced search feature/tool |
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Top navigation bar |
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Links in the center of the page |
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Medicare Part A or B Quick links |
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Site map |
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None of these |
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Don't recall |
|
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|
|
How would you describe your experience browsing/looking for information on this site today? (Please select all that apply.) |
I had no difficulty browsing/looking for information on this site |
|
Checkbox, one-up vertical |
Multi |
Y |
Skip Logic Group |
Navigation Experience |
|
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|
|
Links often did not take me where I expected |
B |
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Had difficulty finding relevant information |
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Too many links/navigational options to choose from |
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Had technical difficulties (error messages, broken links, etc.) |
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Could not navigate back to previous information |
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I had a navigation difficulty not listed above: |
A |
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A |
Other navigation difficulty: |
Open-ended |
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Experience |
|
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|
|
B |
Please describe the specific navigation links or paths that did not take you where they should have. |
Open-ended |
|
Text area, no char limit |
Single |
N |
Skip Logic Group |
OE_Nav Paths |
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|
CWS01712 |
|
How are you primarily navigating through the website? |
Links within the page |
|
Drop down, select one |
Single |
Y |
|
Primary Nav Method |
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Top Navigation Bar |
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Bottom Navigation Bar |
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Search Tool |
H |
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Site Map |
|
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|
CWS01713 |
H |
What was your experience with the search functionality? |
I had no difficulty searching on this site |
|
Radio button, one-up vertical |
Single |
Y |
|
Search Exp |
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Too many results |
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Too few results |
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Returned no results |
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Received an error message |
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Results were not what I was looking for |
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Other search issue |
I |
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|
CWS01714 |
I |
Please describe your experience with search. |
|
|
Text area, no char limit |
|
Y |
|
OE_Search Exp |
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| CWS01715 |
|
Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
Y |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
Y |
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Email Sat |
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2 |
G |
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3 |
G |
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4 |
G |
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5 |
G |
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6 |
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7 |
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8 |
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9 |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
|
|
Text area, no char limit |
|
N |
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Low Rate |
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| CWS01718 |
|
Where are you located? |
Alabama |
|
Drop down, select one |
Single |
Y |
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Located |
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Georgia |
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Tennessee |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia (Washington DC) |
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Florida |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Mississippi |
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Missouri |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Texas |
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Utah |
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Vermont |
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West Virginia |
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Wyoming |
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Other |
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| CWS01719 |
|
If you could identify one improvement to this site, what would that improvement be? |
|
|
Text area, no char limit |
|
N |
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Improvements |
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| Model Instance Name: |
|
|
red & strike-through: DELETE |
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| CMS - Cahaba J10 MAC |
|
|
underlined & italicized: RE-ORDER |
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| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
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pink: ADDITION |
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| Date: |
7/30/2009 |
blue + -->: REWORDING |
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| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
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QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
| AED08187 |
|
What is your Medicare line of business? |
Alabama Part A |
|
Drop down, select one |
Single |
Y |
|
Medicare line |
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Alabama Part B |
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Georgia Part A |
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Georgia Part B |
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Mississippi Part B |
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Tennessee Part A |
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Tennessee Part B |
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HH&H |
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ESRD |
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Religious Non-medical Health Care Institution (RNHC) |
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Independent Organ Procurement Organization |
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Histocompatibility Lab |
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None of the above |
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| C51958 |
|
Which best describes you? |
Provider of medical services |
|
Radio button, one-up vertical |
Single |
Y |
|
Role |
Required by CMS |
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| Supplier of medical equipment or supplies |
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Staff of a provider/supplier who works primarily with billing or insurance
Staff of provider/supplier working primarily with billing/insurance |
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| Administrative staff of a provider/supplier |
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| Other staff of a provider/supplier |
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Provider/supplier |
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| Consultant or attorney |
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| Billing service |
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Local, state, or federal government employee or contractor |
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Software vendor |
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Other health care insurer or agency |
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| Other (please specify) |
SKIP A |
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| C7000003 |
SKIP A |
Other - which best describes you? |
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Text field, <100 char |
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Y |
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OE_Role |
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| C51960 |
|
What is your primary reason for visiting this site today? |
Download forms |
|
Radio button, one-up vertical |
Single |
Y |
|
Primary Visit Reason |
Required by CMS |
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| Learn of, or register for, workshops, seminars or other training events |
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| Find contact information |
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| Find general Medicare program information |
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| Research a specific question on Medicare policy or billing |
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| Find information on fees or fee schedules |
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| Find out about a Local Coverage Determination (LCD) |
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| Read Medicare publications such as newsletters, articles, press releases, etc. |
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| Find enrollment information |
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| Take an on-line training course |
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| Other (please specify) |
SKIP B |
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| C7000004 |
SKIP B |
Other - primary reason? |
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Text field, <100 char |
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OE_Reason |
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| C51957 |
|
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 |
|
Visit Frequency |
Required by CMS |
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| Once or twice before |
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| Three or four times before |
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| More than once per week but not every day |
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| Every day |
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| CWS01706 |
|
Did you find what you were looking for? |
Yes - I found what I was looking for |
|
Drop down, select one |
Single |
Y |
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Found Info |
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No - I did not find what I was looking for |
C/H |
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I don't know yet; I am still looking |
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I wasn't looking for anything in particular |
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| CWS01707 |
H |
Please tell us exactly what you were looking for. |
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|
Text area, no char limit |
|
T |
|
Looking For |
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| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
|
Radio button, one-up vertical |
Single |
Y |
|
Do Next |
Recommended by CMS |
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Call the Cahaba call center |
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Return to the Cahaba website later and try again |
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Send an email |
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Write a letter |
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Other (please specify) |
D |
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| CWS01709 |
D |
Please describe what you will do next. |
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Text area, no char limit |
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Y |
|
OE_Do Next |
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| CWS01710 |
|
Which areas of the site did you primarily use today? |
News |
|
Radio button, one-up vertical |
Single |
Y |
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Area Used |
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Calendar of events |
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Transition schedule |
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Local Coverage Determinations (LCDs) |
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Frequently Asked Questions (FAQs) |
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Past Correspondences/Communications |
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Contact Information |
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Other (please specify) |
E |
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| CWS01711 |
E |
Other Area Used |
|
|
Text field, <100 char |
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Y |
|
OE_Area Used |
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| CWS01712 |
|
How are you primarily navigating through the website? |
Links within the page |
|
Drop down, select one |
Single |
Y |
|
Primary Nav Method |
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Top Navigation Bar |
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Bottom Navigation Bar |
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Search Tool |
H |
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Site Map |
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| CWS01713 |
H |
What was your experience with the search functionality? |
I had no difficulty searching on this site |
|
Radio button, one-up vertical |
Single |
Y |
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Search Exp |
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Too many results |
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Too few results |
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Returned no results |
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Received an error message |
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Results were not what I was looking for |
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Other search issue |
I |
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| CWS01714 |
I |
Please describe your experience with search. |
|
|
Text area, no char limit |
|
Y |
|
OE_Search Exp |
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| CWS01715 |
|
Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
Y |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
Y |
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Email Sat |
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2 |
G |
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3 |
G |
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4 |
G |
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5 |
G |
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9 |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
|
|
Text area, no char limit |
|
N |
|
Low Rate |
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| CWS01718 |
|
Where are you located? |
Alabama |
|
Drop down, select one |
Single |
Y |
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Located |
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Georgia |
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Tennessee |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia (Washington DC) |
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Florida |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Mississippi |
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Missouri |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Rhode Island |
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South Carolina |
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South Dakota |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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Other |
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|
| CWS01719 |
|
If you could identify one improvement to this site, what would that improvement be? |
|
|
Text area, no char limit |
|
N |
|
Improvements |
|
|
|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
|
|
|
|
|
|
|
|
|
| CMS - Cahaba J10 MAC |
|
|
underlined & italicized: RE-ORDER |
|
|
|
|
|
|
|
|
|
| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
|
|
pink: ADDITION |
|
|
|
|
|
|
|
|
|
| Date: |
7/30/2009 |
blue + -->: REWORDING |
|
|
|
|
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|
|
|
|
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|
|
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|
|
|
|
|
|
|
|
| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
|
|
|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
|
|
What is your Medicare line of business? |
Alabama Part A |
|
Drop down, select one |
Single |
Y |
|
Medicare line |
|
|
|
|
|
|
Alabama Part B |
|
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Georgia Part A |
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Georgia Part B |
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Mississippi Part B |
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Tennessee Part A |
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Tennessee Part B |
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HH&H |
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|
ESRD |
|
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|
Religious Non-medical Health Care Institution (RNHC) |
|
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|
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|
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|
|
|
Independent Organ Procurement Organization |
|
|
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|
|
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|
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|
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|
|
Histocompatibility Lab |
|
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|
|
|
|
|
|
|
|
|
|
None of the above |
|
|
|
|
|
|
|
|
|
| 51958 |
|
Which best describes you? |
Billing or administrative staff for provider/supplier |
|
Radio button, one-up vertical |
Single |
Y |
|
Role |
Required by CMS |
|
|
|
|
|
Provider/supplier |
|
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Billing service |
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Consultant or attorney |
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Local, state, or federal government employee or contractor |
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Software vendor |
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Other health care insurer or agency |
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Other (please specify) |
A |
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| 7000003 |
A |
Other - best describes |
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Text field, <100 char |
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Y |
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OE_Role |
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|
| 51960 |
|
What is your primary reason for visiting this site today? |
Download forms |
|
Radio button, one-up vertical |
Single |
Y |
|
Primary Visit Reason |
Required by CMS |
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Find contact information |
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Find enrollment information |
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Find general Medicare program information |
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Find information on fees or fee schedules |
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Find out about Local Coverage Determination (LCD) |
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Learn of, or register form, workshops, seminars or other training events |
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Read Medicare publications such as newsletters, press releases, etc. |
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Research a specific question on Medicare policy or billing |
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Take an on-line training course |
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Other (please specify) |
B |
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| 7000004 |
B |
Other - primary reason |
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Text field, <100 char |
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OE_Reason |
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| 51957 |
|
In the last 30 days, how many times have you visited this Web site? |
This is my first time |
|
Radio button, one-up vertical |
Single |
Y |
|
Visit Frequency |
Required by CMS |
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Once or twice before |
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Three or four times before |
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More than once per week but not every day |
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Every day |
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| CWS01706 |
|
Did you find what you were looking for? |
Yes - I found what I was looking for |
|
Drop down, select one |
Single |
Y |
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Found Info |
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|
No - I did not find what I was looking for |
C/H |
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I don't know yet; I am still looking |
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I wasn't looking for anything in particular |
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| CWS01707 |
H |
Please tell us exactly what you were looking for. |
|
|
Text area, no char limit |
|
T |
|
Looking For |
|
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|
| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
|
Radio button, one-up vertical |
Single |
Y |
|
Do Next |
Recommended by CMS |
|
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|
Call the Cahaba call center |
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Return to the Cahaba website later and try again |
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Send an email |
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Write a letter |
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Other (please specify) |
D |
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| CWS01709 |
D |
Please describe what you will do next. |
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|
Text area, no char limit |
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Y |
|
OE_Do Next |
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| CWS01710 |
|
Which areas of the site did you primarily use today? |
News |
|
Radio button, one-up vertical |
Single |
Y |
|
Area Used |
|
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Calendar of events |
|
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Transition schedule |
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Local Coverage Determinations (LCDs) |
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Frequently Asked Questions (FAQs) |
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Past Correspondences/Communications |
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Contact Information |
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Other (please specify) |
E |
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| CWS01711 |
E |
Other Area Used |
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|
Text field, <100 char |
|
Y |
|
OE_Area Used |
|
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| CWS01712 |
|
How are you primarily navigating through the website? |
Links within the page |
|
Drop down, select one |
Single |
Y |
|
Primary Nav Method |
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Top Navigation Bar |
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Bottom Navigation Bar |
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Search Tool |
H |
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Site Map |
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| CWS01713 |
H |
What was your experience with the search functionality? |
I had no difficulty searching on this site |
|
Radio button, one-up vertical |
Single |
Y |
|
Search Exp |
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Too many results |
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Too few results |
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Returned no results |
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Received an error message |
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Results were not what I was looking for |
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Other search issue |
I |
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| CWS01714 |
I |
Please describe your experience with search. |
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|
Text area, no char limit |
|
Y |
|
OE_Search Exp |
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| CWS01715 |
|
Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
Y |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
Y |
|
Email Sat |
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2 |
G |
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3 |
G |
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4 |
G |
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G |
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9 |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
|
|
Text area, no char limit |
|
N |
|
Low Rate |
|
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| CWS01718 |
|
Where are you located? |
Alabama |
|
Drop down, select one |
Single |
Y |
|
Located |
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Georgia |
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Tennessee |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia (Washington DC) |
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Florida |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Mississippi |
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Missouri |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Rhode Island |
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South Carolina |
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South Dakota |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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Other |
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| CWS01719 |
|
If you could identify one improvement to this site, what would that improvement be? |
|
|
Text area, no char limit |
|
N |
|
Improvements |
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|
| Model Instance Name: |
|
|
red & strike-through: DELETE |
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| CMS - Cahaba J10 MAC |
|
|
underlined & italicized: RE-ORDER |
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| MID: FRkpwtNoQ0NxZVwZQcNs0A== |
|
|
pink: ADDITION |
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| Date: |
4/23/2009 |
blue + -->: REWORDING |
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| CMS - Cahaba J10 MAC CUSTOM QUESTION LIST |
|
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|
|
QID
(Group ID) |
Skip Logic Label |
Question Text |
Answer Choices
(limited to 50 characters) |
Skip to |
Type (select from list) |
Single or Multi |
Required
Y/N |
Special Instructions |
25 character limit. Leave blank if you want DOT to fill this part out.
CQ Label |
|
|
|
| 51958 |
|
Which best describes you? |
Billing or administrative staff for provider/supplier |
|
Radio button, one-up vertical |
Single |
Y |
|
Role |
Required by CMS |
|
|
|
|
|
Provider/supplier |
|
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|
|
|
|
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|
Billing service |
|
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Consultant or attorney |
|
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|
Local, state, or federal government employee or contractor |
|
|
|
|
|
|
|
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|
|
Software vendor |
|
|
|
|
|
|
|
|
|
|
Other health care insurer or agency |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
A |
|
|
|
|
|
|
| 7000003 |
A |
Other - best describes |
|
|
Text field, <100 char |
|
Y |
|
OE_Role |
|
|
| 51960 |
|
What is your primary reason for visiting this site today? |
Download forms |
|
Radio button, one-up vertical |
Single |
Y |
|
Primary Visit Reason |
Required by CMS |
|
|
|
|
|
Find contact information |
|
|
|
|
|
|
|
|
|
Find enrollment information |
|
|
|
|
|
|
|
|
|
Find general Medicare program information |
|
|
|
|
|
|
|
|
|
Find information on fees or fee schedules |
|
|
|
|
|
|
|
|
|
Find out about Local Coverage Determination (LCD) |
|
|
|
|
|
|
|
|
|
Learn of, or register form, workshops, seminars or other training events |
|
|
|
|
|
|
|
|
|
Read Medicare publications such as newsletters, press releases, etc. |
|
|
|
|
|
|
|
|
|
Research a specific question on Medicare policy or billing |
|
|
|
|
|
|
|
|
|
Take an on-line training course |
|
|
|
|
|
|
|
|
|
Other (please specify) |
B |
|
|
|
|
|
| 7000004 |
B |
Other - primary reason |
|
|
Text field, <100 char |
|
|
|
OE_Reason |
|
|
| 51957 |
|
In the last 30 days, how many times have you visited this Web site? |
This is my first time |
|
Radio button, one-up vertical |
Single |
Y |
|
Visit Frequency |
Required by CMS |
|
|
|
|
Once or twice before |
|
|
|
|
|
|
|
|
Three or four times before |
|
|
|
|
|
|
|
|
More than once per week but not every day |
|
|
|
|
|
|
|
|
Every day |
|
|
|
|
|
|
| CWS01706 |
|
Did you find what you were looking for? |
Yes - I found what I was looking for |
|
Drop down, select one |
Single |
Y |
|
Found Info |
|
|
|
|
|
|
No - I did not find what I was looking for |
C/H |
|
|
|
|
|
|
|
|
|
|
|
I don't know yet; I am still looking |
|
|
|
|
|
|
|
|
|
|
|
|
I wasn't looking for anything in particular |
|
|
|
|
|
|
|
|
|
| CWS01707 |
H |
Please tell us exactly what you were looking for. |
|
|
Text area, no char limit |
|
T |
|
Looking For |
|
|
|
| CWS01708 |
C |
What will you do next? |
Nothing, although I did not find/complete what I wanted |
|
Radio button, one-up vertical |
Single |
Y |
|
Do Next |
Recommended by CMS |
|
|
|
|
|
Call the Cahaba call center |
|
|
|
|
|
|
|
|
|
|
Return to the Cahaba website later and try again |
|
|
|
|
|
|
|
|
|
|
Send an email |
|
|
|
|
|
|
|
|
|
|
Write a letter |
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
D |
|
|
|
|
|
|
| CWS01709 |
D |
Please describe what you will do next. |
|
|
Text area, no char limit |
|
Y |
|
OE_Do Next |
|
|
| CWS01710 |
|
Which areas of the site did you primarily use today? |
News |
|
Radio button, one-up vertical |
Single |
Y |
|
Area Used |
|
|
|
|
|
|
Calendar of events |
|
|
|
|
|
|
|
|
|
|
|
Transition schedule |
|
|
|
|
|
|
|
|
|
|
|
Local Coverage Determinations (LCDs) |
|
|
|
|
|
|
|
|
|
|
|
Frequently Asked Questions (FAQs) |
|
|
|
|
|
|
|
|
|
|
|
Past Correspondences/Communications |
|
|
|
|
|
|
|
|
|
|
|
Contact Information |
|
|
|
|
|
|
|
|
|
|
|
Other (please specify) |
E |
|
|
|
|
|
|
|
| CWS01711 |
E |
Other Area Used |
|
|
Text field, <100 char |
|
Y |
|
OE_Area Used |
|
|
|
| CWS01712 |
|
How are you primarily navigating through the website? |
Links within the page |
|
Drop down, select one |
Single |
Y |
|
Primary Nav Method |
|
|
|
|
|
|
Top Navigation Bar |
|
|
|
|
|
|
|
|
|
|
|
Bottom Navigation Bar |
|
|
|
|
|
|
|
|
|
|
|
Search Tool |
H |
|
|
|
|
|
|
|
|
|
|
Site Map |
|
|
|
|
|
|
|
|
| CWS01713 |
H |
What was your experience with the search functionality? |
I had no difficulty searching on this site |
|
Radio button, one-up vertical |
Single |
Y |
|
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Returned no results |
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Received an error message |
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Results were not what I was looking for |
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Other search issue |
I |
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| CWS01714 |
I |
Please describe your experience with search. |
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Text area, no char limit |
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OE_Search Exp |
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| CWS01715 |
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Are you enrolled in our E-Mail Service? |
Yes |
F |
Drop down, select one |
Single |
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Enrolled |
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No |
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| CWS01716 |
F |
Please rate your overall satisfaction with Cahaba's E-Mail notification service. |
1 - Very Dissatisfied |
G |
Radio button, one-up vertical |
Single |
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Email Sat |
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10 - Very Satisfied |
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| CWS01717 |
G |
Please tell us the reason for the rating given above. |
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N |
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Low Rate |
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| CWS01718 |
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Where are you located? |
Alabama |
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Single |
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Located |
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Georgia |
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Tennessee |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia (Washington DC) |
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Florida |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Mississippi |
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Missouri |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Rhode Island |
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South Carolina |
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South Dakota |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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Other |
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| CWS01719 |
|
If you could identify one improvement to this site, what would that improvement be? |
|
|
Text area, no char limit |
|
N |
|
Improvements |
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|
