544 CMS Novitas JH MAC

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Overview

Welcome and Thank You Text
Model Qsts
Custom Qs

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Sheet 1: Welcome and Thank You Text

Model Instance Name:
CMS - Novitas JH MAC
MID:	cwZRoAAYhptYdlcRBklYZw==
Date:	8/9/2012
Welcome and Thank You Text
	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below.
					Examples
					Welcome Text Example
	Welcome Text
	Thank you for visiting the Novitas Solutions, Inc. Web site. You have been randomly selected to take part in this brief Web site satisfaction survey. Please take a few minutes to share your opinions regarding our Web site elements, such as navigation, search, content, etc., which are essential in helping us provide the best online experience possible. Your comments and scores on this survey will be directed to the Medicare Internet Team. Therefore, please limit your comments and scores on this survey to your experiences and opinions on the Web site only.
					Thank You Text Example
	Thank You Text
	Thank you for your time in completing this survey. Your input is very valuable and will be taken into consideration.

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Sheet 2: Model Qsts

Model Instance Name:
CMS - Novitas JH MAC
MID:		cwZRoAAYhptYdlcRBklYZw==
Partitioned (Y)
Date:	8/9/2012
CMS - Novitas JH MAC
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)			CUSTOMER SATISFACTION			FUTURE BEHAVIORS
	MQ Label			MQ Label			MQ Label
		Content (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Primary Resource (1=Very Unlikely, 10=Very Likely)
1	Content - Accuracy	Please rate the accuracy of information on this site.	21	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	24	Primary Resource	How likely are you to use this site as your primary resource for getting information on Medicare?
2	Content - Quality	Please rate the quality of information on this site.	22	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Very Unlikely, 10=Very Likely)
3	Content - Freshness	Please rate the freshness of content on this site.	23	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	25	Recommend	How likely are you to recommend this site to someone else?
		Functionality (1=Poor, 10=Excellent, Don't Know)						Return (1=Very Unlikely, 10=Very Likely)
4	Functionality - Usefulness	Please rate the usefulness of the services provided on this site.				26	Return	How likely are you to return to this site?
5	Functionality - Convenient Services	Please rate the convenience of the services on this site.
6	Functionality - Accomplish Goal	Please rate the ability to accomplish what you wanted to on this site.
		Look and Feel (1=Poor, 10=Excellent, Don't Know)
7	Look and Feel - Readability	Please rate the ease of reading this site.
8	Look and Feel - Organization	Please rate the clarity of site organization.
9	Look and Feel - Layout	Please rate the clean layout of this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
10	Navigation - Steps	Please rate the degree to which the number of steps it took to get where you want is acceptable.
11	Navigation - Find	Please rate the ability to find information you want on this site.
12	Navigation - Layout	Please rate the clarity of the site map/directory.
13	Navigation - Ease	Please rate the ease of navigation on this site.
		Search (1=Poor, 10=Excellent, Don't Know)
14	Search - Usefulness	Please rate the usefulness of search results on this site.
15	Search - Comprehensive	Please rate how this site provides comprehensive search results.
16	Search - Organization	Please rate the organization of search results on this site.
17	Search - Narrow	Please rate how the search feature helps you to narrow the results to find the information you want.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
18	Site Performance - Loading	Please rate the speed of loading the page on this site.
19	Site Performance - Consistency	Please rate the consistency of speed on this site.
20	Site Performance - Reliability	Please rate the reliability of site performance on this site.

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Sheet 3: Custom Qs

Model Instance Name:
CMS - Novitas JH MAC
MID: cwZRoAAYhptYdlcRBklYZw==
Date:	8/9/2012
CMS - Novitas JH MAC CUSTOM QUESTION LIST
QID	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	CQ Label
LNH0240		In the last 30 days, how many times have you visited this website?	LNH0240A01	This is my first time		Radio button, one-up vertical	Single	Y		Visit Frequency
			LNH0240A02	Once or twice
			LNH0240A03	Three or four times
			LNH0240A04	More than once per week but not every day
			LNH0240A05	Every day
LNH0241		Which best describes you?	LNH0241A01	Provider of medical services		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Best describes you
			LNH0241A02	Supplier of medical equipment or supplies
			LNH0241A03	Staff of provider/supplier working primarily with billing/insurance
			LNH0241A04	Administrative staff of a provider/supplier
			LNH0241A05	Other staff of a provider/supplier
			LNH0241A06	Consultant or attorney
			LNH0241A07	Billing service
			LNH0241A08	Other	A
LNH0242	A	Please explain briefly:				Text area, no char limit		N	Skip Logic Group*	Other-Best Describes You
LNH0243		What is your primary reason for visiting this site today?	LNH0243A01	Download forms		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Reason for visiting
			LNH0243A02	Learn of, or register for, workshops, seminars or other training events
			LNH0243A03	Find contact information
			LNH0243A04	Find general Medicare program information
			LNH0243A05	Research a specific question on Medicare policy or billing
			LNH0243A06	Find information on fees or fee schedules
			LNH0243A07	Find out about a Local Coverage Determination (LCD)
			LNH0243A08	Read Medicare publications such as newsletters, articles etc.
			LNH0243A09	Find enrollment information
			LNH0243A10	Take an on-line training course
			LNH0243A11	Other	B
LNH0244	B	Please explain briefly:				Text area, no char limit		N	Skip Logic Group*	Other-Primary Reason
ACQhar0014749		What information center(s) or topic(s) did you access on our Web site today (check all that apply)?	LNH0245A01	Appeals		Checkbox, one-up vertical	Multi	Y	OPS Group	Info Centers or Topics Access
			LNH0245A02	Audit and Reimbursement (Part A Fees)
			LNH0245A03	CERT
			LNH0245A04	Claims/Eligibility
			LNH0245A05	Electronic Billing (EDI)
			LNH0245A06	Enrollment
			LNH0245A07	Evaluation and Management
			LNH0245A08	Part B Fee Schedules
			LNH0245A09	Forms Catalog
			LNH0245A10	Medical Policy
			LNH0245A11	Medicare News & Bulletins
			LNH0245A12	Self-Service Tools
			LNH0245A13	Provider Training and Events
			LNH0245A14	I did not use an information center, but was looking for information on this topic:	C
ACQhar0014750	C	Other information of interest:				Text area, no char limit		N	OPS Group	Other info of Interest
LNH0247		Did you use any search features on this site today?	LNH0247A01	Yes	D, E, F	Radio button, one-up vertical	Single	N	Skip Logic Group*	Search Feature Usage
			LNH0247A02	No
LNH0248	D	How would you rate the helpfulness of the search tool?	LNH0248A01	Very helpful		Radio button, one-up vertical	Single	N	Skip Logic Group*	Helpfulness of Search Tool
			LNH0248A02	Somewhat helpful
			LNH0248A03	Fair
			LNH0248A04	Somewhat unhelpful
			LNH0248A05	Very unhelpful
LNH0249	E	What search term(s) did you use?				Text area, no char limit		N	Skip Logic Group*	Search Terms Used
LNH0250	F	Please briefly explain your experience with the search tool.				Text area, no char limit		N	Skip Logic Group*	Search Tool Experience
LNH0251		How did you look for the information you wanted / needed on this site? (select all that apply)	LNH0251A01	Using the navigation menu on the left side of the page		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Look for Information
			LNH0251A02	Using links in the center of the page
			LNH0251A03	Using the site search feature
			LNH0251A04	Using the site map
			LNH0251A05	Other	G
LNH0252	G	What other method did you use to look for the information you wanted / needed?				Text area, no char limit		N	Skip Logic Group*	Other Method to Look for Info
LNH0253		Have you previously obtained Medicare information on another contactor's web site (ex. Trailblazer, Pinnacle, Cahaba?)	LNH0253A01	Yes	H	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Prior Site Usage
			LNH0253A02	No
			LNH0253A03	Don't Know
LNH0254	H	How do the information and services you receive from the Novitas Solutions, Inc. web site compare to the other contractor's web site?	LNH0254A01	Better		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Compare Prior Service
			LNH0254A02	About the Same
			LNH0254A03	Worse	I
LNH0255	I	Please explain what we can improve at the Novitas Solutions, Inc. web site to better assist you.				Text area, no char limit		N	Skip Logic Group*	Improve JH
LNH0256		Were you able to accomplish your goal in visiting the Web site today?	LNH0256A01	Yes		Radio button, one-up vertical	Single	N	Skip Logic Group*	Accomplish Goal
			LNH0256A02	No	J
LNH0257	J	Please explain what you were unable to accomplish:.				Text area, no char limit		N	Skip Logic Group*	Reason for Visit
LNH0258		How could the Web site be improved to make your job easier?				Text area, no char limit		N		One Improvement
LNH0259		If you are over the age of 18 and would like Novitas to respond to your feedback regarding this Web site, please provide your name, along with an e-mail address or telephone number here:				Text area, no char limit		N		Contact Information