546 CMS WPS J8 MAC Questionnaire

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Overview

Current Model Qsts
Current Custom Qsts

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Sheet 1: Current Model Qsts

Model Instance Name:
CMS - WPS J8 MAC
ZApxdwM4pkFQIIopcQM4Fg==					Use Model number 410
Partitioned? Yes
Date:		7/19/2012
CMS - WPS J8 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=Not Very Likely, 10=Very Likely)
1	Content - Accuracy	Please rate the accuracy of information on this site.	21	Satisfaction - Overall	What is youroverall 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=Not Very Likely, 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)						Likelihood to Return (1=Not Very Likely, 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 - Accomlish 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 - Clicks	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 - Layout	Please rate the ease of navigation on this site.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
14	Site Performance - Loading	Please rate the speed of loading the page on this site.
15	Site Performance - Consistency	Please rate the consistency of speed on this site.
16	Site Performance - Relability	Please rate the reliability of site performance on this site.
		Search (1=Poor, 10=Excellent, Don't Know)
17	Search - Usefulness	Please rate the usefulness of search results on this site.
18	Search - Comprehensive	Please rate how this site provides comprehensive search results.
19	Search - Organization	Please rate the organization of search results on this site.
20	Search - Narrow	Please rate how the search feature helps you to narrow the results to find the information you want.

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Sheet 2: Current Custom Qsts

Model Instance Name:			red & strike-through: DELETE
CMS - WPS J8 MAC			underlined & italicized: RE-ORDER	Use Model number 410
ZApxdwM4pkFQIIopcQM4Fg==			pink: ADDITION
Date:	7/19/2012		blue + -->: REWORDING
CMS - WPS J8 MAC
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
51960		What is your primary reason for visiting this site today?	Access claim status and/or beneficiary eligibility		Radio button, one-up vertical	Single	Y	OPS Group*	Visit Reason
			Download forms					CMS Required
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Research a specific question on Medicare policy or billing
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Read Medicare publications such as newsletters, articles, etc.
			Find enrollment information
			Take an on-line training course
			Other (please specify)	A
7000004	A	Other - primary reason?			Text field, <100 char	Single	N	OPS Group*	Other Visit Reason
51957		In the last 30 days, how many times have you visited this website?	This is my first time		Radio button, one-up vertical	Single	Y	CMS Required	Visit Frequency
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
51958		Which best describes you?	Provider of medical services		Radio button, one-up vertical	Single	Y	OPS Group*	Best Describes you
			Supplier of medical equipment or supplies					CMS Required
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	A
7000003	A	Other - which best describes you?			Text field, <100 char	Single	N	Skip Logic Group*	OE_Best Describes
AML002754		Which best describes your area of interest?	Medicare Part A		Radio button, one-up vertical	Single	Y		Area of Interest
			Medicare Part B
			Other
AML002755		Are you registered to receive WPS Medicare News messages?	Yes, I am registered to receive WPS Medicare News messages		Radio button, one-up vertical	Single	Y		Registered
			No, I choose not to register for WPS Medicare News messages
			No, I was not aware that WPS Medicare provided News messages
			No, but please provide a link to sign up after I submit this survey
AML002756		Did you use the search function on the WPS Medicare website today?	Yes	A, G	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Search Use
			No	G
AML002757	A	How helpful did you find the search function?	Very helpful		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Search Helpful
			Somewhat helpful	B, C, H
			Not helpful	B, C, H
AML002758	B	What improvement(s) would you recommend to make the search function more helpful?			Text area, no char limit	Single	N	Skip Logic Group*	Search Improvement
AML002759	C	Which of the following describes your experience with the search function?	Received too few results	D	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Search Exp
			Received too many results	D, F
			Could not refine results	F
			Results were not what I was looking for	D, F
			Other
AML002760	D	Did you try to use the drop-down category list located to the left of the search box to refine the search results?	Yes	E	Radio button, one-up vertical	Single	Y	Skip Logic Group*	Refine Search
			No
			I did not know that was available
AML002761	F	What search term or word(s) did you use to search?			Text area, no char limit	Single	N	Skip Logic Group*	Search Term
AML002762	G	What other method(s) did you use to look for information on the WPS Medicare website? Select all that apply	Top Navigation		Checkbox, one-up vertical	Single	Y	Skip Logic Group*	Other Method
			Left Navigation
			Links in center of page
			External search engine (e.g. Google, Bing, Yahoo)
			Site Map
			Contact WPS Medicare
			None of the above					Mutually Exclusive
AML002763	E	Did you try to refine your search by adding additional search terms?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Able to Refine Search
			No
AML002764	H	What specific information were you trying to find?			Text area, no char limit	Single	N	Skip Logic Group*	Search trying find
AML002765		Do you find the placement of information on the WPS Medicare website logical?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Info Placement
			No (please explain)	A
AML002766	A	Why did you find the placement of information illogical?			Text area, no char limit	Single	N	Skip Logic Group*	OE_Placement
AML002767		Did you find what you were looking for on the WPS Medicare website today?	Yes		Radio button, one-up vertical	Single	Y	Skip Logic Group*	Looking for
			No	A
AML002768	A	What specifically were you seeking?			Text area, no char limit	Single	N	Skip Logic Group*	Specifically Seeking
AML002769		If you could identify one improvement to the WPS Medicare website, what would that improvement be?			Text area, no char limit	Single	N		OE_Improvement
AML002770		If you are over the age of 18 and would like WPS to respond to your feedback regarding this website, please provide your email address here.			Text field, <100 char	Single	N		Email