Form 722 2013 722 CMS NGS DME MAC

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Overview

Current Model Qsts
Current Custom Qs
Custom Qs (9-29-10)
Custom Qs 9-15-10
Custom Qs 10-1-09
Custom Qs 07-24-09
Custom Qs 06-02-09
Custom Qs 3-20-09
Custom Qs 03-03-09
Custom Qs 7-3-08

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Sheet 1: Current Model Qsts

Model Instance Name:
CMS - NGS DME MAC B
MID	QphpZ1ZQINdF4RwgM5lJQg==
Date:	9/6/2006
This is Model 410, common to all CMS measures
CMS - NGS DME MAC B MODEL QUESTION LIST
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	NOTE: All questions under each element are required. Element questions are partitioned among surveys.		Satisfaction questions are required. Satisfaction questions appear on all surveys.		Future behaviors may be modified based on your site's objectives. Future behavior questions appear on all surveys.
	Content (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Likelihood to Return (1=Not Very Likely, 10=Very Likely)
1	Please rate the accuracy of information on this site.	21	What is your overall satisfaction with this site?	24	How likely are you to return to this site?
2	Please rate the quality of information on this site.	22	How well does this site meet your expectations?
3	Please rate the freshness of content on this site.	23	How does this site compare to your idea of an ideal website?		Recommend (1=Not Very Likely, 10=Very Likely)
	Functionality (1=Poor, 10=Excellent, Don't Know)			25	How likely are you to recommend this site to someone else?
4	Please rate the usefulness of the services provided on this site.
5	Please rate the convenience of the services on this site.				Primary Resource (1=Not Very Likely, 10=Very Likely)
6	Please rate the ability to accomplish what you wanted to on this site.			26	How likely are you to use this site as your primary resource for getting information on Medicare?
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
7	Please rate the ease of reading this site.
8	Please rate the clarity of site organization.
9	Please rate the clean layout of this site.
	Navigation (1=Poor, 10=Excellent, Don't Know)
10	Please rate the degree to which the number of steps it took to get where you want is acceptable.
11	Please rate the ability to find information you want on this site.
12	Please rate the clarity of the site map/directory.
13	Please rate the ease of navigation on this site.
	Site Performance (1=Poor, 10=Excellent, Don't Know)
14	Please rate the speed of loading the page on this site.
15	Please rate the consistency of speed on this site.
16	Please rate the reliability of site performance on this site.
	Search (1=Poor, 10=Excellent, Don't Know)
17	Please rate the usefulness of search results on this site.
18	Please rate how this site provides comprehensive search results.
19	Please rate the organization of search results on this site.
20	Please rate how the search feature helps you to narrow the results to find the information you want.

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Sheet 2: Current Custom Qs

Model Instance Name:						red & strike-through: DELETE
CMS - NGS DME MAC B						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	9/29/2010					violet (bold): SKIP-LOGIC
CMS - NGS DME MAC B CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type	Required Y/N	Single or Multi
51958		Which best describes you?	Provider of medical services		OPS Group	Radio buttons	Y	select one
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	SKIP A
7000003	SKIP A	Other - which best describes you?			OPS Group
51957		In the last 30 days, how many times have you visited this website?	This is my first time			Radio buttons	Y	select one
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
ACQCol0002021		What is your primary reason for visiting this site today?	Download forms		Skip Logic Group	Radio buttons	Y	select one
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Access claim status and/or beneficiary eligibility
			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	SKIP K
ACQCol0002022	SKIP K	Please specify your other reason for visiting this site today.			Skip Logic Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Links in the middle of the page
			Search box
			Site map
			Other
EDO06347		Did you use the search feature on this site?	Yes	H	Skip Logic Group	Radio buttons	Yes	Single
			No
EDO06348	H	Please describe your experience with the search feature.	I had no difficulty using the search feature on this site		Skip Logic Group	Radio buttons	No	Single
			The search feature was difficult to find
			The search feature was difficult to use
			Returned no results/received an error message
			Could not tell where the search results would take me
			Too many results
			Too few results
			Results were not related to what I was looking for
			Could not sort the results
			Could not refine the results
			Other
EDO06349	H	What Keywords did you use?			Skip Logic Group	Text box	No	Single
EDO06350	H	Please indicate how helpful you feel the search feature was in finding the information you were looking for.	Very helpful		Skip Logic Group	Radio buttons	No
			Somewhat helpful	I
			Not at all helpful	I, J
EDO06351	J	Why do you feel the search feature was not at all helpful?			Skip Logic Group	Unlimited text field	No	Single
EDO06352	I	What would make the search feature more helpful?			Skip Logic Group	Unlimited text field	No	Single
AED08114		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No	SKIP E, F
			Not yet	SKIP E, F
AED08115	SKIP E	What were you trying to locate? (Please be specific)				Open ended	N
AED08116	SKIP F	What will you do next?	Nothing, although I did not find/complete what I wanted		OPS Group	Radio buttons	Y	select one
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP G
AED08117	SKIP G	Other (please specify)			OPS Group
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N
AED07561		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.				Open ended	N

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Sheet 3: Custom Qs (9-29-10)

Model Instance Name:						red & strike-through: DELETE
CMS - NGS DME MAC B						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	9/29/2010					violet (bold): SKIP-LOGIC
CMS - NGS DME MAC B CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type	Required Y/N	Single or Multi
51958		Which best describes you?	Provider of medical services		OPS Group	Radio buttons	Y	select one
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	SKIP A
7000003	SKIP A	Other - which best describes you?			OPS Group
51957		In the last 30 days, how many times have you visited this website?	This is my first time			Radio buttons	Y	select one
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
NEW		What is your primary reason for visiting this site today?	Download forms		Skip Logic Group	Radio buttons	Y	select one
			Learn of, or register for, workshops, seminars or other training events
			Find contact information
			Find general Medicare program information
			Access claim status and/or beneficiary eligibility
			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	SKIP K
NEW	SKIP K	Please specify your other reason for visiting this site today.			Skip Logic Group
51960		What is your primary reason for visiting this site today?	Download forms		OPS Group	Radio buttons	Y	select one
			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)	SKIP B
7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Links in the middle of the page
			Search box
			Site map
			Other
EDO06347		Did you use the search feature on this site?	Yes	H	Skip Logic Group	Radio buttons	Yes	Single
			No
EDO06348	H	Please describe your experience with the search feature.	I had no difficulty using the search feature on this site		Skip Logic Group	Radio buttons	No	Single
			The search feature was difficult to find
			The search feature was difficult to use
			Returned no results/received an error message
			Could not tell where the search results would take me
			Too many results
			Too few results
			Results were not related to what I was looking for
			Could not sort the results
			Could not refine the results
			Other
EDO06349	H	What Keywords did you use?			Skip Logic Group	Text box	No	Single
EDO06350	H	Please indicate how helpful you feel the search feature was in finding the information you were looking for.	Very helpful		Skip Logic Group	Radio buttons	No
			Somewhat helpful	I
			Not at all helpful	I, J
EDO06351	J	Why do you feel the search feature was not at all helpful?			Skip Logic Group	Unlimited text field	No	Single
EDO06352	I	What would make the search feature more helpful?			Skip Logic Group	Unlimited text field	No	Single
AED08114		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No	SKIP E, F
			Not yet	SKIP E, F
AED08115	SKIP E	What were you trying to locate? (Please be specific)				Open ended	N
AED08116	SKIP F	What will you do next?	Nothing, although I did not find/complete what I wanted		OPS Group	Radio buttons	Y	select one
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP G
AED08117	SKIP G	Other (please specify)			OPS Group
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N
AED07561		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.				Open ended	N

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Sheet 4: Custom Qs 9-15-10

Model Instance Name:						red & strike-through: DELETE
CMS - NGS DME MAC B						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	9/10/2010					violet (bold): SKIP-LOGIC
CMS - NGS DME MAC B CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type	Required Y/N	Single or Multi
51958		Which best describes you?	Provider of medical services		OPS Group	Radio buttons	Y	select one
			Supplier of medical equipment or supplies
			Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Consultant or attorney
			Billing service
			Other (please specify)	SKIP A
7000003	SKIP A	Other - which best describes you?			OPS Group
51957		In the last 30 days, how many times have you visited this website?	This is my first time			Radio buttons	Y	select one
			Once or twice
			Three or four times
			More than once per week but not every day
			Every day
51960		What is your primary reason for visiting this site today?	Download forms		OPS Group	Radio buttons	Y	select one
			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)	SKIP B
7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today? What method are you primarily using to locate information on this site today? NOTE TO DOT: Just changing the bolding for this question	Top navigation menu			Radio buttons	Y	select one
			Right navigation bar
			Links in the middle of the page
			Search box
			Site map
			Other
EDO06347		Did you use the search feature on this site?	Yes	H	Skip Logic Group	Radio buttons	Yes	Single
			No
EDO06348	H	Please describe your experience with the search feature.	I had no difficulty using the search feature on this site		Skip Logic Group	Radio buttons	No	Single
			The search feature was difficult to find
			The search feature was difficult to use
			Returned no results/received an error message
			Could not tell where the search results would take me
			Too many results
			Too few results
			Results were not related to what I was looking for
			Could not sort the results
			Could not refine the results
			Other
EDO06349	H	What Keywords did you use?			Skip Logic Group	Text box	No	Single
EDO06350	H	Please indicate how helpful you feel the search feature was in finding the information you were looking for.	Very helpful		Skip Logic Group	Radio buttons	No
			Somewhat helpful	I
			Not at all helpful	I, J
EDO06351	J	Why do you feel the search feature was not at all helpful?			Skip Logic Group	Unlimited text field	No	Single
EDO06352	I	What would make the search feature more helpful?			Skip Logic Group	Unlimited text field	No	Single
AED08114		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No	SKIP E, F
			Not yet	SKIP E, F
AED08115	SKIP E	What were you trying to locate? (Please be specific)				Open ended	N
AED08116	SKIP F	What will you do next?	Nothing, although I did not find/complete what I wanted		OPS Group	Radio buttons	Y	select one
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP G
AED08117	SKIP G	Other (please specify)			OPS Group
CWS01239		Are you subscribed to our Listserv?	Yes			Radio buttons	Yes	Single
			No	SKIP D
CWS01240	SKIP D	Please share with us your reason for not subscribing to our Listserv.				Open ended	No
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N
AED07561		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.				Open ended	N

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Sheet 5: Custom Qs 10-1-09

Model Instance Name:						red & strike-through: DELETE
CMS NGS AdminaStar Federal DME MAC						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	10/1/2009					violet (bold): SKIP-LOGIC
CMS NGS AdminaStar Federal DME MAC CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type (select from list)	Required Y/N	Single or Multi
C51958		Which best describes you?	Provider of medical services		OPS Group	Radio buttons	Y	select one
			Supplier of medical equipment or supplies
			Staff of a provider/supplier who works primarily with billing or insurance Staff of provider/supplier working primarily with billing/insurance
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Provider/supplier
			Consultant or attorney
			Billing service
			Local, state, or federal government employee or contractor
			Software vendor
			Other health care insurer or agency
			Other (please specify)	SKIP A
C7000003	SKIP A	Other - which best describes you?			OPS Group
C51957		In the last 30 days, how many times have you visited this website?	This is my first time			Drop-down menu Radio buttons	Y	select one
			Once or twice before
			Three or four times before
			More than once per week but not every day
			Every day
C51960		What is your primary reason for visiting this site today?	Download forms		OPS Group	Radio buttons	Y	select one
			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, press releases, etc.
			Find enrollment information
			Take an on-line training course
			Other (please specify)	SKIP B
C7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Right navigation bar
			Links in the middle of the page
			Search box
			Site map
			Other
AED08114		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No	SKIP E, F
			Not yet	SKIP E, F
AED08115	SKIP E	What were you trying to locate? (Please be specific)				Open ended	N
AED08116	SKIP F	What will you do next?	Nothing, although I did not find/complete what I wanted		OPS Group	Radio buttons	Y	select one
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP G
AED08117	SKIP G	Other (please specify)			OPS Group
CWS01239		Are you subscribed to our Listserv?	Yes			Radio buttons	Yes	Single
			No	SKIP D
CWS01240	SKIP D	Please share with us your reason for not subscribing to our Listserv.				Open ended	No
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N
AED07561		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.				Open ended	N

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Sheet 6: Custom Qs 07-24-09

Model Instance Name:						red & strike-through: DELETE
CMS NGS AdminaStar Federal DME MAC						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	7/21/2009					violet (bold): SKIP-LOGIC
CMS NGS AdminaStar Federal DME MAC CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type (select from list)	Required Y/N	Single or Multi
C51958		Which best describes you?	Staff of a provider/supplier who works primarily with billing or insurance		OPS Group	Radio buttons	Y	select one
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Provider/supplier
			Billing service
			Consultant or attorney
			Local, state, or federal government employee or contractor
			Software vendor
			Other health care insurer or agency
			Other (please specify)	SKIP A
C7000003	SKIP A	Other - which best describes you?			OPS Group
C51957		In the last 30 days, how many times have you visited this website?	This is my first time			Drop-down menu	Y	select one
			Once or twice before
			Three or four times before
			More than once per week but not every day
			Every day
C51960		What is your primary reason for visiting this site today?	Find general Medicare program information		OPS Group	Radio buttons	Y	select one
			Find contact information
			Find enrollment information
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Research a specific question on Medicare policy or billing
			Learn of, or register for, workshops, seminars or other training events
			Take an on-line training course
			Read Medicare publications such as newsletters, press releases, etc.
			Download forms
			Other (please specify)	SKIP B
C7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Right navigation bar
			Links in the middle of the page
			Search box
			Site map
			Other
CMMM00009		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No	SKIP E, F
			Not yet	SKIP E, F
NEW		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No	SKIP E, F
			Not yet	SKIP E, F
NEW	SKIP E	What were you trying to locate? (Please be specific)				Open ended	N
NEW	SKIP F	What will you do next?	Nothing, although I did not find/complete what I wanted		OPS Group	Radio buttons	Y	select one
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP G
NEW	SKIP G	Other (please specify)			OPS Group
JIC00319	SKIP E	If you did NOT find what you were looking for, what were you trying to locate? (Please be specific)				Open ended	N
JIC00320		If you did not find what you were looking for, what will you do next?	Not applicable; I found/completed what I wanted		OPS Group	Radio buttons	Y	select one
			Nothing, although I did not find/complete what I wanted
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP C
JIC00322	SKIP C	Other (please specify)			OPS Group
CWS01239		Are you subscribed to our Listserv?	Yes			Radio buttons	Yes	Single
			No	SKIP D
CWS01240	SKIP D	Please share with us your reason for not subscribing to our Listserv.				Open ended	No
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N
AED07561		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email add				Open ended	N

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Sheet 7: Custom Qs 06-02-09

Model Instance Name:						red & strike-through: DELETE
CMS NGS AdminaStar Federal DME MAC						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	3/3/2009					violet (bold): SKIP-LOGIC
CMS NGS AdminaStar Federal DME MAC CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type (select from list)	Required Y/N	Single or Multi
C51958		Which best describes you?	Staff of a provider/supplier who works primarily with billing or insurance		OPS Group	Radio buttons	Y	select one
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Provider/supplier
			Billing service
			Consultant or attorney
			Local, state, or federal government employee or contractor
			Software vendor
			Other health care insurer or agency
			Other (please specify)	SKIP A
C7000003	SKIP A	Other - which best describes you?			OPS Group
C51957		In the last 30 days, how many times have you visited this website?	This is my first time			Drop-down menu	Y	select one
			Once or twice before
			Three or four times before
			More than once per week but not every day
			Every day
C51960		What is your primary reason for visiting this site today?	Find general Medicare program information		OPS Group	Radio buttons	Y	select one
			Find contact information
			Find enrollment information
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Research a specific question on Medicare policy or billing
			Learn of, or register for, workshops, seminars or other training events
			Take an on-line training course
			Read Medicare publications such as newsletters, press releases, etc.
			Download forms
			Other (please specify)	SKIP B
C7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Right navigation bar
			Links in the middle of the page
			Search box
			Site map
			Other
CMMM00009		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No
			Not yet
JIC00319		If you did NOT find what you were looking for, what were you trying to locate? (Please be specific)				Open ended	N
JIC00320		If you did not find what you were looking for, what will you do next?	Not applicable; I found/completed what I wanted		OPS Group	Radio buttons	Y	select one
			Nothing, although I did not find/complete what I wanted
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP C
JIC00322	SKIP C	Other (please specify)			OPS Group
CWS01239		Are you subscribed to our Listserv?	Yes			Radio buttons	Yes	Single
			No	SKIP D
CWS01240	SKIP D	Please share with us your reason for not subscribing to our Listserv.				Open ended	No
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N
NEW		From time to time, National Government Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email add				Open ended	N

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Sheet 8: Custom Qs 3-20-09

Model Instance Name:						red & strike-through: DELETE
CMS NGS AdminaStar Federal DME MAC						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	3/3/2009					violet (bold): SKIP-LOGIC
CMS NGS AdminaStar Federal DME MAC CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type (select from list)	Required Y/N	Single or Multi
C51958		Which best describes you?	Staff of a provider/supplier who works primarily with billing or insurance		OPS Group	Radio buttons	Y	select one
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Provider/supplier
			Billing service
			Consultant or attorney
			Local, state, or federal government employee or contractor
			Software vendor
			Other health care insurer or agency
			Other (please specify)	SKIP A
C7000003	SKIP A	Other - which best describes you?			OPS Group
C51957		In the last 30 days, how many times have you visited this website?	This is my first time			Drop-down menu	Y	select one
			Once or twice before
			Three or four times before
			More than once per week but not every day
			Every day
C51960		What is your primary reason for visiting this site today?	Find general Medicare program information		OPS Group	Radio buttons	Y	select one
			Find contact information
			Find enrollment information
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Research a specific question on Medicare policy or billing
			Learn of, or register for, workshops, seminars or other training events
			Take an on-line training course
			Read Medicare publications such as newsletters, press releases, etc.
			Download forms
			Other (please specify)	SKIP B
C7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Right navigation bar
			Links in the middle of the page
			Search box
			Site map
			Other
CMMM00009		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No
			Not yet
JIC00319		If you did NOT find what you were looking for, what were you trying to locate? (Please be specific)				Open ended	N
JIC00320		If you did not find what you were looking for, what will you do next?	Not applicable; I found/completed what I wanted		OPS Group	Radio buttons	Y	select one
			Nothing, although I did not find/complete what I wanted
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP C
JIC00322	SKIP C	Other (please specify)			OPS Group
NEW		Are you subscribed to our Listserv?	Yes			Radio buttons	Yes	Single
			No	SKIP D
NEW	SKIP D	Please share with us your reason for not subscribing to our Listserv.				Open ended	No
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N

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Sheet 9: Custom Qs 03-03-09

Model Instance Name:						red & strike-through: DELETE
CMS NGS AdminaStar Federal DME MAC						underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==					pink: ADDITION
						blue + -->: REWORDING
Date:	3/3/2009					violet (bold): SKIP-LOGIC
CMS NGS AdminaStar Federal DME MAC CUSTOM QUESTION LIST
CQID	Skip To	Question Text	Answer Choices (limited to 50 characters)	Skip From	Skip Type	Type (select from list)	Required Y/N	Single or Multi
C51958		Which best describes you?	Staff of a provider/supplier who works primarily with billing or insurance		OPS Group	Radio buttons	Y	select one
			Administrative staff of a provider/supplier
			Other staff of a provider/supplier
			Provider/supplier
			Billing service
			Consultant or attorney
			Local, state, or federal government employee or contractor
			Software vendor
			Other health care insurer or agency
			Other (please specify)	SKIP A
C7000003	SKIP A	Other - which best describes you?			OPS Group
C51957		In the last 30 days, how many times have you visited this website?	This is my first time			Drop-down menu	Y	select one
			Once or twice before
			Three or four times before
			More than once per week but not every day
			Every day
C51960		What is your primary reason for visiting this site today?	Find general Medicare program information		OPS Group	Radio buttons	Y	select one
			Find contact information
			Find enrollment information
			Find information on fees or fee schedules
			Find out about a Local Coverage Determination (LCD)
			Research a specific question on Medicare policy or billing
			Learn of, or register for, workshops, seminars or other training events
			Take an on-line training course
			Read Medicare publications such as newsletters, press releases, etc.
			Download forms
			Other (please specify)	SKIP B
C7000004	SKIP B	Other - primary reason?			OPS Group
JIC00315		What method are you primarily using to locate information on this site today?	Top navigation menu			Radio buttons	Y	select one
			Right navigation bar
			Links in the middle of the page
			Search box
			Site map
			Other
JIC00316		Do you find the recent enhancements made to the Web site to be:	An improvement over the previous design			Radio buttons	Y	select one
			On par with the previous design
			Inferior to the previous design
			Don't know/Didn't notice
JIC00317		Do you find the new site navigation easier or more difficult than before the site redesign?	Easier			Radio buttons	Y	select one
			More difficult
			Not sure
JIC00318		Do you find it easier or more difficult to identify content relevant to your needs since the site redesign?	Easier			Radio buttons	Y	select one
			More difficult
			Not sure
CMMM00009		While visiting the site, did you find what you were looking for?	Yes			Radio buttons	Y	select one
			No
			Not yet
JIC00319		If you did NOT find what you were looking for, what were you trying to locate? (Please be specific)				Open ended	N
JIC00320		If you did not find what you were looking for, what will you do next?	Not applicable; I found/completed what I wanted		OPS Group	Radio buttons	Y	select one
			Nothing, although I did not find/complete what I wanted
			Call the NGS Contact Center
			Return to the NGS website later and try again
			Try the CMS website
			Try another contractor's website
			Send an email
			Write a letter
			Other (please specify)	SKIP C
JIC00322	SKIP C	Other (please specify)			OPS Group
JIC00321		If you could identify one improvement to this site, what would that improvement be?				Open ended	N

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Sheet 10: Custom Qs 7-3-08

Model Instance Name:				red & strike-through: DELETE
CMS NGS AdminaStar Federal DME MAC				underlined & italicized: RE-ORDER
MID	QphpZ1ZQINdF4RwgM5lJQg==			pink: ADDITION
				blue + -->: REWORDING
Date:	7/3/2008			violet (bold): SKIP-LOGIC
CMS NGS AdminaStar Federal DME MAC CUSTOM QUESTION LIST
CQID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Type (select from list)	Single or Multi	Required Y/N	Important Notes from Your Satisfaction Research Analyst
C51958		Which best describes you?	Staff of a provider/supplier who works primarily with billing or insurance Administrative staff of a provider/supplier Other staff of a provider/supplier Provider/supplier Billing service Consultant or attorney Local, state, or federal government employee or contractor Software vendor Other health care insurer or agency Other (please specify) (SKIP A)	Radio buttons	Y	select one	Existing
C7000003	SKIP A	Other - which best describes you?					Existing
C51957		In the last 30 days, how many times have you visited this website?	This is my first time Once or twice before Three or four times before More than once per week but not every day Every day	Drop-down menu	Y	select one	Existing
C51960		What is your primary reason for visiting this site today?	Find general Medicare program information Find contact information Find enrollment information Find information on fees or fee schedules Find out about a Local Coverage Determination (LCD) Research a specific question on Medicare policy or billing Learn of, or register for, workshops, seminars or other training events Take an on-line training course Read Medicare publications such as newsletters, press releases, etc. Download forms Other (please specify) (SKIP B)	Radio buttons	Y	select one	Existing
C7000004	SKIP B	Other - primary reason?					Existing
NEW		What method are you primarily using to locate information on this site today?		Radio buttons	Y	select one	New July 2008
NEW		Do you find the recent enhancements made to the Web site to be:	An improvement over the previous design On par with the previous design Inferior to the previous design Don't know/Didn't notice	Radio buttons	Y	select one	New July 2008
NEW		Do you find the new site navigation easier or more difficult than before the site redesign?	Easier More difficult Not sure	Radio buttons	Y	select one	New July 2008
NEW		Do you find it easier or more difficult to identify content relevant to your needs since the site redesign?	Easier More difficult Not sure	Radio buttons	Y	select one	New July 2008
CMMM00009		While visiting the site, did you find what you were looking for?	Yes No Not yet	Radio buttons	Y	select one	Existing
NEW		If you did NOT find what you were looking for, what were you trying to locate? (Please be specific)		Open ended	N		New July 2008
NEW		If you did not find what you were looking for, what will you do next?	Not applicable; I found/completed what I wanted Nothing, although I did not find/complete what I wanted Call the NGS Contact Center Return to the NGS website later and try again Try the CMS website Try another contractor's website Send an email Write a letter Other (please specify)	Radio buttons	Y	select one	New July 2008
NEW		If you could identify one improvement to this site, what would that improvement be?		Open ended	N		New July 2008
C9671		Where are you located?					Unmap if currently active on survey
CMMM00008		Which best describes your Medicare contract of interest?					Unmap if currently active on survey
CMMM00010		If you did not find what you were looking for, what specifically were you researching?					Unmap if currently active on survey
CMMM00011		How does our website rate compared to other payers’ Web sites?					Unmap if currently active on survey
CMMM00012		If you answered "Not as good," then what is our site missing that the others have?					Unmap if currently active on survey
CMMM00013		If you could identify one to three improvements to the website, what would those improvements be?					Unmap if currently active on survey
CMMM00395		How did you primarily look for information on this site today?					Unmap if currently active on survey