Medicare Beneficiary and Family-Centered Satisfaction Survey

CMS 10393 Supporting Statement – Attachment F

Beneficiary and Family Centered Data Collection

Direct Follow-up Instructions

(Beneficiary Experience with QIO: help desk call)

Direct follow-up will be conducted by telephone with a sample of beneficiaries/representatives who spoke with the BFCC QIO. This call may not have resulted in the initiation of an appeal or complaint case.

Telephone introduction

Hello may I please speak with {Name of beneficiary/representative}?

This is {Name of interviewer} and I am calling on behalf of the Centers for Medicare & Medicare services. I wanted to ask you about the call you recently made to {QIO name}. Do you have a few minutes to speak with me?

Thank you.

I would like to ask you some questions about your call to {QIO name}. My questions should take about 5 minutes and your participation is completely voluntary. Any feedback you provide will be treated as confidential.