CMS-10068.Survey 2010 Crosswalk

Revisions to CMS-10068 Medicare Ombudsman Customer Service Feedback Survey

Issue #	Section	Action to be performed	Changes	Reason for the Change
	(Section 1: Title)	Revise as follows:	Replace: Beneficiary Customer Service Feedback Survey With: Medicare Ombudsman Customer Service Feedback Survey	Revised to help focus the survey towards the Ombudsman’s office only, and not Medicare in general.
	(Section 2: Instructions) 1rst Paragraph, 1rst Sentence	Revise as follows:	Replace: Thinking about the way we handled your letter, please tell us how much you agree or disagree with each of the following statements, using a scale where 5 means you strongly agree and 1 means you strongly disagree. With: Thinking about how the Office of the Medicare Ombudsman responded to your request, please tell us how satisfied you are by answering a few questions.	Revised to ensure the responses to the questions pertain to the service that the Ombudsman’s office provided and not Medicare in general. Changed measurement scale based on satisfaction, rather than agreement for clarification purposes.
	(Section2: Instructions) 2nd Paragraph, 2nd Sentence	Revise as follows	Replace: Just use a pen or pencil to circle one number for each question. With: Based on a scale where 5 means you are very satisfied and 1 means you are very dissatisfied, please circle one number for each question that best describes your experience.	Revised for clarification purposes.
	(Section 3: Survey) Scale (a)	Revise as follows:	Replace:  Strongly Disagree/Strongly Agree With: Very Dissatisfied/Very Satisfied	Revised for clarification purposes.
	(Section 3: Survey) Scale (b)	Add:	Add:  Under Very Dissatisfied and  under Very Satisfied	Added to avoid beneficiary confusion about which number means “Very Dissatisfied” vs. “Very Satisfied.”
	(Section 3: Survey) #1	Revise as follows	Replace: Medicare answered my letter within a reasonable time. With: Overall, how satisfied are you with the way the Office of the Medicare Ombudsman handled your concern?	Revised to ensure the response is regarding the service the Ombudsman’s office provided and not Medicare in general. Moved timeliness question to #3 to help beneficiaries first focus on the quality & clarity of the response.
	(Section 3: Survey) #2	Revise as follows:	Replace: Medicare gave me the information I needed. With: How satisfied are you that the information we gave you is clear and understandable?	Revised clarity question for clarification purposes. Order of questions changed for reason given in #6.
	(Section 3: Survey) #3	Revise as follows:	Replace: The information I received from Medicare was clear and understandable. With: How satisfied are you that the information we gave you responded to your question?	Revised quality question for clarification purposes. Order of questions changed for reason given in #6.
	(Section 3: Survey) #4	Revise as follows:	Replace: I am satisfied with the way my letter was handled. With: How satisfied are you with the time it took us to respond to your question?	Revised timeliness question for clarification purposes. Order of questions changed for reason given in #6.
	(Section 4: Additional Questions) Question #1	Revise as follows:	Replace: If you have any suggestions for ways we can improve how we respond to your written requests for information, please tell us here: With: Please tell us how the Office of the Medicare Ombudsman can better respond to your future questions:	Revised for clarification purposes and to ensure the response is regarding the service the Ombudsman’s office can provide and not Medicare in general.
	(Section 4: Additional Questions) Question #2	Delete	Delete: Please circle YES or NO to answer this question: If you have another question like this in the future, would you write to us again? YES NO	Deleted because responses to this question in previous surveys were either not given or provided little or no value in measuring overall satisfaction with the Office of the Medicare Ombudsman.
	(Section 4: Additional Questions) Question#3	Delete	Delete: If you have any other comments or questions about the service we gave you, please tell us here:	Deleted because this question in previous surveys proved to be too open-ended and placed additional burden on the Office of the Medicare Ombudsman to answer other unrelated questions.
	(Section 5: Closing)	Revise as follows:	Replace: Thank you for taking the time to answer our questions. Please send us your completed survey in the enclosed envelope as soon as possible. With: Thank you for taking the time to answer our survey. Please send us your completed survey in the enclosed postage paid envelope as soon as possible.	Revised to provide clarification.

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