Veterans Choice Program Provider Satisfaction Survey

Veterans Choice Program

Provider Satisfaction Survey

OMB No. 2900-0770
Estimated Burden: 10 minutes

Expiration Date: 9/30/2020

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 10 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this online/mail survey will lead to improvements in the quality of service delivery to community providers from Department of Veterans Affairs (VA) Medical Center staff and from health care networks Health Net and TriWest staff through the Veterans Choice Program. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

Privacy Act Statement: This survey is not a collection of personal information; please do not enter any personal information in the open text fields. By voluntarily providing information on https://www.va.gov/communitycare, you are consenting to VA’s use and disclosure of that information in the manner described in this limited policy. The VA general Web privacy policy is available at www.va.gov/privacy.

Unique Identifier Code (UIC)

Please enter the UIC that is printed under your business name on the survey invitation letter (7-8 characters):

______________________________

The statements and questions in this survey are regarding your experience with the Veterans Choice Program.

Please think about your experience with VA Medical Center Staff in the last 3 months

Courteous

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Able to answer my Veterans Choice Program related questions the first time

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Adequately accessible for advice and assistance

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Keep me informed of conditions and changes that affect me

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Now think about your experience with Health Net/TriWest Staff in the last 3 months

Courteous

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Able to answer my Veterans Choice Program related questions the first time

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Adequately accessible for advice and assistance

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Keep me informed of conditions and changes that affect me

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

The next questions are regarding Authorizations for Care, Clinical Documentation, Billing and Payments in the last 3 months

Authorizations for care

Authorizations for care are complete for all services, including ancillary requests, in order to provide the necessary care for an authorized episode.

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Authorizations for care provide enough information for care and treatment.

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Clinical Documentation

I have the necessary history, test results, imaging, supporting documents etc. needed to evaluate and treat Veterans Choice Program patients when they present at my office.

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Clinical documentation is received in a timely manner

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

I understand the process to submit clinical documentation (including the time requirements) to Health Net/TriWest.

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Billing and Payments

I understand the billing process to submit claims to Health Net/TriWest.

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Payments by Health Net/TriWest for error-free claims are issued within 30 days of receipt.

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Please think about your Satisfaction with Services provided by Health Net/TriWest Staff in the last 3 months

How satisfied are you with the following services?

Authorizations for Care

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

Billing (excluding document submission)

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

Document Submission

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

Payments

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

Response to Inquiries

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

The next questions are regarding any Problems and Complaints you may have encountered

Have you experienced a problem in the last 3 months?

Ο Yes Ο No (Please skip to the next section, Overall Satisfaction)

Problems and complaints

Resolved quickly

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

Resolved with minimal effort on your part

Ο Always Ο Most of the Time Ο Sometimes Ο Rarely Ο Never

VA Medical Center Staff

Flexible in finding solutions to problems

Ο Always Ο Most of the time Ο Sometimes Ο Rarely Ο Never Ο Does not apply

Effectively handle problems or mistakes.

Ο Always Ο Most of the time Ο Sometimes Ο Rarely Ο Never Ο Does not apply

Health Net Tri/West Staff

Flexible in finding solutions to problems

Ο Always Ο Most of the time Ο Sometimes Ο Rarely Ο Never Ο Does not apply

Effectively handle problems or mistakes.

Ο Always Ο Most of the time Ο Sometimes Ο Rarely Ο Never Ο Does not apply

In which of the following areas did you experience the problem(s)? Mark all that apply

Ο Authorizations for Care Ο Billing (excluding document submission)

Ο Payments Ο Response to Inquiries

Ο Other – please specify __________________________________________________________

Describe the problem(s) and how the problem(s) was resolved. ______________________________

________________________________________________________________

Overall Satisfaction

Overall, how satisfied are you with your interaction with VA Medical Center staff regarding the Veterans Choice Program?

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

Overall, how satisfied are you with your interaction with Health Net/TriWest staff regarding the Veterans Choice Program?

Ο Very Ο Satisfied Ο Somewhat Ο Somewhat Ο Dissatisfied Ο Very

Satisfied Satisfied Dissatisfied Dissatisfied

Will you continue to provide care to Veterans on behalf of VA?

Ο Definitely Yes Ο Probably Yes Ο Probably No Ο Definitely No Ο Not Sure

Is there anything you would like to share about the Veterans Choice Program? _________________

_______________________________________________________________

What is your greatest pain point with the Veterans Choice Program? _________________________

_______________________________________________________________

Overall Experience with Department of Veterans Affairs (VA)

Now think about your experiences with all the services provided by the VA (which includes healthcare, benefits programs or memorial services).

Please tell us how you feel about the following statements:

I got the service I needed.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

It was easy to get the service I needed.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

I felt like a valued customer.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

I trust VA to fulfill our country’s commitment to Veterans.

Ο Strongly Ο Agree Ο Neither Agree Ο Disagree Ο Strongly

Agree nor Disagree Disagree

About You

Where do you work?

Ο Independent Medical Office Ο Private Hospital

Ο University Hospital Ο Other – please specify _________________________

What is your occupation?

Ο Clinician Ο Billing and Accounts Receivable Personnel

Ο Office Manager or Office Staff Ο Other – please specify _________________________

Within the last 3 months how many Veterans did you provide care for?

Ο Fewer than 10 Ο 10-39 Ο 40-69 Ο 70-99 Ο 100 or more Ο Do not know

How would you describe the geographic area where you provide care?

Ο Urban Ο Rural Ο Highly Rural

END OF SURVEY Thank you for your time!