A1.
IF CALLING A DOCTOR’S OFFICE/GROUP PRACTICE:
Hello, have I reached the office of [SBD PROVIDER]?
IF CALLING A BILLING SERVICE:
Hello, have I reached the billing service for [PROVIDER_NAME]?
PHONE NUMBER: [SBD PROVIDER TELEPHONE NUMBER]
[IF A1 = 1 GO TO A2,
IF A1 = 2 GO TO CONTACT BLOCK,
IF A1 = 3 GO TO EXIT]
A2. I have [an] authorization form[s] for [SBD_PROVIDER_FILL]]] for the release of professional billing records for services rendered at a Hospital or Institution and billed separately from that facility during [FILL_YR].
The professional billing records include charges, sometimes referred to as professional fees, for services provided to a patient in the hospital that were not included in the hospital bill.
[IF A2= 1 GO TO B1,
IF A2=2, GO TO EXIT SCREEN]
B1. My name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services.
We are conducting MEPS which is a study about how people in the United States use and pay for health care. For quality assurance and training purposes, this call may be monitored.
POC: [POC NAME]
I have [an] authorization form[s] for the release of physician billing and payment records. These are records that include charges, sometimes referred to as professional fees, for services provided to a patient in the hospital that were not included in the hospital bill. I would like to speak to the person that can help me with that process.
[IF B1=1, GO TO B2,
IF B1=2, GO TO CONTACT BLOCK;]
B2. Several patients identified [one or more doctors, including [PROVIDER_NAME], / [PROVIDER_NAME]] as providing health care during [FILL_YR]. Each patient signed an authorization form allowing us to contact you for information about the health care services provided in [FILL_YR] at one or more hospitals or institutions.
The information we need is included in the final billing records. Are the final billing records maintained in your office, or is an external billing service used?
[IF B2 = 1 GO TO B2b,
IF B2= 2 GO TO B2_1]
B2_1. Are you the person who deals with the external billing service?
[IF B2_1 = 1, GO TO C2,
IF B2_1 = 2, GO TO B2a]
B2a. I'll need to collect the name and telephone number for the person in your office who deals with the external billing service.
PRESS "NEXT" TO GO TO THE CONTACT BLOCK. ADD THE NEW POC TO THE CONTACT BLOCK AND CALL THEM USING SECTION C: IDENTIFY BILLING SERVICE.
NEXT BUTTON TAKES USER TO CONTACT BLOCK
B2b. I would like to fax the authorization form[s] to you, along with additional information explaining the study. I need to be sure I have the correct information for the packet. Should I direct it to you?
[GO TO CONTACT BLOCK]
B3. Can you please provide the name and number for the person who (needs to receive the courtesy packet/needs to receive the forms to approve the release of data?)
[IF B3 = 1 GO TO CONTACT BLOCK,
IF B3 = 2 GO TO EXIT SCREEN.]
C1. Hello, my name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services. We are conducting MEPS which is a study about how people in the United States use and pay for health care. For quality assurance and training purposes, this call may be monitored.
POC: [POC NAME]
I have [an] authorization form[s] for the release of physician billing and payment records. These are records that include charges, sometimes referred to as professional fees, for services provided to a patient in the hospital that were not included in the hospital bill. I would like to speak to the person that can help me get in touch with the external billing service that maintains your records.
CONTINUE, THIS PERSON CAN HELP = 1
COLLECT CONTACT INFORMATION FOR SOMEONE ELSE = 2
[IF C1=1, GO TO C2,
IF C1=2, GO TO CONTACT BLOCK]
C2. (READ IF NECESSARY: At this time, [NUMBER FROM SBD PATIENT LIST] patient[s] identified [SBD PROVIDER] as a source of health care during 2016. [The/Each] patient signed an authorization form allowing us to contact you for information about the cost of the care they received from [SBD PROVIDER] in 2016.)
We should be able to get all of the information we need from the billing service.
We can also fax you a copy of the authorization form[s] for your files.
I need to be sure I have the correct information for the packet. Should I direct it to you?
[GO TO CONTACT BLOCK]
C3. Can you please provide the name of the billing service, the name of a contact person, their telephone number and title?
[IF C3 = 1 GO TO CONTACT BLOCK,
IF C3 = 2 GO TO EXIT SCREEN.]
D1. Have I reached [BILLING SERVICE]?
PHONE NUMBER: [BILLING SERVICE TELEPHONE NUMBER]
[IF D1 = 1 GO TO D2,
IF D1 = 2 GO TO EXIT]
D2. We were referred to you by [SBD PROVIDER] about [NUMBER FROM SBD PATIENT LIST] of their patients who received medical service in 2016. I have [an] authorization form[s] for the release of billing records containing professional fees and would like to speak to the person that can help me with that process.
IF THE PERSON YOU NEED TO TALK TO IS UNAVAILABLE ATTEMPT TO GET THEIR CONTACT INFORMATION VIA THE CONTACT BLOCK AND SET AN APPOINTMENT IF POSSIBLE.
[IF D2= 1 GO TO E1,
IF D2=2 OR 3, GO TO EXIT SCREEN]
E1. Hello, my name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services. We are conducting MEPS which is a study about how people in the United States use and pay for health care. For quality assurance and training purposes, this call may be monitored.
POC: [POC NAME]
I have [an] authorization form[s] for the release of physician billing and payment records. These are records that include charges, sometimes referred to as professional fees, for services provided to a patient in the hospital that were not included in the hospital bill. I would like to speak to the person that can help me with that process.
[IF E1=1, GO TO E2,
IF E1=2, GO TO CONTACT BLOCK;]
E2. I would like to fax the authorization form[s] to you, along with additional information explaining the study. I need to be sure I have the correct information for the packet. Should I direct it to you?
[GO TO CONTACT BLOCK]
E3. Can you please provide the name and number for the person who needs to receive the courtesy packet/needs to receive the forms to approve the release of data?
[IF E3 = 1 GO TO CONTACT BLOCK,
IF E3 = 2 GO TO EXIT SCREEN]
F1. Once you have received the authorization form[s] [if # of patients is < or =25, show “we will call back to collect the data over the phone”, if # of patients is >25, show “you can send us the billing records containing professional fees by either fax or mail, or we can call back to collect the data over the phone”. We are requesting information about charges, payments, and services provided for each date of hospital or institution service in [FILL_YR]. We don’t need information about Office Visits. Can you confirm that you have records for the professional services provided by [one or more doctors, including [PROVIDER_NAME], / [PROVIDER_NAME]] at a hospital or institution in [FILL_YR]?
[IF F1 = 1 GO TO F2,
IF F1 = 2 GO TO F2,
IF F1 = 3 GO TO F2]
F2. Within the next [30 minutes / 24 hours] we will [fax/mail] you the authorization form[s] and include an instruction sheet. If you have any questions about what to send us, please call our toll-free number on the instruction sheet. We will call to verify that you received the authorization forms.
[We will work with you to set up a good time to collect the data over the phone.
We may call again if other patients identify your practice as a source of medical services.]
[Instrument logic will be implemented so text only appears on screen when provider verification has not been completed]: Before we send you the form(s) I’ll need to determine that all of the providers I have listed were in fact associated with this health care practice in 2016. I’m going to read you a list of providers; please tell me if each one was associated with this health care practice in 2016.]
[GO TO EXIT.]
G_Intro. May I please speak to [POC NAME]?
[IF G_Intro=1, GO TO G1,
IF G_Intro =2, GO TO APPOINTMENT SCREEN]
G1. Hello, my name is (YOUR NAME). I am calling on behalf of the U.S. Department of Health and Human Services. For quality assurance and training purposes, this call may be monitored. We previously spoke about the MEPS study.
Did you receive the authorization form[s] we [faxed/mailed] to you?
[IF G1=1 and F1 = 1 (PHONE) GO TO G2;
IF G1=1 and F1 = 2 (FAX) OR 3 (MAIL) GO TO G4;
IF G1=2 OR 3, GO TO G5]
G2. If it is convenient for you, we can just go ahead and complete the data forms together over the phone right now. I’d be happy to hold on while you get the information you need from your records. Remember, we are interested in information from physician billing and payment records for professional fees. By professional fees, I mean fees that cover services provided during the patient's hospital stay but are not part of the hospital bill
[IF G2=1 GO TO EXIT SCREEN;
IF G2=2 GO TO G3]
G3. I understand. What would be the best day and time to call you back to complete the data forms?
[IF COMPLETE, GO TO EXIT SCREEN]
G4.
Our records indicate that you will [fax/mail] the records to us.
Please send in the final billing records for all [FILL_YR] dates of service for each patient listed. The information we are attempting to collect from these records includes services, charges, payments, and adjustments for each date of service.
[IF THE POC MENTIONS UB04 OR CMS 1500, SAY:]
We need a final itemized statement that includes payments and adjustments so that we do not have to call back to obtain this information, but we can use UB04/CMS 1500 forms to accompany these final itemized statements.
When will you send us these records?
DATE:
IF DATE IS SELECTED REPEAT THE DATE AND THE DAY OF THE WEEK
OR
(NUMBER OF DAYS/WEEKS)
G4_1: Thank you. We will call you back if we do not receive the records by [FILL DATE FROM G4 (CALCULATE DATE IF DAYS/WEEKS ENTERED)].
YOUR NEXT STEPS WILL BE TO EXIT THE CONTACT GUIDE AND CODE THE CASE AS “AFs RECEIVED. WAITING FOR RECORDS TO BE SENT”. THEN SET A CALL BACK AFTER THE RECORDS ARE EXPECTED SO WE CAN PROMPT AGAIN IF THEY STILL HAVE NOT BEEN RECEIVED.
GO TO EXIT SCREEN
G4_2:
INTERVIEWER: USE THIS SCREEN WHEN PROMPTING FOR RECORDS
We were anticipating receiving billing records from you by [DATE/CALCULATED DATE FROM G4], but my records show we have not received them. Have you sent the records to us?
IF G4_2 = 2 GO G4_5
G4_3: How did you send the records? Did you fax, mail hard copies via express or regular mail, mail CDs via express or regular mail, or use healthport?
IF POC IS SENDING CD: Was the password provided or did you send it separately?
G4_4: What date did you send them?
DATE:
Thank you for sending them. The records are received in a separate department and it can take a few days to upload the documents into our system. We will investigate and call you back if we have further questions. We apologize for any inconvenience.
INTERVIEWER:
NEXT WILL ROUTE TO EXIT SCREEN
G4_5
We need to obtain these records for the study as soon as possible. Is there something that can be done to speed up (or expedite) the process?
INTERVIEWER: LISTEN TO POC TO DETERMINE IF THERE IS ANYTHING WE CAN DO TO HELP FACILITATE THEM SENDING IN RECORDS. OFFER:
When will you send us these records?
DATE:
IF DATE IS SELECTED REPEAT THE DATE AND DAY OF THE WEEK
OR
(NUMBER OF DAYS/WEEKS)
Please send in the complete medical records and final billing records for all 2016 dates of service for each patient listed. The information we are attempting to collect from these records includes services, charges, payments, and adjustments for each date of service. [IF THE POC MENTIONS UB04 OR CMS 1500, SAY:] We need a final itemized statement that includes payments and adjustments so that we do not have to call back to obtain this information, but we can use UB04/CMS 1500 forms to accompany these final itemized statements.
G4_6: Thank you. We will call you back if we do not receive the records by [FILL DATE FROM G4_5 (CALCULATE DATE IF DAYS/WEEKS ENTERED)].
INTERVIEWER: SET A CALL BACK AFTER THE RECORDS ARE EXPECTED SO WE CAN PROMPT AGAIN IF THEY STILL HAVE NOT BEEN RECEIVED.
GO TO EXIT SCREEN
G5. I’m sorry. Let me re-send the authorization form[s] to you.
I need to be sure I have the correct information for the packet. Should I direct it to you?
[IF G5=1, GO TO CONTACT BLOCK,
IF G5=2, GO TO CONTACT BLOCK]
H1. ASK (BY NAME) TO SPEAK WITH THE POC WHO DEALS WITH THE EXTERNAL BILLING SERVICE
This is (YOUR NAME) calling on behalf of the U.S. Department of Health and Human Services.
For quality assurance and training purposes, this call may be monitored.
We previously spoke about the MEPS study. Thank you for providing the contact information for [BILLING SERVICE NAME]. Unfortunately we were unable to locate [BILLING SERVICE NAME] with the contact information you provided. Could you please verify the contact information we currently have for [BILLING SERVICE NAME]?
[PRESENT BILLING SERVICE CONTACT INFO HERE]
[IF H1=1, GO TO H2,
IF H1=2, GO TO CONTACT BLOCK]
H2. That is currently the information we have on file. Do you know of any other way we can get in touch with [BILLING SERVICE NAME]?
[IF H2 = 1 GO TO CONTACT BLOCK,
IF H2=2 GO TO EXIT]
I1. ASK (BY NAME) TO SPEAK WITH THE POC WHO DEALS WITH THE EXTERNAL BILLING SERVICE
This is (YOUR NAME) calling on behalf of the U.S. Department of Health and Human Services. For quality assurance and training purposes, this call may be monitored.
We previously spoke about the MEPS study. Thank you for providing the contact information for [BILLING SERVICE NAME]. We were able to locate [BILLING SERVICE NAME] with the information you provided. However, they reported that they did not maintain the physician billing and payment records for [SBD PROVIDER(S)] in 2016. Could you please check to see if another billing service maintained physician billing and payment records containing professional fees for [SBD PROVIDER(S)] in 2016?
[IF I1=1, GO TO CONTACT BLOCK,
IF I1=2, GO TO EXIT SCREEN]
CONTACT FIELDS
PROVIDER NAME:
BILLING SERVICE NAME:
POC FIRST NAME:
POC LAST NAME:
PHONE:
TIME ZONE:
EXT:
FAX:
VERIFY FAX:
E-MAIL:
TITLE:
DEPARTMENT:
ADDRESS:
CITY:
STATE:
ZIP:
FOLLOW-UP QUESTIONS
CB1. WILL YOU BE CALLING THIS PERSON NEXT?
CB2. WHAT TYPE OF POC IS THIS PERSON?
CB3. WHAT TYPE OF PACKET ARE YOU SENDING?
CB3A: COMMENTS
CB4. ADD ANOTHER POC?
TYPICAL CONTACT SEQUENCE BY SECTION:
INTERNAL BILLING: A, B, Contact Block, F, end call
EXTERNAL BILLING SERVICE: Call provider, A, B, C, Contact Block, end call.
Call billing service: D, E, edit Contact Block, F, end call
VERIFY AFs WERE RECEIVED: Go to G
PROGRAMMER NOTES
[IF FIRST RADIO BUTTON IS SELECTED, GO TO B1.
IF SECOND RADIO BUTTON IS SELECTED, GO TO C1.
IF THIRD RADIO BUTTON IS SELECTED, GO TO D1.
IF FOURTH RADIO BUTTON IS SELECTED, GO TO G1.]
Can you please provide me with a better time to call back in order to reach him/her?
DATE:
R’s TIME: AM/PM
TIME ZONE:
[ALL GO TO EXIT SCREEN FROM HERE]
PRESS FINISH TO EXIT CONTACT GUIDE AND GO TO CASE MANAGEMENT SYSTEM.
DO NOT HANG UP UNTIL YOU GET TO CALL DISPOSITION SCREEN.
IF POC RECEIVED AUTHORIZATION FORMS AND CAN REPORT DATA BY PHONE NOW, ENTER EVENT CODE 441: AFs Received – Ready for Phone Data Collection
IF YOU NEED TO SEND A COURTESY OR PERMISSION PACKET:
[EXIT TO CMS BY PRESSING FINISH, BREAK-OFF SHOULD BE A SEPARATE FUNCTION.]
INTRODUCTION:
May I please speak to [POC NAME]?
Hello, my name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services. We are conducting MEPS which is a study about how people in the United States use and pay for health care.
For quality assurance and training purposes, this call may be monitored.
I recently spoke with {POC YOU ARE WORKING WITH FOR DATA COLLECTION} about the study. I explained that at this time, [NUMBER FROM SBD PATIENT LIST] patient[s] identified [SBD PROVIDER] as a source of health care during 2016. [The/Each] patient signed an authorization form allowing us to contact you for information about the cost of the care they received from [SBD PROVIDER] in 2016. Much of the information we need is within the physician billing and payment records containing professional fees.
{POC YOU ARE WORKING WITH FOR DATA COLLECTION} has agreed to participate and provide us with the information we are looking for, but has requested that we first send you a copy of the authorization form[s] in order to receive permission to release the data to us.
I'm calling to confirm that you are in fact the best person to receive the form[s] and information about the study by fax, and confirm your contact information so that I can address the fax to you.
[NEXT TAKES USER TO CONTACT BLOCK]
VERIFY PERMISSION PACKET RECEIPT:
May I please speak to [POC NAME]?
(Hello, my name is (YOUR NAME).) I am calling on behalf of the U.S. Department of Health and Human Services. We previously spoke about the MEPS study. For quality assurance and training purposes, this call may be monitored. Did you receive the authorization form[s] we sent to you?