A1. Hello, have I reached the office of [PROVIDER]?)
PHONE NUMBER: [PROVIDER TELEPHONE NUMBER]
YES = 1
NO, BUT CAN RECORD A NEW NUMBER = 2
NO, NEED TO TRACE THE CASE = 3
A2. I have [an] authorization form[s] for the release of billing and payment records and would like to speak to the person that can help me with that process.
[IF A2= 1 GO TO B1,
IF A2=2, GO TO CONTACT BLOCK
IF A2=3 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]
READ IF NECESSARY: I have [an] authorization form[s] for the release of billing and payment records and 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. Thank you. First, can you confirm that this is a doctor’s office and not a hospital?
[IF B2 = 3 OR 4 GO TO B3a_1,
IF B2 = 2 GO TO B4,
ELSE CONTINUE TO B3]
B3. And is there at least one physician in the practice who is a Medical Doctor or a Doctor of Osteopathy?
ALL SPECIALTIES ARE CONSIDERED MD/DO EXCEPT FOR: DENTISTS, OPTOMETRISTS, CHIROPRACTORS AND PODIATRISTS
[IF B3 = 1 or 3 GO TO B4,
IF B3 = 2 CONTINUE]
B3_1: Is this office under the supervision of MD or DO?
[IF B3_1 = 1 (YES) GO TO B4.
IF B3_1 = 2 (NO) CONTINUE
B3a.
WHAT KIND OF OFFICE IS THIS PROVIDER? [CODE ALL THAT APPLY]
I’m sorry. The information I was hoping to collect today is specific to doctor’s offices. Because this is not a doctor’s office one of my colleagues will be calling back to collect the necessary information.
CLICK NEXT TO GO TO THE EXIT SCREEN. ONCE YOU EXIT, CODE THE CASE AS “PROVIDER INELIGIBLE”
[GO TO EXIT SCREEN]
B3a_1: I'm sorry. The information I was hoping to collect today is specific to doctor's offices.
CLICK NEXT TO GO TO THE EXIT SCREEN. ONCE YOU EXIT, CODE THE CASE AS “PROVIDER INELIGIBLE”
[GO TO EXIT SCREEN]
B4. At this time, [NUMBER FROM PATIENT LIST] patient[s] identified [PROVIDER] as a source of health care during 2017. [The/Each] patient signed an authorization form allowing us to contact you for information about the cost of the care they received from [PROVIDER] in 2017. Much of the information we need is within the billing and payment records. Are the billing and payment records maintained in your office, or is an external billing service used?
[IF B4 = 1 GO TO B4b,
IF B4 = 2 GO TO B4_1]
B4_1. Are you the person who deals with the external billing service?
[IF B4_1 = 1, GO TO C2,
IF B4_1 = 2, GO TO B4a]
B4a. 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]
B4b. 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]
B5. 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 B5 = 1 GO TO CONTACT BLOCK,
IF B5 = 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]
READ IF NECESSARY: I have [an] authorization form[s] for the release of billing and payment records and would like to speak to the person that can help me get in touch with the external billing service that maintains your billing and payment records.
[IF C1=1, GO TO C2,
IF C1=2, GO TO CONTACT BLOCK]
C2. (READ IF NECESSARY: At this time, [NUMBER FROM PATIENT LIST] patient[s] identified [PROVIDER] as a source of health care during 2017. [The/Each] patient signed an authorization form allowing us to contact you for information about the cost of the care they received from [PROVIDER] in 2017.)
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 [PROVIDER] about [NUMBER FROM PATIENT LIST] of their patients who received medical service in 2017. I have [an] authorization form[s] for the release of billing and payment records 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]
READ IF NECESSARY: I have [an] authorization form[s] for the release of billing and payment records and 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. We were referred to you by [PROVIDER] for information about one or more of [his/her/their] patients. At this time, [NUMBER FROM PATIENT LIST] patient[s] signed an authorization form allowing us to contact you for information about the cost of the care they received from [PROVIDER] in 2017.
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 and B2 = 1, show “we will call back to collect the data over the phone”, if # of patients is >25 or B2 DOES NOT = 1, show “you can send us the billing and payment records by either fax or mail, or we can call back to collect the data over the phone.”] For each date of service in 2017, we are requesting information about charges, payments, diagnoses, and services provided.
[IF F1 = 1 GO TO F2,
IF F1 = 2 GO TO F2,
IF F1 = 3 GO TO F2,
IF F1=4 GO TO F2]
F2. Within the next [30 minutes / 24 hours] we will [fax/mail] you the authorization forms and include an instruction sheet. If you have any questions about the information we need, 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 2017. I’m going to read you a list of providers; please tell me if each one was associated with this health care practice in 2017.]
IF CB3= 1 or 2, GO TO EXIT;
IF CB3=4, GO TO F3
F3. When the authorization form packet is ready, you will receive an email with your unique username to access the electronic portal. The portal password is the part of your email address before the @ sign and the number 1234. Your password is <fill portal password> all in lower case. It is highly recommended that you change your password after your first log-in.
Each authorization form packet will be encrypted with a password also. Your password for the packet is <fill AF password>. This password is also in lower case.
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 B2 = 2 (Hospital) GO TO G4 (Obtain date we can expect records)
ELSE IF G1=1 and F1 (How provider will respond) = 1 (PHONE) GO TO G2 (Indicates whether will complete by phone now or at a later date), ELSE IF G1=1 and F1 = 2 (FAX) OR 3 (MAIL) OR 4 (ELECTRONIC PORTAL) GO TO G4 (Obtain date we can expect records);
ELSE GO TO G5 (Need to resend AFs)
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.
[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?
DATE:
R’s TIME: AM/PM
TIMEZONE:
[IF COMPLETE, GO TO EXIT SCREEN]
G4. Our records indicate that you will [fax/mail] the records to us.
Please send in the complete medical records and final billing records for all 2017 dates of service for each patient listed. The information we are attempting to collect from these records includes diagnosis, 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)
IF THE NUMBER OF DAYS OR WEEKS IS ENTERED THE SYSTEM WILL TRANSLATE THIS INFORMATION INTO A DATE FOR G4_1, G4_2.
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 medical and 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 TO G4_5
G4_3: How did you send the records? Did you fax, mail hardcopies via express or regular mail, mail CDs via express or regular mail, or use a record service's portal?
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 THE DAY OF THE WEEK
OR
(NUMBER OF DAYS/WEEKS)
Please send in the complete medical records and final billing records for all 2017 dates of service for each patient listed. The information we are attempting to collect from these records includes diagnosis, 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, ]
G6. Once we verify that you have received the authorization forms, you will receive an email with your unique username to access the electronic portal. The portal password is the part of your email address before the @ sign and the number 1234. Your password is <fill portal password> all in lower case. It is highly recommended that you change your password after your first log-in.
YOU WILL NEED TO SET THE EVENT CODE 150 (CREATE WEB PORTAL ACCOUNT FOR UPLOAD/DOWNLOAD - WEB) TO SEND THE EMAIL TO THE POC.
GO TO EXIT
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 billing and payment records for [PROVIDER(S)] in 2017. Could you please check to see if another billing service maintained billing and payment records for [PROVIDER(S)] in 2017?
[IF I1=1, GO TO CONTACT BLOCK,
IF I1=2, GO TO EXIT SCREEN]
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 PATIENT LIST] patient[s] identified [PROVIDER] as a source of health care during 2017. [The/Each] patient signed an authorization form allowing us to contact you for information about the cost of the care they received from [PROVIDER] in 2017. Much of the information we need is within the billing and payment records.
{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 am 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?
[NEXT TAKES USER TO CONTACT BLOCK]
CB3. Can you provide a fax number to receive the information?
[INTERVIEWER: IF POC ASKS ABOUT MAIL, OFFER THE MAIL OPTION. IF POC REQUESTS ELECTRONIC PORTAL, DISCUSS WITH YOUR SUPERVISOR BEFORE SELECTING THIS OPTION.]
FAX = 1
MAIL = 2
ELECTRONIC PORTAL = 4
N/A = 3
☐ INDIVIDUALIZED PACKETS NEEDED. (COMMONLY USED FOR VA CASES.)
CB3A: COMMENTS
CONTACT FIELDS
PROVIDER NAME:
GROUP/PRACTICE NAME:
BILLING SERVICE NAME:
POC FIRST NAME:
POC LAST NAME:
PHONE:
TIME ZONE:
EXT:
FAX:
VERIFY FAX:
E-MAIL:
VERIFY 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?
CB2a Does this office handle records for…
CB4. ADD ANOTHER POC?
If the user indicated earlier in the contact guide that the provider has no billing service (B4=1, B4b=1), then the program will complete this screen and skip to Section F of contact guide to explain next steps to this provider POC. If the user indicated earlier that there is a billing service (B4=2), then the program will complete this screen and skip to Exit screen.
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
CLICK ON YOUR NEXT STEP:
[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?
[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 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.]