Appendix B5 Appellant Climate Survey - Web (English)
OMHA Annual Appellant Climate Survey
Appendix B5 Appellant Climate Survey - Web (English)
OMB: 0990-0330
Appendix
B5.
Appellant Climate Survey-Web
English
InstructionsClick the response that most closely describes your answer to each question. If you do not have an answer, you may leave it blank. In the questions that follow, “OMHA” refers to the Office of Medicare Hearings and Appeals. |
Section I. Hearings History
1. Approximately how many OMHA hearings have you participated in during the last 12 months?
0
1
2 to 10
More than 10
1b. Please respond to the survey questions based on your most recent hearing experience with OMHA over the last 12 months.
When answering these questions, think of the last hearing you participated in, which we show as [date] in the [field office]. Is that correct? [IF NO, THEN ASK]
2a. Approximately when was the last hearing you participated in? Month ______ Year _____
2b. Do you recall the office that heard this case?
Albuquerque
Arlington
Atlanta
Cleveland
Denver
Irvine
Kansas City
Miami
New Orleans
Phoenix
Seattle
3. Which of the following best describes your relationship to the appellant?
The appellant
Employee of the appellant
Appellant’s authorized or appointed representative
Other. Please specify:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0330. The time required to complete this information collection is estimated to average 11 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave. SW, Suite 537-H, Washington DC 20201, Attention: PRA Reports Clearance Officer.
Section II. Overall Experience
4. Independent of the judge’s decision, to what extent do you think you were given the opportunity to have your case fully heard and considered?
Very great extent
Great extent
Some extent
Very little extent
Not heard and considered at all
5. Next, think about the entire process of working with OMHA, from requesting a hearing up to receiving a final decision. Regardless of the outcome of that decision, how satisfied were you with the process of working with OMHA overall?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
6. How satisfied were you with the professionalism of OMHA staff when they assisted you with the
hearing process (from requesting a hearing up to receiving a final decision)?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very
dissatisfied
Section III. Request for Hearing
You may have requested a hearing by downloading, printing, and mailing or faxing Form OMHA-100—Request for an Administrative Law Judge Hearing. Or, you may have created an account and requested an appeal using the OMHA e-Appeal portal or website which allows you to fill in the form online. In some cases, you may request an appeal by phone.
7. Which of these methods did you use to request a hearing?
Mail [ask question 8]
OMHA e-Appeal Portal or website [ask question 8]
Phone [Go to question 9]
Fax [ask question 8]
8. Did you use form OMHA-100? That form is called a Request for an Administrative Law Judge Hearing.
Yes
No
8a. How satisfied were you with the clarity of the form you filled out?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
9. How satisfied were you with your experience using [DISPLAY ANSWER FROM QUESTION 7] to
request a hearing?
Very satisfied
[SKIP TO Q11A]
Neither satisfied nor dissatisfied
Dissatisfied
10. [If answer to Q9=d or e, then ask] Why were you dissatisfied?
[GO TO Q11A]
Section IV. Communications and Web Tools
11a. [SKIP IF NON-BENEFICIARY] When you received written notification of your scheduled
hearing, it may have included a “Notice of Nondiscrimination”. This document included
instructions in a variety of languages on how to obtain free aid and services for people with
disabilities and how to obtain free language services. Did you receive this document?”
No
Don’t know
11b. [Another/A] document you should have received is the Index of the Administrative Record
(Form-156) or Exhibit List. How satisfied were you with how clearly it listed all the documents
admitted to the administrative record and with its organization?”
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Didn’t receive
Don’t know
12. OMHA offers two online tools that allow you to look up the status of the appeals you have filed. The
first is the Administrative Law Judge Appeal Status Information System abbreviated as AASIS. The
second is the OMHA e-Appeal Portal. Have you used either of these tools to look up the status of
your appeal?
Yes
No [GO TO Q17]
13. [If answer to prior question is a] Which tool did you use to check the status of your appeal?
OMHA e-Appeal Portal
Both
14a. [If answer to Q13 is B or C] How satisfied are you with [OMHA e-Appeal Portal]’s capability to provide updates on your appeal?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
14b. [If answer to Q14a=d or e, then ask] Why were you dissatisfied?
15. [If answer to Q13 is b or C] Did you use the OMHA e-Appeal Portal to upload documents after
the appeal was assigned to a Judge?
Yes
No [GO TO Q17]
16. How satisfied are you with using the e-Appeal Portal to electronically upload documents?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
16a. [If answer to Q16=d or e, then ask] Why were you dissatisfied?
17. Have you accessed OMHA’s website?
No, I did not try
No, I do not have access to a computer and/or the Internet
No, I tried to but could not find it
Yes [GO to question 18]
18. [If 17d, then] Do you have any suggestions for improving the OMHA website?
19. Did you ever use the beneficiary or national toll-free helplines to contact OMHA?
Yes [GO TO Q20]
No [GO TO Q21]
20. How satisfied were you with the customer service provided by OMHA through the toll‑free helpline?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Section V. Experience Scheduling Your Hearing
21. There were four different phases of the scheduling process (listed below), starting with your initial request for a hearing, up to when you actually participated in the hearing and received the Judge’s decision. Please rate your level of satisfaction with each phase.
Phases of the Scheduling Process |
Very Satisfied |
Satisfied |
Neither Satisfied nor Dissatisfied |
Dissatisfied |
Very Dissatisfied |
The timeframe between filing your request for a hearing and when you were notified that your case had been assigned to a Judge |
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The amount of time you waited after the appeal was assigned until your hearing was scheduled |
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The timeframe after the hearing was scheduled but before it was held |
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The timeframe between the hearing and receiving a decision |
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22. Overall, how satisfied were you with the entire process to schedule the Judge’s hearing(s)?
Skip to q24
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
23. Please explain why you were dissatisfied in the space provided below.
24. After your hearing was scheduled, was it ever rescheduled?
No [go TO Q25]
24A. Did you request the hearing to be rescheduled or did the Judge change the time and/or place of
the hearing.
You requested a rescheduling of the hearing.
The Judge changed the time and/or place of the originally scheduled hearing.
Both parties requested the hearing be rescheduled and/or change in time and/or place at least one time
24B. How satisfied were you with the rescheduling process?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Section VI. Interaction with OMHA Between Scheduling and Hearing
25. Did you have any interaction with OMHA staff after the hearing was scheduled, but before the hearing was conducted?
Yes
No [skip to Q29]
26. What was the purpose of the interaction between you and OMHA staff [please check all that apply]?
a. Submit evidence or other documents
b. Request a copy of the administrative record
c. Discuss procedural matters
d. Get general questions about the hearing process answered
e. Other. Please specify:
27. During the period after the hearing was scheduled but before it was held, how satisfied were you
with your interaction with OMHA staff overall?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
28. Please explain why your interaction was less than helpful in the space provided below.
Section VII. Telephone Hearing
Next are questions about your telephone hearing.
29. What type of hearing did you have?
Telephone
Video
30. Overall, how satisfied were you with the [use of telephone/use of video] to conduct your hearing(s)?
Skip to Q31
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
30a. Please explain why you were dissatisfied in the space provided below.
31. [Beneficiaries only and question 29 is a] Were you offered the option of a video hearing?
Yes [GO TO 32]
No [ask 31A]
Don’t Remember [ask 31A]
31A. If offered, would you have participated in a video hearing?
Yes
No
Section VIII. Final Questions
32. Regardless of the Judge’s decision, how satisfied were you with the interaction you had with the Judge?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
33. Regardless of the judge’s decision, how satisfied were you with how clearly the decision explained the final outcome and reasoning behind the Judge’s decision?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
34. Regardless of the Judge’s decisions, please respond to the following statements about the Judge during your hearing(s) experience.
|
Always |
Often |
Some- times |
Never |
a. The Judge clearly stated the relevant issue(s) in my case(s). |
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b. The Judge was professional. |
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c. The Judge was an effective listener. |
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d. The Judge was prepared. |
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e. The Judge conducted an orderly hearing(s). |
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35. Based on your experience with the OMHA appeals process, do you have any suggestions for improvement?
END, closing statement►
These are all the questions we have for you. Thank you very much for taking the time to speak with us. If you would like to make a comment about this survey or confirm that it meets the necessary requirements as a valid information collection tool under the Paperwork Reduction Act, please contact the OMHA Survey Team at (866) 207-4466.
Section VIII. Final Questions for Non-Beneficiaries Only
As part of a broader effort to improve the Medicare appeals process, OMHA has offered alternative methods instead of the hearing process to seek review of appeals. The next questions describe one of OMHA’s Special Initiatives.
36. OMHA’s Settlement Conference Facilitation (SCF) program is an alternative dispute resolution process at OMHA that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals through mediation with the Centers for Medicare & Medicaid Services (CMS). Are you aware of this program?
Yes
No [skip to Closing Statement]
37. Have you participated in the Settlement Conference Facilitation program?
Yes
No [skip to Closing Statement]
38. How satisfied were you with your settlement conference facilitation experience?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Thank you for taking the time to respond to this survey. If you would like to make a comment about this survey or confirm that it meets the necessary requirements as a valid information collection tool under the Paperwork Reduction Act, please contact the OMHA Survey Team at 1-866-207-4466.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Filter questions for VTC, telephone, in-person |
| Author | Paul Ruggiere, PhD |
| File Modified | 0000-00-00 |
| File Created | 2024-09-23 |
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