Spreadsheet: 30399d1225899516-not-solved-but-closed-cant-exit-design-mode-because-error-msg-report-card
Sheet: Monitoring Form

 |  |  |  | Specialty Customer Service - Call Monitoring Form
 |  |  |  | [NAME]: |  |  |  |  |  |  |  |  |  |  |  | Date of Call:
 |  |  |  | Monitorer: |  |  |  |  |  |  |  |  |  |  |  | Patient's Account Number:
0 | 0 |  |  | Was the Caller the Patient? |  |  |  |  |  | Yes |  | No |  |  |  | Caller's Name:
 |  |  |  | Yes |  | No |  | N/A |  | GREETING
0 | 0 | 0 |  |  |  |  |  |  |  | Inbound |  |  | "Thank you for calling Pharmacy Services." |  |  |  |  |  |  |  |  | Proper Opening
0 | 0 | 0 |  |  |  |  |  |  |  | OUTBOUND
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | "My name is…(CSR [NAME])" |  |  |  |  |  |  |  |  | Identifies Self
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | "May I have the patient's name and date of birth, or account number this call is regarding?" |  |  |  |  |  |  |  |  | Identifies Account
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | "May I ask with whom I am speaking?" |  |  |  |  |  |  |  |  | Identifies Caller
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR verifies address, Social Security #, or Date of Birth            (HIPAA Authentication - must be 1 item more than what was used to identify the account) |  |  |  |  |  |  |  |  | Authentication of Caller - MUST DO if caller is the Patient
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  | Yes |  | No |  | N/A |  | COMPLIANCE
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR does not convey PHI without authenticating the caller as the patient.  If the caller is not the patient or MDO representative, the CSR does not offer PHI to the caller. |  |  |  |  |  |  |  |  | Protected/Personal Health Information (PHI)
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR does not counsel on medications/therapy or engage in personal history about medications. |  |  |  |  |  |  |  |  | Inappropriate Discussion about Medication/Therapy
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | Did the CSR offer to transfer the caller to a pharmacists when questioned about clinical information? |  |  |  |  |  |  |  |  | Transfer to a RPh Appropriately
0 | 0 |  |  |  |  |  |  |  |  | All |  |  |  |  |  |  |  |  |  |  |  | Documentation
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  | Yes |  | No |  | N/A |  | COMMUNICATION and COURTESY
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Listening:  CSR properly identified the nature of the call - asked appropriate probing questions if necessary. |  |  |  |  |  |  |  |  | Listening
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Listening:  CSR allowed caller to talk without interruption, providing recognition responses when appropriate
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Listening:  CSR provided the caller with their undivided attention
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Courtesy:  CSR uses "PLEASE" and "Thank You" when requesting and receiving information. |  |  |  |  |  |  |  |  | Courtesy
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | Courtesy:  CSR uses proper hold/transfer techniques: Gaining permission to place the caller on hold, returning to the caller within 60 seconds, thanking the caller for holding.
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | Courtesy:  CSR explains "silent times" and/or reasons for placing the caller on hold.
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Communication:  CSR shows empathy to caller - Expresses willingness to assist and maintains a patient and positive tone. |  |  |  |  |  |  |  |  | Communication
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Communication:  CSR provides information in a clear manner and avoids the use of jargon.
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Communication:  CSR controlled idle conversation - focusing caller to content of the call.
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | Communication:  CSR took ownership of the call, diffusing emotional content, made efforts to preventing call escalation.
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  | Yes |  | No |  | N/A |  | RESOURCE KNOWLEDGE
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR covered outlined information for NEW PATIENTS.  Does patient have proper understanding of what to expect in the future? |  |  |  |  |  |  |  |  | New Patient Dialog
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR Demonstrated resourcefullness and initiative in answering questions or handling customer issues.    Takes ownership and offers to follow-up with the caller for any outstanding requests or concerns. |  |  |  |  |  |  |  |  | Promise Form / Followup Process
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR demonstrated proper navigation of applications to provide accurate information in a timely manner and to properly reflect information obtained during the course of the customer contact. |  |  |  |  |  |  |  |  | Navigation / Documentation
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  |  |  |  |  |  |  | ORDER VERIFICATION
0 |  |  |  | Yes |  | No |  | N/A |  | Checkbox if Not Applicable - whole area
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR verifies medication(s) by having the caller provide the prescription# OR the Name AND Strength of the medication.  If not verified by prescription#, the CSR provides and confirms, by caller's approval, the quantity of the medication being requested. |  |  |  |  |  |  |  |  | Medication Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR inquires and verifies amount of medication on hand. |  |  |  |  |  |  |  |  | On Hand Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR asks the caller for the complete ship-to address.  CSR takes appropriate steps if change in address is required to ensure proper delivery. |  |  |  |  |  |  |  |  | Address Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR asks the caller to verify the primary phone # - and secondary phone # if available.  CSR takes steps if a change in telephone number is provided AND/OR enters additional/alternative telephone numbers as appropriate. |  |  |  |  |  |  |  |  | Phone Number Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR asks for and obtains an appropriate delivery date.  Receives a valid explanation if requesting delivery prior to the Refill-Too-Soon date.  Appropriately overrides shipping method as necessary. |  |  |  |  |  |  |  |  | Delivery Date Confirmation
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR confirms need for signature release / required.                                   IF REQUIRED: CSR expresses the patient's responsibility, toward the package and for the availability of a signature on the date of delivery.                                                                                                                      IF RELEASE:  CSR Expresses driver's perogative and patient's responsibility to obtain package if not left.  Also expresses that if left, patient is responsible for the package as is considered delivered. |  |  |  |  |  |  |  |  | Signature Release / Communication of Patient responsibility towards delivery
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR addresses the [NAME] and expresses limit to the patient.  Provides explanation of expectation as appropriate. |  |  |  |  |  |  |  |  | [NAME]
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR asks for payment as appropriate.  If payment by CC - asks for autocharge as appropriate.  Collects Outstanding Balances. |  |  |  |  |  |  |  |  | Obtainment of payment                                 (Scripmed)
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR properly documents payment information.  Manually processing payment information if needed. |  |  |  |  |  |  |  |  | Payment Processing / Documentation                          (ACH / SCCP)
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Prior to saving the scheduled order, the CSR reviews the order with the patient to ensure accuracy and patient's knowledge. |  |  |  |  |  |  |  |  | Order Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Upon saving the scheduled order, the CSR offers/provides the patient with the order / reference number. |  |  |  |  |  |  |  |  | Confirmation of scheduled order
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | Upon scheduling an order, the representative inquires if the patient has any known medical allergies and whether the patient is taking any medications other than those dispensed by BioScrip |  |  |  |  |  |  |  |  | Allergy / Medication profile update
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  |  |  |  |  |  |  | ORDER STATUS
0 |  |  |  | Yes |  | No |  | N/A |  | Checkbox if Not Applicable - whole area
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR asks probing questions to  properly identify the order being inquired upon |  |  |  |  |  |  |  |  | Order Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR controls the call by providing status of order without providing unnecessary information. |  |  |  |  |  |  |  |  | Call Control
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR properly verifies the delivery address for the order in question. - If not the patient, CSR asks the caller to provide the address. |  |  |  |  |  |  |  |  | Address Verification
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR inquires about amount of medication on hand and provides alternative solutions for the patient to resolve an immediate need of medication if appropriate. |  |  |  |  |  |  |  |  | Compliance
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR takes correct action to prevent further delay of delivery as appropriate |  |  |  |  |  |  |  |  | Service
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  |  |  |  |  |  |  | Miscellaneous
 |  |  |  | Yes |  | No |  | N/A
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR properly places the account into Follow-up appropriately. |  |  |  |  |  |  |  |  | Follow-up
0 | 0 | 0 |  |  |  |  |  |  |  | All |  |  | CSR inquires about amount of medication on hand and provides alternative solutions for the patient to resolve an immediate need of medication if appropriate. |  |  |  |  |  |  |  |  | On Hand Verification
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  | Yes |  | No |  | N/A |  | CLOSING
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR summarizes the call and offers additional assistance. |  |  |  |  |  |  |  |  | Extending Assistance
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR ends call with: "Thank you and have a good day / evening." |  |  |  |  |  |  |  |  | Closing
0 | 0 |  |  |  |  |  |  |  |  | All |  |  | CSR Properly documents the call. |  |  |  |  |  |  |  |  | End of Call Documentation
 |  |  |  | Monitor Comments:
N |  |  |  |  |  |  |  |  |  |  |  | Not all areas responded to.  Please complete
 |  |  |  | Scoring Sheet
 |  |  |  | Scoring:
 |  |  |  |  | HIPAA Criticals Failed |  |  |  |  |  |  |  | Total Areas answered (excluding N/A's)
 |  |  |  |  | Business Criticals Failed |  |  |  |  |  |  |  | Overall Percentage Passed:
 |  |  |  |  | Non-Criticals Failed
 |  |  |  |  |  |  | Total Failed:
 |  |  |  |  | Pass / Fail Overview
 |  |  |  | Areas of Failures (if any)
 |  |  |  | Monitor's Comments:
 |  |  |  | Representative's Comments:
 |  |  |  | Commitment for Improvement - Action Plan
 |  |  |  | Reviewer's Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:
 |  |  |  | Representative's Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:
 |  |  |  | Manager/Supervisor Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:
 |  |  |  | NOTE: THE INTENDED PURPOSE OF THIS FORM IS FOR DATA ENTRY ONLY.  DO NOT ATTEMPT TO MODIFY THE FORM
 |  |  |  | OUTSIDE OF THE INPUT FIELDS.  IF YOU HAVE IDENTIFIED A NEED TO MODIFY THE FORM - CONTACT JIM NICKERSON.