Working together
to make today a good day
The Care GuidanceSM Program is a three-year demonstration project being conducted by Montefiore Medical Center to provide care management services to selected fee-for-service Medicare beneficiaries in the Bronx. The program, funded by Medicare, is part of a demonstration to test various methods for improving the quality of healthcare for Medicare recipients. The program does not change the participant's Medicare coverage, costs, choice of provider or access to care. It does not require healthcare providers to alter, in any way, the services they provide, administrative procedures or Medicare claims billing or reimbursement. The goal of the program is to help Medicare beneficiaries gain access to information and resources that will help them maintain or improve their health.
Program Highlights
Frequently Asked Questions
View/Download the Care Guidance Program Overview
View/Download the Updated Program Presentation
View/Download Provider brochure
View/Download Patient brochure
View All Links and Resources
Contact the Care Guidance Program
Program Highlights
By partnering with program participants, their families, caregivers and the medical community, the Care Guidance Program seeks to:
- Help physicians manage high-risk patients
- Reduce medication complications, emergency room visits and avoidable hospitalizations
- Improve the quality of life for both the participants and their caregivers
- Support participants in the community
Participants may be eligible to receive:
- Personal one-on-one support of a Care Manager to increase patient compliance
with physicians' treatment plans
- Disease-specific information and resources
- Assistance with arranging advance directives and healthcare proxies
- Falls prevention and other health promotion programs
- In-home monitoring equipment and home visits, if needed
Frequently Asked Questions
Does the Care Guidance Program replace the services provided to the participants by their current physician?
Participants can use their own doctors, choose their own specialists and receive treatment from any hospital or treatment facility they choose. The role of the Care Guidance Program is to support doctors' efforts by helping patients adhere to treatment plans.
Do participants pay any additional cost for these services and do all current Medicare benefits stay the same?
Medicare is working with Montefiore Medical Center to provide these services at no additional cost to the patients. Existing Medicare coverage and benefits will not change. Participants will continue to have only the Medicare costs (premium, deductibles, and co-payments) they already have.
Who is eligible to participate in the Care Guidance Program?
Enrollment in the program is restricted. Participants were selected by Medicare based on their current health status or healthcare usage. Participation in the program is completely voluntary.
How will I know if a person is eligible for the program or has already enrolled?
Beneficiaries eligible for the program have received a letter from Medicare. You can also call the Care Guidance Program at 888-667-8447 to verify eligibility or enrollment. (Note: Patients cannot be referred into the program.)
Does the Care Guidance Program affect Medicare billing or reimbursement?
The Care Guidance Program has no affect on Medicare billing or reimbursement. You should continue to bill Medicare for program participants in the same way as other fee-for-service Medicare beneficiaries. This is not a managed care plan. This program has no pre-certification or prior approval requirements.
How can I help support the program?
You can encourage those beneficiaries who have been invited by Medicare to participate in the program to call and enroll in the program TODAY. You can also cooperate with our Care Guidance team who may call you to discuss issues of concern regarding a program participant.
Why is Medicare sponsoring this project?
Medicare is sponsoring the Care Guidance Program to test whether care coordination and close monitoring of beneficiaries' medical conditions will result in fewer emergency room visits and hospital admissions while enhancing quality of care.
When does the project start and end?
The demonstration project will begin on June 1, 2006 and run through May 30, 2009. |
