Be Informed About Medicare

Be Informed About Medicare At some point you will be asked about Medicare, what is covered, what is not. As a nurse, you may not have to know the details of Medicare, but it can prove to be beneficial. If a patient has been instructed to undergo a test or procedure, they may question you as their nurse, asking about Medicare paying for the test. It helps to have some information regarding this complex and controversial program.

Medicare Basics Medicare is a government program designed to help cover some medical costs for older Americans. It covers more than senior citizens in certain exceptions, for instance, if an individual is legally considered disabled, they will at some point be eligible for Medicare. The cost of Medicare is just over $100 a month, and in certain situations that cost may be offset by a state's low income program.

Related: What does an RN Do? Advocating for Patients Hospitals differ on how they handle obtaining authorization for patients to remain hospitalized. Some have a designated nurse to speak with insurance carriers regarding all patient care, including Medicare patients. Other companies leave it to the nurse that cares directly for the patient, in these cases if it is your patient, you must speak with the company providing medical coverage for the patient. There may be times your role moves away from nursing and more into an advocacy role for the patient. It's important to have proper advocacy training, or the patient could suffer.

Medicare and Advocacy Here is an example situation: A 64 year old female was admitted to the hospital with pain in her abdomen.

After multiple tests, it was determined a portion of her intestines were destroyed, possibly from a blood clot. The patient underwent surgery and began the healing process while hospitalized. This was not laparoscopic surgery, so there was some extensive recovery to take place. After 6 days the patient was suffering from severe diarrhea. Because her surgical procedure was considered doing well, the Medicare representative suggested the patient be discharged. The nurse caring for the patient had never encountered the situation of advocating for the patient to remain hospitalized, so when Medicare pushed for her release, the nurse advised the

patient she would be released. The nurse expressed concerns to other nurses, but without realizing she could essentially argue for the patient to remain hospitalized, she provided home care instructions and the patient was released. 3 days later the patient was readmitted, and spent 3 weeks in ICU. She suffered from severe dehydration among other complications, that according to the physicians could have been avoided had she not been released so quickly. It is indeed the physician that signs the release, but much of this decision is based on the tending Nurse's evaluation. In this case, it would have most likely been beneficial for the nurse to at least propose to the Medicare official that the patient remain hospitalized until her severe diarrhea was under control. The nurse learned a valuable lesson in being a patient advocate, and thankfully the patient did go on to recover.

Personalities differ, and some people do not like confrontation, of course nurses are no exception. If you happen to fall into the category of not feeling comfortable debating patient care with any insurance carrier, including Medicare, you may need some training in this area. There are courses and classes that specifically instruct on advocating for patients. The proper training can build confidence and ensure your level of comfort in advocating for patients is adequate to speak on the patient's behalf.

Related: Nursing Specialist in High Demand Today Speaking with a Medicare Representative Prior to conversing with Medicare, arrange all pertinent information on the patient so that it is at your fingertips. It may be helpful to avoid terms such as:  I think  I feel  The patient has expressed  The family has requested Medicare puts those terms into an elective category. Instead, opt for terms such as:  The patient’s vitals support…  My documentation indicates  The patient is unable to…  Avoid entering the family into the conversation at all. Medicare views family involvement as support for the patient, and may be less like to approve additional hospital time.

Of course, this is entirely dependent on individual experience.

There is no question, a nurse is more than a provider of medical care, and being an advocate for your patient is yet another important role nurses

assume. Hospitals have an administrative staff that can offer advocacy advice and work as a liaison between nurse, patient, and Medicare.

Take advantage of any training sessions aimed toward patient care with advocacy. The last thing to consider with Medicare is to always follow up. If you don't receive the answer anticipated, call back. The next Medicare representative may have a completely different response.

Related: Leading Registered Nurse Marilyn Valerio Abalos, RN, BSN is to be Published in the Worldwide Leaders in Healthcare Please follow us on Facebook, Linkedin, Pinterest and Twitter