Nursing Essays on Financial Consideration in Case Management

Financial Consideration in Case Management

With the growing number of patients suffering from cancer and other chronic illnesses, the need for hospice care has increased. As such, it was essential for hospice care to be incorporated in the Medicare program. In the Medicare, the hospice services offered to patient with terminal illnesses with a life expectancy of about 6 months or less. Doctors must review patients who have been in the hospice care for 6 months. This is done to determine if they are still terminally ill and whether they still require the hospice services (Centers for Medicare & Medicaid Services, 2017).

The hospice care covers all services and the items required for relieving pain, drugs, provision of medical equipment, nursing, social services, and medical services. Other services covered by Medicare include grief counseling and spiritual needs. Hospice services are provided in Medicare-covered nursing facilities, hospitals, or the hospice centers for patients who require short-term stays. It however, covers respite care that can be up to five days, which gives family care providers an opportunity to rest. Patients can be required to pay up to 5% of the amount approved by Medicare for inpatient respite services. Patients can continue to receive hospice services as long as hospice doctors conduct assessments and certify that they are still terminally ill (Centers for Medicare & Medicaid Services, 2017).

Patients are not charged for hospice care. For outpatient services, patients pay a copayment that can be up to $5 per prescription. These usually cover symptom management drugs. In cases where Medicare does not cover a drug required by a patient, the doctor contacts the patient’s Medicare drug plan to check if the drug is covered under section D (Centers for Medicare & Medicaid Services, 2017).

I agree with Bower that all nurses should read the Medicare document. Bower in her article pointed out the importance of understanding the inclusion criteria for services offered by Medicare to patients (Bower, 2012). Nurses have a patient advocacy role (Davoodvand, Abbaszadeh, & Ahmadi, 2016). It is their duties to inform patients about the information entailed in the Medicare document that would benefit them. Aside from this, nurses have a responsibility of helping patients and their care providers in their decision-making.



Bower, K. A. (2012). Managing Care: The Crucial Nursing-Case Managment Partnership. NurseLeader, 10(6), 26-29. Retrieved from text. Retrieved from NurseLeader.

Centers for Medicare & Medicaid Services. (2017). Medicare and You 2017. Retrieved from Centers for Medicare & Medicaid Services.

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient Advocacy from the Clinical Nurses’ Viewpoint: A Qualitative Study. Journal of Medical Ethics and History of Medicine, Retrieved from