Michigan Nursing Home Administrator (NHA) Practice Exam

What is required for prior authorization of services before they are performed?

1. No requirements are needed

2. Mandatory Medicaid compliance documentation

3. A physician’s signature only

4. Approval from the local DSS office

The correct answer is: Mandatory Medicaid compliance documentation

Prior authorization is an essential step in the healthcare process, particularly for services involving Medicaid. For services to be approved before they are performed, mandatory Medicaid compliance documentation is required. This means that providers must submit documentation that justifies the need for the requested services according to Medicaid regulations. Such documentation typically includes clinical information, prior treatment history, and any other evidence that supports the necessity of the services being requested. In contrast, relying solely on a physician's signature would not suffice, as it does not encompass the breadth of documentation needed to satisfy Medicaid's compliance requirements. Additionally, simply obtaining approval from a local Department of Social Services office does not cover the specific documentation that Medicaid requires for prior authorization. By ensuring comprehensive compliance documentation is submitted, providers can facilitate timely access to necessary services for patients while adhering to Medicaid's policies.