Michigan Nursing Home Administrator (NHA) Practice Exam

What must be done before Medicaid can be billed for services provided?

1. All other possible sources for payment must be billed first

2. Only Medicare can be billed first

3. Facility must obtain prior authorization

4. Facility must wait for 30 days of service

The correct answer is: All other possible sources for payment must be billed first

Billing Medicaid for services provided in a nursing home requires that all other possible sources of payment be billed first. This is a critical step in the billing process because Medicaid serves as the payer of last resort. Prior to billing Medicaid, facilities must ensure that other insurance options, like private insurance or Medicare, are explored and processed. This helps to prevent the unnecessary use of Medicaid funds when other coverage might be available to cover the costs of care provided. For instance, if a patient has Medicare coverage and it is applicable to the services received, those claims must be submitted and settled before Medicaid can be considered. By following this required order of billing, nursing homes help to uphold the financial integrity of the Medicaid system and ensure that eligible individuals can utilize these funds for necessary care. The other options, such as needing to only bill Medicare first or obtaining prior authorization, do not reflect the comprehensive procedures laid out for Medicaid billing. Similarly, waiting 30 days for service is not a stipulated requirement for Medicaid; rather, expediency in billing other sources first is favored.