Michigan Nursing Home Administrator (NHA) Practice Exam

When can a facility begin billing Medicaid after a resident's admission?

1. After 30 days of service

2. Upon discharge from the facility

3. After the local office confirms eligibility

4. Immediately upon admission

The correct answer is: After the local office confirms eligibility

Billing Medicaid for a resident's care can only begin once the local office confirms the resident's eligibility. This is crucial because Medicaid has specific eligibility criteria that must be verified before billing can occur. The local office conducts a thorough evaluation to ensure that the resident meets all necessary standards, including financial qualifications and medical need. Until this confirmation is received, the facility cannot initiate billing, as doing so without validating eligibility could result in denied claims and financial loss for the healthcare provider. Other scenarios, such as billing after a fixed period or upon discharge, do not adhere to Medicaid protocol, which strictly mandates eligibility verification before any billing can commence. Immediate billing upon admission is also not allowed since it presumes eligibility without the necessary verification process.