• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer
  • About Us
  • Medical Billing Process
  • Insurance Contacts & Addresses
    • with Alphabet A to E
      • Insurance Companies with Alphabet A
      • Insurance Companies with Alphabet B
      • Insurance Companies with Alphabet C
      • Insurance Companies with Alphabet D
      • Insurance Companies with Alphabet E
    • With Alphabet F to J
      • Insurance Companies with Alphabet F
      • Insurance Companies with Alphabet G
      • Insurance Companies with Alphabet H
      • Insurance Companies with Alphabet I
      • Insurance Companies with Alphabet J
    • With Alphabet K to O
      • Insurance Companies with Alphabet K
      • Insurance Companies with Alphabet L
      • Insurance Companies with Alphabet M
      • Insurance Companies with Alphabet N
      • Insurance Companies with Alphabet O
    • With Alphabet P to T
      • Insurance Companies with Alphabet P
      • Insurance Companies with Alphabet Q and R
      • Insurance Companies with Alphabet S
      • Insurance Companies with Alphabet T
    • With Alphabet U to Z
      • Insurance Companies with Alphabet U
      • Insurance Companies with Alphabet V
      • Insurance Companies with Alphabet W to Z
  • BCBS Prefix
    • BCBS Alpha Prefix
      • Prefix with Alphabet A to E
        • Prefix List (AAA to AZZ)
        • Prefix List (BAA to BZZ)
        • Prefix List (CAA To CZZ)
        • Prefix List (DAA To DZZ)
        • Prefix List (EAA to EZZ)
      • Prefix with Alphabet F to J
        • Prefix List (FAA to FZZ)
        • Prefix List (GAA to GZZ)
        • Prefix List (HAA to HZZ)
        • Prefix List (IAA to IZZ)
        • Prefix List (JAA to JZZ)
      • Prefix with Alphabet K to O
        • Prefix List (KAA to KZZ)
        • Prefix List (LAA to LZZ)
        • Prefix List (MAA to MZZ)
        • Prefix List (NAA to NZZ)
        • Prefix List (OAA to OZZ)
      • Prefix with Alphabet P to T
        • Prefix List (PAA to PZZ)
        • Prefix List (QAA to QZZ)
        • Prefix List (RAA to RZZ)
        • Prefix List (SAA to SZZ)
        • Prefix List (TAA to TZZ)
      • Prefix with Alphabet U to Z
        • Prefix List (UAA to UZZ)
        • Prefix List (VAA to VZZ)
        • Prefix List (WAA to WZZ)
        • Prefix List (XAA to XZZ)
        • Prefix List (YAA to YZZ)
        • Prefix List (ZAA to ZZZ)
    • BCBS Alpha Numeric Prefix
      • Prefix with Alphabet A to E
        • Prefix List (A2A To A9Z)
        • Prefix List (B2A To B9Z)
        • Prefix List (C2A To C9Z)
        • Prefix List (D2A To D9Z)
        • Prefix List (E2A to E9Z)
      • Prefix with Alphabet F to J
        • Prefix List (F2A to F9Z)
        • Prefix List (G2A to G9Z)
        • Prefix List (H2A to H9Z)
        • Prefix List (I2A to I9Z)
        • Prefix List (J2A To J9Z)
      • Prefix with Alphabet K to O
        • Prefix List (K2A To K9Z)
        • Prefix List (L2A To L9Z)
        • Prefix List (M2A To M9Z)
        • Prefix List (N2A To N9Z)
        • Prefix List (O2A To O9Z)
      • Prefix with Alphabet P to T
        • Prefix List (P2A To P9Z)
        • Prefix List (Q2A To Q9Z)
        • Prefix List (R2A To R9Z)
        • Prefix List (S2A To S9Z)
        • Prefix List (T2A To T9Z)
      • Prefix with Alphabet U to Z
        • Prefix List (U2A To U9Z)
        • Prefix List (V2A To V9Z)
        • Prefix List (W2A To W9Z)
        • Prefix List (X2A To X9Z)
        • Prefix List (Y2A To Y9Z)
        • Prefix List (Z2A To Z9Z)
  • CPT Codes
  • Modifiers
Billing Executive

Billing Executive

Medical Billing Knowledge Base

  • Medical Billing
  • Medical Coding
  • CMS
  • Private Payers
  • Billing Errors
  • Resources
  • Buy Books & Courses

Difference between Insurance Verification and Insurance Authorization

June 15, 2022 by Aamir247 Leave a Comment

Insurance verification and authorization are crucial components in the revenue cycle management or medical billing insurance claims process. RCM is the financial process used by healthcare institutions to track patient care experiences from registration and appointment scheduling until final payment using medical billing software. Insurance verification and prior authorization are independent and distinct processes that both works to prevent claim denial and backlog.

Difference between Insurance Verification and Insurance Authorization

Insurance Verification

The practice of approaching the insurance company to verify whether the patient’s healthcare plans cover the requested procedures or not is known as insurance verification.
The key stage in the medical billing and coding process is insurance verification. In today’s constantly-changing and more complex healthcare market, confirming coverage, benefits, co-payments, and deductibles is more important than ever. As a result, medical care professionals must comprehend the insurance verification procedure and its significance in the healthcare business.

Its objective is to confirm:

  • If the patient has current health insurance coverage
  • What procedures/services are covered and which are not
  • The amount of each process that the insurer will cover and the patient’s financial responsibility.

Insurance verification must be completed before a patient may get medical treatment. Failure to do so may result in an unpaid claim from the insurance company or a patient-facing unexpectedly high expenses.

Role Of Insurance Verification In Medical Billing

Proper insurance verification allows for faster and more efficient payments, minimizes debts, and improves patient satisfaction.

  1. Enhances Cash Flow: Effective insurance verification results in more clean claims, which speeds up acceptance and leads to a shorter billing cycle. Inadequate eligibility and plan-specific benefit verification expose healthcare businesses to claim rejections, denials, and bad debt.
  2. Reduces the number of claim rejections and denials: A patient’s insurance plan must be verified before admission to any hospital, clinic, or medical institution To avoid claim rejection. Filing for claim rejection is a pain and takes a long time. Check that the documented patient information is valid and up to date. Also, ensure that the policies are still in effect and have not been amended. Even the smallest and most insignificant inaccuracy might result in claim rejection or denial. Make sure you’re thorough and attentive.
  3. Improves patient satisfaction: Transparency is ensured by verifying the patient’s insurance before the office visit and speaking with them about what their plan covers and does not cover. Patients will be aware of their care expenses and will be able to better prepare to pay their payments. Patients will avoid costly surprises if the medical billing procedure is transparent throughout.

Insurance Authorization

The process used by insurance companies to assess whether or not a patient is qualified for specific surgeries, drugs, or tests unless in an emergency is known as insurance authorization. It is also known as preauthorization, prior approval, or precertification. Prior authorization establishes the medical necessity of service, treatment plan, prescription medicine, or durable medical equipment (DME).

Role Of Insurance Authorization In Medical Billing

Insurance companies utilize preauthorization and predetermination to guarantee that patients only receive essential treatments and drugs. They will examine prescribed therapies to industry standards and approve those necessary for the patient’s health. If a less expensive, more appropriate therapy is available, they will decline the claim. Preauthorization has the following advantages:

  • Encourages safety
  • Aids in cost reduction
  • Prevents the abuse of drugs
  • Assists patients in avoiding needless medical treatments

The medical coder and the health care practitioner collaborate to authorize medical treatment. The medical coder is responsible for assigning the right CPT code to the medical procedure received by the patient. Consequently, the medical coder must take their responsibilities seriously since providing the incorrect CPT code might result in rejection.

Insurance Verification V/S Insurance Authorization

The following are the variables between insurance verification and insurance authorization:

  • Insurance verification occurs before the patient contact, whereas the prior authorization process begins when a physician’s treatment, test, prescription, or equipment requires preapproval from the insurer.
  • Medical billing professionals must be familiar with the CPT codes for the services for which clearance is sought for the preauthorization process to go smoothly. Insurance verification focuses on coverage status, active/inactive status, and eligibility status.
  • Prior authorization is concerned with getting prior authorization for treatments, whereas insurance verification is concerned with drafting and filing medical claims and receiving reimbursement for patient care.

Insurance verification and authorization both are time-consuming processes that may result in refusal. An outsourced medical billing partner who provides HIPAA compliant medical billing relieves your overloaded employees. A medical billing company’s precise verification speeds up approval and authorization, allowing you to focus on providing value-based treatment, which benefits your practice’s financial line.

About us

Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections.

We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte.

Learn More

How To Avoid Radiology Claim Denials With Insurance Authorizations?

Different Insurance Policies In Medical Billing

Insurance denial CO 39: Authorization/Referral Problem

Authorization number is Missing or Invalid – Denial Code CO-15


Post Views: 5

Filed Under: Medical Billing, Posts, Resources Tagged With: Insurance Authorization, Insurance Verification, medical billing, prior authorization

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Medical Billing & Coding Books

1 Stop Medical Billing Solutions

Save Time & Money by choosing “ONE STOP“ Solutions!

Revenue Cycle Management
Online Reputation
Virtual Staffing (RPO)

Free Standing Emergency Rooms, Micro Hospitals

www.rcmxpertz.com

Books for HCPCS & CPT Codes 2023

E-mail Newsletter

  • Facebook
  • GitHub
  • Instagram
  • Pinterest
  • Twitter
  • YouTube

Medical Jobs & Projects

  • Integrated Medical Services (IMS)

    Certified Medical Coder

    • Phoenix, AZ
    • Integrated Medical Services (IMS)
    • Full Time
  • Yeo & Yeo

    Medical Biller

    • Saginaw, Michigan
    • Yeo & Yeo
    • Full Time
  • UnitedHealth Group

    (OP) Medical Coder

    • HARTFORD, CONNECTICUT
    • UnitedHealth Group
    • Full Time
  • Aston Carter

    Medical Biller

    • Atlanta - Fulton County - GA Georgia - USA
    • Aston Carter
    • Full Time
  • Yeo & Yeo Affiliated Medical Billing

    Medical Biller

    • Saginaw, Michigan
    • Yeo & Yeo Affiliated Medical Billing
    • Full Time

Footer

Billing Executive – a “Medical Billing and Coding Knowledge Base” for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. Learn more about us!

Quick Links

  • Expert Advice for Medical Billing & Coding
  • Medical Billing and Coding Courses
  • List a Medical Billing Job or a Project
  • Medical Billing and Coding Jobs
  • Contact Us

Subscribe via Email

  • Privacy Policy

Proudly created by AJ Graphics

DISCLAIMER: Billing Executive does not claim ownership of all the informational content published or shared on this website, including any content shared by third parties. The content published or shared on this website, including any content shared by third parties is for informational/educational purposes.