HS215 Unit 3 Therapy Eligibility Verification Example

Reviewed by Elspeth Marlowe, MSN, RN Medical Insurance and Billing Purdue University Global Free custom sample in 24 to 48h

In this HS215 Unit 3 eligibility verification exercise, a composite patient is referred for twenty physical therapy visits after rotator cuff surgery, and a six-step check before the first visit finds that her plan will pay for only ten. Purdue Global HS 215 asks BS in Health Science learners to show how eligibility work prevents denials. The exercise confirms active coverage and in-network status, reads the therapy benefit with its twelve-visit combined limit, finds the prior authorization rule after six visits, subtracts visits already used this year and estimates her share given what remains of her deductible. Sections describe what the clinic does next, what would have happened without verification and how each step is documented.

CourseHS215 Medical Insurance and Billing
UnitUnit 3
Paper typeEligibility verification exercise
LengthAbout 650 words, 5 pages double-spaced
FormatAPA 7 student paper
SchoolPurdue University Global
ProgramBS in Health Science
UpdatedOctober 2026

Free sample paper for HS215 Unit 3

1

Twelve Visits Allowed, Twenty Ordered: A Unit 3 Eligibility Verification Exercise for Physical Therapy After Shoulder Surgery

[Student Name]

Purdue University Global

HS215: Medical Insurance and Billing

Unit 3 Eligibility Verification Exercise

[Instructor Name]

[Date]

The patient, plan and figures are composite; the textbook and federal handbook cited are real.

What this part is doingNaming the gap between visits ordered and visits allowed in the lead shows what the verification is designed to catch.
2

The Referral

A composite 51-year-old woman had surgery to repair a torn rotator cuff. Her surgeon orders outpatient physical therapy, two visits a week for ten weeks, twenty visits in all. She calls to schedule at an outpatient therapy clinic and gives her employer PPO card. The front desk verifies before the first visit.

Step 1: Is Coverage Active on the Date of Service?

Checked through the payer's online portal using her member ID, date of birth and the planned start date. Result: coverage active, subscriber is the patient, effective since January of this year. Recorded with the date and the reference number of the inquiry.

Step 2: Is the Clinic In Network?

Checked on the payer's provider directory and confirmed by phone. Result: the clinic and the treating therapist are both in network. Recorded with the representative's name and call reference.

Step 3: What Is the Therapy Benefit?

Result from the portal benefit summary: outpatient rehabilitation is covered at the in-network level with a [$40] copay per visit after the deductible; the plan limits physical, occupational and speech therapy combined to [12] visits per calendar year.

Step 4: Is Authorization Required?

Result: the plan requires prior authorization for therapy beyond the first [six] visits, with clinical notes showing progress. The clinic can request authorization after the initial evaluation and must submit progress notes before visit seven.

Step 5: What Has Already Been Used?

The portal shows [two] therapy visits used earlier this year, for a different condition, which count against the same combined limit. Remaining visits: [10].

Step 6: What Will the Patient Owe?

Her plan is typical of employer coverage in pairing a deductible with copays (KFF, 2024). The deductible of [$1,500] has [$1,180] already met from her surgery claims, leaving [$320]. The first visit's allowed amount is estimated at [$180], so she will owe the full allowed amount for the first visit and part of the second until the deductible is met, then [$40] per visit. The estimate is given to her in writing at scheduling, with a note that it may change once claims process (Smith, 2022).

The plan is active, in network and covers therapy, and still only ten of the twenty ordered visits will be paid unless someone acts now.

What this part is doingPlacing the key finding after the steps that produced it shows how verification reveals problems that a simple active-coverage check would miss.
3

What the Verification Changes

Three actions follow. First, the clinic tells the patient that her plan allows about ten more therapy visits this year and that the remaining visits would be her cost unless the plan approves an exception. Second, the clinic notes that prior authorization must be requested before visit seven, and assigns the task to the authorization coordinator with a reminder date. Third, the therapist is told about the limit, so the plan of care can prioritize the most important goals and the surgeon can be asked whether a home program could cover later weeks.

What Would Have Happened Without It

Visit limits like this are common in commercial plans and in Medicare Advantage plans, while Original Medicare instead applies a threshold after which therapy must be shown to be medically necessary (Centers for Medicare & Medicaid Services, 2024). Without verification, the clinic might have scheduled all twenty visits, billed visits seven onward without authorization and received denials, while the patient faced unexpected bills for visits beyond the limit. Each problem would have surfaced weeks later, after the services were given.

What this part is doingDescribing the cost of skipping verification makes the case for each step concrete for staff who see it as paperwork.
4

Documentation

Every step records the date, the source, the reference number or representative's name and the result. If a claim is later denied, this record is the clinic's evidence of what the payer said.

5

References

Centers for Medicare & Medicaid Services. (2024). Medicare & you 2025: The official U.S. government Medicare handbook. U.S. Department of Health and Human Services.

KFF. (2024). 2024 employer health benefits survey. KFF.

Smith, L. M. (2022). Fordney's medical insurance and billing (16th ed.). Elsevier.

The Purdue Global HS215 Unit 3 instructions

Unit 3 calls on students to complete an eligibility and benefits verification for a case, documenting each step and its result. Worksheets of Length depends on the prompt. Instructors expect coverage confirmed for the date of service, network status checked, the specific benefit for the service read rather than assumed, authorization requirements identified and the patient's estimated share calculated. Many prompts emphasize documentation, including dates, sources and reference numbers, because the record may be needed if a claim is later denied. Students are often asked to explain what the findings mean for scheduling and for the patient. Using placeholders for identifiers is expected. Students are often asked what the findings mean for the schedule, the therapist and the patient.

How this HS215 Unit 3 example is built

The exercise presents the referral and plan, then works through six numbered steps: active coverage, network status, the therapy benefit, authorization, visits already used and the patient's estimated share. Each step records its source and result. The highlighted sentence states the central finding that only half the ordered visits will be paid without action. A section lists three actions: informing the patient, scheduling the authorization request and telling the therapist about the limit. Another section describes the denials and bills that would have followed without verification, and a final section explains the documentation standard. Each step's result is written in one sentence with its source, so the record could be handed to a colleague.

Reading the HS215 Unit 3 grading rubric

Verification exercises tend to be marked on completeness of the steps, accuracy of benefit interpretation, quality of documentation, the actions taken on findings and clarity. Benefit interpretation often weighs most, since misreading a visit limit or deductible leads directly to denials or surprise bills. Completeness rewards checking network status, authorizations and prior use, not only active coverage. Documentation earns credit when every step records date, source and reference. Actions score well when they address both the clinic's process and the patient's understanding. A clear estimate with its assumptions and placeholders for identifiers round out the marks. Instructors often check that the estimate states its assumptions, such as the deductible already met.

HS215 Unit 3 help: mistakes that cost points

The most common weakness is stopping at active coverage, as if a valid policy meant every service is paid. Another is ignoring visits already used for other conditions under a combined limit. Some students calculate the patient's share without checking what is left of the deductible. Others identify an authorization requirement but assign no one to request it. Leaving out documentation makes the work impossible to defend if a claim is denied. If your case involves a different service, perhaps a sleep study or a home health episode, send the plan details, and we will work the verification step by step with documentation.

Get an HS215 Unit 3 example written to your instructions

Attach the scenario and any verification template supplied for Unit 3, plus the rubric. Placeholder identifiers fill that template, each check carries its explanation, and the completed exercise is returned in 24-48h. A first custom sample is free, and the person verified is invented, with no real chart behind them. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

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HS215 Unit 3 questions, answered

What is the difference between a referral and a prior authorization?

A referral is a primary care provider's direction sending a patient to a specialist, typically required by HMO-type plans. A prior authorization is the payer's own approval of a specific service before it happens, often required for imaging, surgery or certain drugs regardless of plan type. A patient can need both, and the exercise records each separately.

How should real member numbers be handled?

They should not appear at all. Use placeholders such as brackets or clearly fictional formats, and keep names generic. Even where an assignment encourages a workplace example, identifiers from actual patients have no place in coursework. Graders in billing courses notice realistic-looking numbers and may ask where they came from, which is a conversation worth avoiding.

Where can I find a free HS215 Unit 3 sample paper?

The complete Unit 3 eligibility exercise is posted here, finding a visit limit and authorization rule before physical therapy begins.

Why check visits already used this year?

Many plans combine physical, occupational and speech therapy under one annual limit, so visits for an earlier condition reduce what remains.

What should the clinic tell the patient about the visit limit?

That her plan pays for about ten more therapy visits this year, that later visits may be her cost unless an exception is approved, and what the authorization step involves.