| Course | HCA 110 Insurance and Healthcare Reimbursement |
|---|---|
| Module | Module 3 |
| Paper type | Record review paper |
| Length | About 1,036 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Health Care Administration |
| Updated | September 2026 |
Free sample paper for HCA 110 Module 3
Does the Note Support the Claim? A Pre-Billing Record Review of One Family Medicine Visit
Student Name
Health Care Administration Program, Aspen University
HCA 110: Insurance and Healthcare Reimbursement
Instructor Name
Month Day, Year
Does the Note Support the Claim? A Pre-Billing Record Review of One Family Medicine Visit
A claim is only as strong as the record behind it. Payers can request records and deny or recover payment for any code the documentation does not support, and auditors look for the same gaps. A pre-billing record review compares each code on a claim against what the provider actually wrote before the claim goes out. This paper reviews one composite family medicine visit, identifies what the note supports and what it does not, and describes how the reviewer queried the provider.
The Visit
Mr. R., a composite 61-year-old man, came to a family medicine practice for a scheduled follow-up of type 2 diabetes and hypertension and mentioned right knee pain. The physician reviewed his glucose log and laboratory results, adjusted his metformin dose, examined the knee and gave a corticosteroid injection into the joint. The draft claim listed an established patient office visit, a large joint injection, the injected drug and three diagnoses.
How the Review Works
The reviewer reads the full note, not only the assessment and plan, and asks three questions for each code. Is the condition or service documented? Is it documented with the detail the code requires? Is the link between diagnosis and service clear? Diagnosis coding follows the official ICD-10-CM guidelines, which direct coders to code conditions that are documented and affect care at the encounter, and to code to the highest level of specificity documented (Centers for Medicare & Medicaid Services & National Center for Health Statistics, 2025).
Findings
The table summarizes the review of each line of the draft claim.
| Claim line | What the note shows | Finding |
|---|---|---|
| Type 2 diabetes | Glucose log reviewed, metformin increased, no complications named | Supported; specificity of complications needs a query |
| Hypertension | Blood pressure recorded, medication continued | Supported |
| Right knee osteoarthritis | Pain and swelling examined; diagnosis written as knee pain | Not supported as written; note says pain, not osteoarthritis |
| Office visit level | Two chronic illnesses managed, drug adjusted | Supported at the level billed |
| Large joint injection | Procedure note with site, consent, technique | Supported; needs modifier for separate visit |
| Injected drug | Drug and dose documented | Supported |
Diagnosis Specificity
The diabetes code on the draft claim was for type 2 diabetes with a complication, but the note named no complication. The laboratory results showed a slightly elevated urine albumin, which might support diabetic kidney disease, but the physician had not documented that diagnosis. The reviewer cannot assume it. Coding a complication the provider has not documented would overstate the patient's condition, while leaving out a real complication would understate it. The right step is a query.
Pain Versus Diagnosis
The draft claim coded right knee osteoarthritis, but the assessment said only right knee pain, with no imaging mentioned. The coder had assumed the diagnosis from the injection. A symptom code for knee pain is correct when no definitive diagnosis is documented. If the physician had diagnosed osteoarthritis from the exam and history, the note should say so, and the query asks.
Visit Plus Procedure
Billing an office visit on the same day as a minor procedure requires that the visit be significant and separately identifiable from the procedure. Here the physician managed two chronic conditions unrelated to the knee, so a separate visit is supported, and a modifier is added to the visit code to show it. If the visit had addressed only the knee before the injection, the visit would usually be included in the procedure.
The Provider Query
The reviewer sent the physician a written query through the record system. It quoted the relevant results and note text and asked two open questions: whether a diabetes complication was present and, if so, which one, and what the diagnosis for the right knee was. A compliant query does not suggest the answer that pays more; it presents the facts and lets the provider decide. The physician added an addendum documenting stage 2 chronic kidney disease due to diabetes and primary osteoarthritis of the right knee based on history and exam.
Why Accuracy Needs Training
Coding errors are common even among physicians. In a mock coding survey in orthopedic surgery, practicing surgeons chose correct codes 72.8% of the time, senior residents 51.0% and junior residents 47.4%, and any coding education was associated with better scores (Greenky et al., 2020). Review before billing catches errors that training alone does not prevent.
Better Notes, Better Claims
Documentation itself can improve. In one vascular surgery service, training advanced practice providers and introducing standardized note templates raised the capture of inpatient visit charges from 21.4% to 37.9% of inpatients and increased reimbursement from Medicare by 65% (Seligson et al., 2021). The lesson for a small practice is that clear templates and feedback help providers document what they do, which supports accurate codes in both directions.
Compliance and Privacy
Record review is a compliance activity. Coding to what is documented protects the practice from overpayment claims and fraud allegations, and a pattern of unsupported codes can trigger audits. Reviewers access protected health information for payment and operations, which the HIPAA Privacy Rule permits, but they should see only the records they need and discuss findings only with those involved (U.S. Department of Health and Human Services, 2022).
Building a Review Routine
A small practice cannot review every claim in depth, so it chooses where to look. Useful targets include claims with visit and procedure on the same day, new providers' claims for their first months, high-dollar services and diagnosis codes that often lack specificity, such as diabetes and heart failure. A monthly sample of ten claims per provider, with feedback shared privately, helps each provider see patterns in their own notes. Over time, the review finds fewer errors and becomes a coaching tool rather than a correction step.
Conclusion
The review of Mr. R.'s visit found that most lines were supported but that two diagnoses were not documented at the level coded. A neutral query to the physician produced an addendum that supported accurate, specific codes, and a modifier correctly showed a separate visit. Reviewing the record before billing costs a few minutes per claim and prevents denials, recoveries and compliance risk that cost far more.
References
Centers for Medicare & Medicaid Services & National Center for Health Statistics. (2025). ICD-10-CM official guidelines for coding and reporting FY 2026. https://www.cms.gov/medicare/coding-billing/icd-10-codes
Greenky, M. R., Winters, B. S., Bishop, M. E., McDonald, E. L., Rogero, R. G., Shakked, R. J., Raikin, S. M., Daniel, J. N., & Pedowitz, D. I. (2020). Coding education in residency and in practice improves accuracy of coding in orthopedic surgery. Orthopedics, 43(6), 380-383. https://doi.org/10.3928/01477447-20200827-10
Seligson, M. T., Lyden, S. P., Caputo, F. J., Kirksey, L., Rowse, J. W., & Smolock, C. J. (2021). Improving clinical documentation of evaluation and management care and patient acuity improves reimbursement as well as quality metrics. Journal of Vascular Surgery, 74(6), 2055-2062. https://doi.org/10.1016/j.jvs.2021.06.027
U.S. Department of Health and Human Services. (2022). Summary of the HIPAA privacy rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
What the HCA 110 Module 3 instructions ask for
The HCA 110 catalog lists reviewing records among the course topics, and because the module's instructions are posted only inside the course, that listing set this sample's task. A record review assignment usually gives you a note and a set of codes, or asks you to invent one, and asks whether the documentation supports each code. Some prompts ask you to write the provider query as well. Read the prompt to see whether you must assign codes yourself or only evaluate given codes. If you assign codes, use a current code set and the official guidelines, and cite them. Keep patient details generic and never use real records from your workplace.
Inside the HCA 110 Module 3 example
Around 1,040 words make up this example, organized under thirteen headings with one findings table. After the case, the paper states three review questions and applies them to six claim lines in the table. Three sections explain the problems found: a diabetes complication not documented, a knee diagnosis inferred from treatment and the visit billed with a procedure. The query section shows what a compliant query looks like and what the physician added. Evidence sections draw on a coding accuracy survey and a documentation template study. Compliance, privacy and a routine for choosing which claims to review complete the body before the conclusion. Three margin notes explain the review questions, the symptom finding and why the reviewer does not correct codes alone.
Reading the HCA 110 Module 3 grading rubric
Record review papers are generally judged on whether each finding is correct, whether the reasoning is explained, whether compliance is respected and whether sources are used well. Each finding here names what the note says and why that does or does not support the code. The reasoning follows the official coding guidelines on specificity and documentation. Compliance shows in refusing to add an undocumented diagnosis and in the neutral wording of the query. The coding guidelines and two peer-reviewed studies carry APA citations. Balance matters as well: a good review catches overcoding and undercoding alike, and this paper shows both. The conclusion weighs the few minutes a review takes against the cost of a denial or recovery.
HCA 110 Module 3 help from the desk
The mistake that costs most marks is correcting the codes yourself without going back to the provider. A reviewer can recommend and query, but the provider decides the diagnosis. Students also cite general coding websites instead of the official guidelines. Another frequent gap is ignoring modifiers when a visit and a procedure happen on the same day. Explain each finding in a sentence that quotes or paraphrases the note. If you are unsure whether your findings are correct, our tutors can go over the case with you and help you word a query that stays neutral. Mention compliance risk briefly, because unsupported codes are what auditors look for first.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More HCA 110 and Health Care Administration sample papers
- HCA 110 Module 1: Insurance Types and the Revenue Cycle
- HCA 110 Module 2: Verifying Benefits and Estimating Cost
- HCA 110 Module 4: Completing a Clean Claim
- HCA 110 Module 5: Coordination of Benefits and Secondary Claims
- HCA 110 Module 6: Posting Payments and Reading a Remittance
- HCA 110 Module 7: Analyzing Denied Claims
- HCA 110 Module 8: Writing an Appeal for a Denied Claim
- HCA 305 Module 3: Scheduling and Patient Flow
- CIS 450 Module 4: Data Standards and Interoperability
- HCA 100 Module 7: The Language of Health Care
- HCA 315 Module 6: The Medical Record as a Legal Document
HCA 110 Module 3 questions, answered
What does HCA 110 Module 3 usually ask for?
Aspen's HCA 110 description includes reviewing records, so a record review that checks codes against documentation is a typical assignment. Follow the prompt in your classroom.
Can a coder add a diagnosis the provider did not write?
No. Codes must reflect what the provider documented. If the record suggests a condition that is not documented, the coder sends a query and lets the provider decide.
What is a provider query?
A written question to the provider that presents facts from the record and asks for clarification without leading toward a particular answer.
Where can I find a free HCA 110 Module 3 sample paper?
Yes. The record review paper above includes the findings table, the provider query and margin notes, and all of it is open to read. It is the third HCA 110 sample.
What is a modifier in HCA 110 Module 3?
A two-character code added to a procedure code to give more information, such as showing that a visit was separate from a procedure done the same day.