This text is intended to familiarize
claims and investigative personnel with the best weapon available in the
fight against billing fraud - Current Procedural Terminology or "CPT" - the
Bible for healthcare billing.
The reader is
introduced to the concept of CPT and other billing manuals based on CPT, how
they were intended to be used, how they are abused, specific fraudulent
schemes based on CPT, red flag indicators of billing fraud and how to defend
against it.
If you don't
understand CPT now, you will when you finish this training manual.
Written by Eric Tackett
Published by the California Investigative Academy
Understanding CPT
- CPT Construction & Content
- The Purpose of CPT
- Evaluation Management (E/M Codes)
- Radiology Codes
- Physical Medicine Codes
- Other Commonly Abused Sections of CPT
Chapter 3
Common Forms of Billing
Fraud & Abuse
- False Billing
- Upcoding
- Downcoding
- Unbundling
- Rebundling
- Diagnostic Frauds
- "Exotic" Codes
-Other Forms of Billing Fraud
Chapter 4
Indicators of Billing
Fraud
- Reviewing the HCFA 1500 Form
- Reviewing Itemized Invoices/Statements
- CPT vs. ICD-9
- Mutually Exclusive Codes
- Other Indicators of Fraud