If AI is Coding Incorrectly! What do you do?

Corliss
Apr 7
2 min read

Yesterday, we asked: Is AI Coding Correctly? Today, we follow up with, if AI is Coding Incorrectly, what does one do in this Supercharged AI environment?

When patient services are coded incorrectly, and organizational leadership is challenged to believe you. The situation shifts from a technical issue to a compliance and ethical crisis. Incorrect coding—whether upcoding (billing for higher services) or downcoding (missed revenue)—violates False Claims Act (FCA) regulations, which require that claims reflect actual services rendered and are supported by documentation. Should you find yourself in a situation like this.

Here are a Few Step-by-Step Suggestions:

Conduct an immediate humans-in-the-loop (HITL) review AI Health Affairs:
Document Everything (Create a Paper Trail)
Utilize Internal Compliance Channels
Review Contractual/Ethical Obligations
Go above and beyond to try to resolve the issues internally

Summarize Potential Liabilities with Leadership

Try to get leadership to understand the risks:

Audits and Fines: The OIG can impose massive fines for fraudulent claims.
Patient Harm: Inaccurate documentation can affect the patients' future care.
Malpractice Liability: AI errors leading to improper treatment or billing may result in lawsuits.

Remember, Artificial Intelligence (AI) is best understood as a set of technologies that can function as both a tool and a system, depending on its complexity and application. While it is often described as a tool used for automating tasks, modern AI—particularly generative AI and agentic AI—operates more like an integrated, autonomous system.

AI should never be considered the end-all and be-all for anything. As a tool, an integrated or autonomous system, AI is not designed to make decisions. It is not a certified compliance or quality professional. Is not a licensed physician or nurse.

When AI makes a mistake, it is the certified or licensed professionals, the hospital, the revenue cycle leader, or other staff who will be called in to explain who failed to audit, question, or hold AI Accountable. #P3Quality #RevenueCycle #HealthcareAI #AgenticAI #MarketResearch

About the Author

Corliss Collins, BSHIM, RHIT, CRCR, CCA, CAIMC, CAIP, CSM, CBCS, CPDC, serves as the Principal and Managing AI Advisor. P3 Quality is an Artificial Intelligence (AI) Tech company. Our Approach is to provide precise strategies that drive AI Medical Coding and Revenue Cycle Management (RCM) System Solutions, and Supply Chain Clarity.

Disclosures/Disclaimers:

If AI is Coding Incorrectly? What do you do? We are not Attorneys. This analysis draws on research patterns, trends, and innovations in AI for Revenue Cycle Management (RCM). Some of the blog content is generated by AI. Reasonable efforts have been made to ensure the validity of all materials and the consequences of their use. If any copyrighted material has not been appropriately acknowledged, use the contact page to notify us so we can make the necessary updates.

LinkedIn Profile: www.linkedin.com/in/ccollinsrhitcca

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