Using AI? Prioritize These Regulations and Rules
Question: Our practice leadership wants to incorporate more artificial intelligence (AI) into our coding workflow. I’m worried about compliance — what can we do to make sure we’re not exposing ourselves to compliance risk? Iowa Subscriber Answer: AI relies on documentation — and not just medical documentation of specific patients, but high-quality data and documentation, generally. So if you’re using AI in your practice, you need to be certain that your data is standardized and high quality, and that your documentation is consistent and comprehensive. As an organization, you should invest time (or money) in data, cleansing, and standardization to enhance AI performance, said Becky Strom in her “Leveraging AI for Fraud in Coding, Auditing, and the Payer” presentation at RISKCON 2025. Make sure any AI-powered coding platforms stay compliant with Centers for Medicare & Medicaid Services (CMS) regulations, your payer policies, and HIPAA guidelines, she recommended. “Continuous monitoring and auditing are essential to prevent noncompliance,” she said. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
