AI Upcoding and Coding Compliance Risks Quiz

Answers and explanations appear as you take the quiz.

1. Why can a biased AI coding model cause more compliance damage than one person who upcodes?
   • AI models are legally treated as billing agents
   • Its lean toward higher codes repeats across every claim it processes
   • AI tools can bill payers directly without a provider
   • Payers cannot audit claims that AI tools produced
2. Under the False Claims Act, which state of mind can make a provider liable even without intent to defraud?
   • Only actual knowledge that a specific code was false
   • Negligence in any clerical task
   • Reckless disregard or deliberate ignorance of the truth
   • Mistakes discovered after a claim is paid
3. A hospital's contract says the coding vendor will indemnify it. Why is the hospital still exposed if AI-suggested codes are unsupported?
   • The billing provider certifies and submits the claim
   • Indemnification clauses are illegal in healthcare
   • Vendors are exempt from all federal law
   • Contracts only cover undercoding
4. After an internal audit finds that AI-accepted codes led to Medicare overpayments, what does federal law require?
   • Nothing unless a payer asks for repayment
   • Waiting for the next annual cost report
   • Deleting the audit findings
   • Reporting and returning the identified overpayments within 60 days
5. Which warning sign does the guide link to automation bias?
   • A coder who asks a lot of questions
   • A per-user acceptance rate of AI suggestions close to 100 percent
   • A model that gives low confidence on rare codes
   • An E/M mix that matches specialty benchmarks
6. How does an ambient scribe create an upcoding risk separate from coding software?
   • It sends claims straight to Medicare
   • It deletes earlier notes
   • It can phrase diagnoses more specifically or severely than the clinician meant, and that wording drives the code
   • It only works on paper charts
7. Why does the guide say to recheck code distributions after each vendor model update?
   • A new model release can change output without notice
   • Updates always lower code levels
   • Regulators require a new contract for each update
   • Old audit data is deleted during updates
8. What position does the guide take on undercoding?
   • It is the recommended way to avoid audits
   • It is legally required when a tool is uncertain
   • It only matters for Medicaid
   • Systematic undercoding is also inaccurate, and the goal is codes that match the record