Certified Risk Adjustment Coder (CRC)

A Certified Risk Adjustment Coder has proven by rigorous examination and experience that they know how to read a medical chart and assign the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., HCC, CDPS, and HHS Risk Adjustment). Invest in your future with the CRC certification—certified coders earn 40% more than non-credentialed coders.

The CRC’s abilities include:

  • Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office or facility setting (e.g., inpatient hospital)
  • A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement – allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models
  • Understand the audit process for risk adjustment models
  • Ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding
  • Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses
CRC Exam

The CRC Exam

  • 150 multiple choice questions
  • 5 hours 40 minutes to finish the exam
  • $650 which includes one year membership
  • One free retake
  • Open code book (manuals)

The CRC examination consists of questions regarding the correct application of ICD-10-CM diagnosis codes used for risk adjustment coding.

The CRC exam thoroughly covers:

Compliance

  • 23 multiple choice questions
  • Identify common coding errors identified in RADV audits
  • Understand the process for prospective audits
  • Understand the process for RADV audits
  • Understand the process for retrospective audits

Diagnosis Coding

  • 60 multiple choice questions
  • Demonstrate the ability to apply the Coding Clinic guidance to coding scenarios
  • Demonstrate the ability to properly code amputations
  • Demonstrate the ability to properly code artificial openings
  • Demonstrate the ability to properly code atherosclerosis
  • Demonstrate the ability to properly code AV fistulas
  • Demonstrate the ability to properly code CHF
  • Demonstrate the ability to properly code CKD
  • Demonstrate the ability to properly code complications of devices
  • Demonstrate the ability to properly code COPD
  • Demonstrate the ability to properly code CVA/Stroke
  • Demonstrate the ability to properly code dementia
  • Demonstrate the ability to properly code depression
  • Demonstrate the ability to properly code DVT
  • Demonstrate the ability to properly code hypertension
  • Demonstrate the ability to properly code malnutrition
  • Demonstrate the ability to properly code manifestations of diseases (eg, DM, stroke, COPD)
  • Demonstrate the ability to properly code mental disorders
  • Demonstrate the ability to properly code neoplasms
  • Demonstrate the ability to properly code pneumonia
  • Demonstrate the ability to properly code pressure ulcers
  • Demonstrate the ability to properly code pulmonary embolism
  • Demonstrate the ability to properly code pulmonary fibrosis
  • Demonstrate the ability to properly code seizures
  • Demonstrate the ability to properly code skin ulcers
  • Identify common coding errors in risk adjustment
  • Identify diagnosis codes that risk adjust
  • OBGYN specific conditions that risk adjust
  • Pediatric specific conditions that risk adjust

Documentation Improvement

  • 18 multiple choice questions
  • Communicate documentation discrepancies with providers
  • Identify documentation discrepancies

Pathophysiology/Medical Terminology/Anatomy

  • 8 multiple choice questions
  • Identify common acronyms for industry terminology
  • Identify common acronyms for medical terminology
  • Identify the anatomic structures, locations and functions
  • Understand disease processes and interactions for common chronic conditions
  • Understand the meaning of common medical terminology

Purpose and Use of Risk Adjustment Models

  • 15 multiple choice questions
  • Demonstrate the ability to apply trumping in the risk adjustment hierarchy
  • Understand the use of data mining from data captured through risk adjustment coding
  • Understand the use of predictive modeling from data captured through risk adjustment coding

Regulatory and Payer Requirements

  • 9 multiple choice questions
  • Review LCD/NCD and apply the policy to inpatient coding
  • Identify services covered by Medicare Parts A, B, C, D
  • Explain proper execution of the ABN and HINN
  • Review private payer policy and apply to inpatient payment
  • Identify precertification requirements

Quality Care

  • 5 multiple choice questions
  • Understand the purpose of HEDIS and alignment with risk adjustment
  • Understand the purpose of STAR ratings and alignment with risk adjustment

Risk Adjustment Models

  • 21 multiple choice questions
  • Demonstrate the ability to apply the ACA risk adjustment model
  • Demonstrate the ability to apply the CDPS risk adjustment model
  • Demonstrate the ability to apply the HCC risk adjustment model
  • Demonstrate the ability to apply the private payers risk adjustment model
  • Understand elements needed to determine the risk adjustment score
Certification Requirements

Risk Adjustment Coding Certification Requirements

  • We recommend having an associate’s degree
  • Pay examination fee at the time of application submission
  • Maintain current membership with the AAPC
    • New members must submit membership payment with examination application
    • Renewing members must have a current membership at the time of submission and when exam results are released
  • All exams will be reported with exact scores and areas of study (65% or less)

We strongly recommend that the candidate have at least two years of experience in risk adjustment coding or a risk adjustment coding course. Membership is required to be renewed annually and 36 Continuing Education Units (CEU’s) must be submitted every two years for verification and authentication of expertise.

Note:

Each examination is separate and distinct from one another To obtain all certifications, each examination must be taken separately and passed Continuing Education Unit (CEU) submissions are required for all certifications For CEU requirements please see our CEU Information page.