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

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