Certified Risk Adjustment Coder (CRC)

A Certified Risk Adjustment Coder (CRC) has proven, through rigorous testing and experience, that he can read a medical record and assign the correct diagnostic codes (ICD-10-CM) for a wide variety of clinical cases and risk adjustment service models (e.g. Hierarchical Condition Categories (HCC), Chronic Disease and Disability Payment System (CDPS), and United States Department of Health Risk Adjustment (HHS)

CRC

The greater the disease burden of the patient, the higher the patient’s risk adjustment value. If the patient is healthy, the risk adjustment value is lower. A patient’s state of health reflects the cost of their health needs. CRCs should ensure that vendor documentation for HCC coding is up to date and disease processes are accurately coded to follow risk adjustment patterns.

Invest in your future with CRC credentials – certified coders earn 40% more than coders without credentials.

As a CRC, you can:

• Review and assign specific medical codes for diagnoses made by physicians and other qualified health care providers in the office or facility (eg, inpatient hospital).
• In-depth knowledge of medical coding policies and regulations, including compliance and reimbursement, and the impact of coding diagnostics on risk adjustment payment models
• Understand the risk adjustment model review process
• Identify and communicate documentation gaps to vendors to improve documentation for accurate risk adjustment coding

Understand the anatomy, pathophysiology and medical terminology required to correctly code diagnoses

The CRC check

• 150 multiple choice questions
• 5 hours 40 minutes to complete the exam
• Open code book (manuals)
• The CRC check consists of questions about the correct application of the ICD-10-CM diagnostic trouble codes that are used for risk adjustment coding

The CRC check includes the following:

Conformity

• 23 multiple choice questions
• Identify common coding errors found during RADV audits
• Understand the anticipated exam process
• Understand the RADV review process
• Understand the retrospective review process

Diagnostic coding

• 60 multiple choice questions
• Demonstrate the ability to apply coding clinic guidelines to coding scenarios
• Demonstrate the ability to correctly code amputations
• Demonstrate the ability to correctly code artificial openings
• Demonstrate the ability to correctly code atherosclerosis
• Demonstrate ability to correctly code AV fistulas
• Demonstrate the ability to correctly code CHF
• Demonstrate ability to correctly code CKD
• Demonstrate the ability to correctly code device complications
• Demonstrate ability to correctly code COPD
• Demonstrate ability to correctly code CVA / Stroke
• Demonstrate the ability to correctly code dementia
• Demonstrate the ability to correctly code depression
• Demonstrate ability to correctly code DVT
• Demonstrate the ability to correctly code high blood pressure
• Demonstrate the ability to correctly code malnutrition
• Demonstrate the ability to correctly code manifestations of disease (e.g., DM, stroke, COPD).
• Demonstrate the ability to correctly code mental disorders
• Demonstrate the ability to correctly code neoplasms
• Demonstrate the ability to correctly code pneumonia
• Demonstrate the ability to correctly code pressure sores
• Demonstrate the ability to correctly code pulmonary embolism
• Demonstrate the ability to correctly code pulmonary fibrosis
• Demonstrate the ability to code seizures correctly
• Demonstrate the ability to correctly code skin ulcers
• Identify common coding errors in risk adjustment
• Identify diagnostic trouble codes that adjust the risk
• OBGYN-specific conditions that adapt to the risk
• Specific pediatric conditions that adapt to the risk

Improved documentation

• 18 multiple choice questions
• Communicate documentation discrepancies with suppliers
• Identify documentation gaps

Pathophysiology / Medical Terminology / Anatomy

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

Purpose and use of risk adjustment models

• 15 multiple choice questions
• Demonstrate the ability to take precedence in the risk adjustment hierarchy
• Understand the use of data mining from ingested data through risk adjustment coding
• Understand the use of predictive modeling based on data captured through risk adjustment coding

Quality maintenance

• 5 multiple choice questions
• Understand the purpose of HEDIS and its alignment with risk adjustment
• Understand the purpose of STAR ratings and the 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 use the private debtor risk adjustment model
• Understand the elements required to determine the risk adjustment value

Approved manuals for use during the exam

Your choice of CIM-10-CM.

Prepare for the CRC® test

• Medical terminology and anatomy course
• CRC Class or Classification
• CRC Study Manual
• Practice exam
• CRC verification

CRC Preparation Course Save up to 66%

This online course prepares students to become eligible for CRC with the AAPC and to qualify for a career as a Medical Risk Adjustment Coder.

CRC Study Guide

The CRC Study Guide reviews each section of the CRC exam in detail and provides practical examples, sample questions, and testing techniques. If you have exam experience or have successfully completed risk adjustment training (such as the courses listed above), this study guide will simplify exam preparation.

CRC Online Practice Exams

These three 50-question online practice exams are the BEST way to measure your CRC certification readiness. The content of the online practice exam mimics that of the certification exam itself.