Certified Risk Adjustment Coder (CRC) Course

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    Health plans would lack adequate money and planning to cover treatment for high-risk patients if risk adjustment coding was not used to ensure that a complete picture of each patient’s health is collected and reported on medical claims. CRCs serve an important role in developing accurate risk scores for patients, which facilitates optimal patient care and ethical payer reimbursement for clinicians and health plans. Students who achieve their CRC credential have demonstrated knowledge of the complexities of diseases linked with chronic disorders and comorbidities, as well as mastery of ICD-10-CM criteria and risk adjustment recommendations. As CRCs, they are equipped to guarantee that clinical documentation appropriately depicts the patient’s health status and that all clinically reported diagnoses are correct.

     

    A Certified Risk Adjustment Coder can examine a medical chart and give appropriate diagnosis (ICD-10-CM) codes for a wide range of clinical cases and risk adjustment models (e.g., HCC-hierarchical condition categories, CDPS-Chronic Illness & Disability Payment System, and HHS- Health and Human Services risk adjustment). The risk adjustment score of a patient can be explained simply as follows: “If the patient is healthy, the risk adjustment score is lower; if the patient has a greater illness burden, the risk adjustment score is higher.” Certified Risk Adjustment Coders must ensure that provider documentation is adequate for HCC coding and that illness processes are correctly classified in order to follow risk adjustment models.

     

    Erendiz Academy and CRC Course:

     

    Erendiz Academy, the premier online and classroom training institute in PAN INDIA, strives to equip you with top-class training in the healthcare business to pass the tough CRC certification examination with very high score percentages.  As a learner you may have many questions such as what is CRC medical coding? How to get CRC certification? What is the course duration? What is exam pattern? How to prepare for final exam so on; we will be happy to answer all your questions and do the best career counseling, please reach out to us for best guidance.

     

    Obtaining a CRC credential demonstrates that you have:

     

    • Excellent Skills in reviewing and assigning precise medical codes for diagnoses performed in the office or facility environment by physicians and other qualified healthcare providers (such as inpatient hospital)
    • Thorough understanding of the influence of diagnosis coding on risk adjustment payment models, as well as expert knowledge of medical coding rules, regulations, including compliance and reimbursement.
    • Understand the audit procedure for risk adjustment models.
    • The capacity to detect and convey documentation deficiencies to providers in order to enhance documentation for proper risk adjustment coding.
    • Knowledge of anatomy, pathophysiology, and medical terminology required to code diagnosis accurately

     

    AAPC’s  CRC New Exam Structure:

     

    • 100 multiple-choice answers.
    • It takes 4 hours to complete the exam.
    • Open the code book (manuals)
    • 70% passing score required

     

    Mode of Training

     

    • Online
    • Classroom

     

    The CRC test consists of questions regarding how to correctly use ICD-10-CM diagnosis codes for risk adjustment coding.

    The CRC Exam Breakdown Structure

    Topics

    Areas

    Exam Questions

    Compliance

     
    • 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

     

    15 MCQ’s

    Diagnosis Coding

     
    • 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

     

    30 MCQ’s

    Documentation Improvement

     
    • Communicate documentation discrepancies with providers
    • Identify documentation discrepancies

     

    12 MCQ’s

    Pathophysiology/Medical Terminology/Anatomy

     
    • 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

     

    5 MCQ’s

    Purpose and Use of Risk Adjustment Models

     
    • 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

     

    10 MCQ’s

    Quality Care

     
    • Understand the purpose of HEDIS and alignment with risk adjustment
    • Understand the purpose of STAR ratings and alignment with risk adjustment

     

    3 MCQ’s

    Risk Adjustment Models

     
    • 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

     

    15 MCQ’s

    Cases
    • Demonstrate the ability to accurately code diagnoses based on medical record documentation.
    • Demonstrate the ability to report diagnoses that risk adjusts.

    10 Cases

     

    ||CRC Exam||Total  100 Questions ||4Hours||Open Code Book||