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Certified Risk Adjustment Coder (CRC^™)

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

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CRC Exam
Approved Manuals
Certification Requirements
FAQ’s

The CRC Exam

150 multiple choice questions
5 hours 40 minutes to finish the exam
One free retake
$380 ($300 AAPC Students) - 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

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

Approved Manuals for Use During Examination

Your choice of ICD-10-CM.

Note:

Electronic devices with an on/off switch (cell phones, smart phones, tablets, etc) are not allowed into the examination room Failure to comply with this policy may result in disqualification of your exam.

Any officially published errata for these manuals may also be used No other manuals are allowed Each code set is updated annually; it is essential that examinees use the current calendar year's coding manuals when taking the certification exam Questions on the CRC test do not require the use of any other outside material.

Individuals with a solid understanding of coding and reimbursement fundamentals, anatomy and terminology should be able to answer each examination question through application of the ICD-10-CM codebook or through careful reasoning and recall.

Approved Exam Manuals

Non-Approved Manuals for Use During Examination

Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:

Any Procedural Coding Expert
Any Procedural Professional
CPT^® Plus! - PMIC
CPT^® Insider's View - AMA
ICD-10-CM Easy Coder
Study Guides

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

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.

An overall score of 70% or higher is required to pass an exam. For examinees who do not pass, only the areas of study/categories with a score of 65% or less are provided for examinees’ preparation.

The areas of study reported reflect scores based on the number of questions in each category/section of the exam; each of the category/section may vary in the number of questions asked.

Continuing Education Unit (CEU) submissions are required for all certifications. For CEU requirements please see our CEU Information page.

* Medical Coding Salary

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