Certified Risk Adjustment Coder (CRC®) - Certification Exam

Without risk adjustment coding to ensure that a complete picture of each patient’s health is captured and reported on medical claims, health plans would lack appropriate funding and planning to cover treatment for high-risk patients. Certified Risk Adjustment Coders (CRCs) play a critical role in establishing accurate risk scores for patients, which promotes optimal patient care and ethical payer reimbursement for providers and health plans.

Students earning their CRC credential possess demonstrated expertise in the complexity of diseases associated with chronic conditions and comorbidities, as well as mastery of ICD-10-CM guidelines and risk adjustment guidelines. As CRCs, they are equipped both to ensure clinical documentation accurately portrays the patient’s health status and to ensure all clinically documented diagnoses are properly reported.

CRC

CRCs Make a Competitive Salary

While risk adjustment diagnoses are pulled from claims data and medical record documentation in all healthcare settings, CRCs often work for health plans and for vendors working with health plans. They also play a valuable role in physician practices and are often tasked with educating physicians on proper documentation and coding. Because CRC have a direct and significant impact on revenue, they are well compensated, earning an average annual salary of $64,995, according to AAPC's 2022 Salary Survey.

As a CRC, you will be able to:

  • Review and assign accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office or facility setting (e.g., inpatient hospital)
  • Thoroughly comprehend medical coding guidelines and regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models
  • Understand the audit process for risk adjustment models
  • Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding
  • Understand the anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses

The CRC Exam

  • 100 multiple choice questions (proctored)
  • 4 hours to finish the exam
  • 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:

  • 15 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
  • 30 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
  • 12 multiple choice questions
  • Communicate documentation discrepancies with providers
  • Identify documentation discrepancies
  • 5 multiple choice questions
  • Identify common acronyms for industry terminology
  • Identify common acronyms for medical terminology
  • Identify the anatomic structures, locations, and functions
  • Explain disease processes and interactions for common chronic conditions
  • Define common medical terms
  • 10 multiple choice questions
  • Demonstrate the ability to apply trumping in the risk adjustment hierarchy
  • Explain the use of data mining from data captured through risk adjustment coding
  • Explain the use of predictive modeling from data captured through risk adjustment coding
  • 3 multiple choice questions
  • Explain the purpose of HEDIS and alignment with risk adjustment
  • Explain the purpose of STAR ratings and alignment with risk adjustment
  • 15 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
  • List the elements needed to determine the risk adjustment score
  • 10 cases with multiple choice questions
  • Demonstrate the ability to accurately code diagnoses based on medical record documentation.
  • Demonstrate the ability to report diagnoses that risk adjusts.

Approved Manuals for Use During the CRC Certification Exam

  • Your choice of ICD-10-CM, published in the current year

Officially published errata for the above code books may also be referenced during the CRC exam. Prior to CRC exam day, confirm reference materials allowed during the certification exam.

ICD-10-CM Complete Code Set 2022

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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.

Risk Adjustment Coding Certification Requirements

The CRC exam is a difficult, high-level exam and not intended for individuals lacking CRC training or equivalent experience working with risk adjustment models.

Additional Requirements

If you haven’t become an AAPC member, you must do so prior to scheduling your CRC exam. Renewing AAPC members are also required to have a current membership to sit for the CRC certification exam.

An overall score of 70% or higher is required to pass the certification exam.

  • If you don’t pass the CRC exam, you will be notified of the categories/areas of study with sub-scores of 65% or lower to help your prepare to retake the exam. The areas of study reported reflect scores based on the number of questions in each category/section of the exam.

All AAPC certification exams exclusively measure proficiencies relating to the one credential named in the exam. To earn additional medical coding credentials will require you to pass additional certification exams.

CEU Requirement: Certified coders are required to complete 36 Continuing Education Units (CEU's) every two years. For CEU requirements please see our CEU Information page.

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