The Certified Risk Adjustment Coder (CRC)

The Certified Risk Adjustment Coder (CRC) is the only certification testing competencies for coders under all risk adjustment models. As risk adjustment payment models gain more momentum, it is important for coders to demonstrate expertise in diagnosis coding for proper risk adjustment determinations. Professionals with the CRC certification demonstrate proficiency with documentation review, determining conditions that qualify for coding, assigning the proper ICD-9-CM diagnosis codes and understanding the impact of reimbursement under various risk adjustment models.

-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 allowing a CRC
to understand the impact of diagnosis coding on risk adjustment payment
models.

-Apply proper diagnosis code assignment under various risk adjustment models
including HCC, CDPS, ACA-HHS and private payer 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.

-Identify common coding errors identified in RADV audits and how to prevent
audit findings.

-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.

 https://www.aapc.com/certification/crc/


Categories: Risk Adjustment, AAPC, CRC
Tags: certification, HCC coding, AAPC, CRC

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