Certified Risk Adjustment Coder (CRC)® Certification
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. Healthcare professionals 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.
Certified Risk Adjustment Coder (CRC)® certification
Exam format
100 multiple-choice questions
Online or in-person options
AAPC offers online and in-person proctored exams. Choose to take the exam at home in a quiet, private location or through your local chapter or a licensed instructor. Learn more about the online proctored exam and how to prepare for the current exam.
Time allowed
In-person and online exams are administered in one sitting, with four hours to complete the exam.
Equipment required for online exam
A reliable internet connection and an external webcam that can be positioned to show your face, hands, keyboard, and the area around the keyboard (about 10 inches) are required.
Experience requirements
A high-level knowledge of medical terminology, anatomy, and pathophysiology, along with an understanding of the proper application of ICD-10-CM diagnosis codes used for risk adjustment coding.
Approved code books
Your choice of ICD-10-CM — published in the current year. No other code books or references are allowed.
Maintaining your certification
To maintain your credential, you must maintain your AAPC annual membership, and earn 36 continuing education units (CEUs) every two years..
The CRC Exam Pattern
CRC Exam Pattern:
· 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.
Compliance
· 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
Diagnosis Coding
· 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
Documentation Improvement
· 12 multiple choice questions
· Communicate documentation discrepancies with providers
· Identify documentation discrepancies
Pathophysiology/Medical Terminology/Anatomy
· 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
Purpose and Use of Risk Adjustment Models
· 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
Quality Care
· 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
Risk Adjustment Models
· 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
Cases
· 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.
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