Credit Recommendation
- BIO 130 - Human Biology: 4 credits, lower division level
- BIO 212 - Anatomy & Physiology: 3 credits, lower division level
- BIO 215 - Pathophysiology: 3 credits, lower division level
- HCA 105 - Medical Terminology: 3 credits, lower division level
- HIM 205 - Reimbursement Methodologies: 3 credits, lower division level
- HIM 210 - Medical Coding and Billing 1: 3 credits, lower division level
- Risk Management: 3 credits, lower division level
- Health Records: 1 credit, lower division level
Effective Dates
January 2018 through December 2023
Issuing Agency
About the Credential
The Certified Risk Adjustment Coder (CRC) is the certification that tests competencies for coders under all risk adjustment models. Professionals with the CRC certification demonstrate proficiency with documentation review, determining conditions that qualify for coding, assigning the proper ICD-10 CM diagnosis codes, and understanding the impact of reimbursement under various risk adjustment models.
How to Apply for the Credit
Credit Recommendation Details / Competencies
The CRC performs the professional risk adjustment involving documentation review and determining conditions that qualify for coding. Skills 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 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.