Certified Risk Adjustment Coder (CRC)

Course Curriculum Overview

Module 1: Introduction to Risk Adjustment

• Overview of risk adjustment models
• Role of risk adjustment coders
• Importance in reimbursement & compliance

Module 2: ICD-10-CM Coding for Risk Adjustment

• Coding structure & guidelines
• Chronic condition coding
• Risk adjustment scenarios

Module 3: Hierarchical Condition Categories (HCCs)

• HCC model fundamentals
• Mapping diagnoses to risk scores
• CMS-HCC vs HHS-HCC models

Module 4: Documentation for Risk Adjustment

• Accurate clinical documentation
• Capturing chronic conditions
• Avoiding common errors

Module 5: Compliance & Regulations

• Medicare & payer guidelines
• Legal and ethical coding practices
• Fraud & abuse prevention

Module 6: Risk Adjustment Audits & QA

• Audit preparation strategies
• Internal quality checks
• Resolving discrepancies

Module 7: Practical Applications

• Real-world case studies
• Chart review & abstraction
• Coding exercises

Module 8: CRC Exam Preparation

• Exam structure & format
• Practice tests & mock exams
• Test-taking strategies

Module 9: Career Development

• Resume building
• Job readiness
• Career pathways in risk adjustment