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ed2go Health and Fitness Medical Certified Risk Adjustment Coder
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certified-risk-adjustment-coder

Certified Risk Adjustment Coder

Prepare yourself for the CRC Certification Exam and begin a new and rewarding career path! This course teaches fundamental medical coding skills for risk adjustment coding. The course covers ICD-10-CM coding for all risk adjustment models (HCC, HHS-ACA, CDPS) and assures a broad knowledge in reviewing and assigning the correct diagnosis codes for all risk adjustment models. Best of all, the registration fee for this course includes AAPC membership, CRC practice exams, and the AAPC Certified Risk Adjustment Coder (CRC™) exam!

In this course you will learn the varying risk adjustment models and the effects of predictive modeling and quality of care. This information will help you understand the impact on risk adjustment models driven by quality of care and predictive modeling. You will be able to identify common errors in diagnosis coding and determine documentation barriers encountered when coding for risk adjustment. Finally, you will utilize practical diagnosis coding skills as they complete hands-on cases throughout the course. 

6 Months / 160 Course Hrs
Open enrollment

Offered in Partnership with your Preferred School

SUNY Adirondack

Why this school? It's been chosen based on your location or if you've visited this school's website. Change School

Learning Method

Instructor-led

Self-Paced. Study on your own schedule

Contact Us for additional information

Certified Risk Adjustment Coder

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Details + Objectives

Course Code: GES167

What You Will Learn
  • Learn and define different models of risk adjustment (HCC, CDPS, HHS-ACA, Hybrid)
  • Understand predictive modeling and its impact on risk adjustment
  • Survey the impact of risk adjustment on the financial well-being of an organization
  • Learn and apply official coding guidelines
  • Identify documentation deficiencies for diagnosis coding
  • Understand the most common conditions in risk adjustment and how to properly code in ICD-10-CM
How the course is taught
  • Self-paced, online course
  • 6 months to complete
  • 6 months to complete
  • 160 course hours
How you will benefit
  • Prepare for a rewarding career and for success on the CRC certification exam
  • Gain a broad base of knowledge in diagnosis codes for all risk adjustment models
  • Become indispensable in organization that needs quality risk adjustment coding
  • Get free AAPC membership, CRC practice exams, and the AAPC Certified Risk Adjustment Coder (CRC™) exam when you enroll

Outline

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Business of Medicine

Survey coding as a profession and understand the difference between hospital and provider services. You will examine a number of important factors that affect the coding profession including the hierarchy of providers, multiple payers, and medical records. You will also learn about important HIPAA laws and compliance rules.

Medical Terminology and Anatomy Review

Discover how medical terminology works and review the basics. You will get an introduction to anatomy and all the body systems. You will also be introduced to the ICD-10-CM coding layout, diagnosis codes, and official guidelines for coding and reporting that you will use throughout the course.

ICD-10-CM Coding Chapters 1–11

Examine codes for infectious diseases, neoplasms, the immune system, mental disorders, metabolic diseases, and many others. You will begin to understand the organization of medical codes as you survey coding involved with diseases of the nervous system, circulatory system, respiratory system, eye, and ear.

ICD-10-CM Coding Chapters 12–21

Learn codes associated with diseases of the skin, subcutaneous tissue, musculoskeletal system, and genitourinary system. You will also survey coding involved in pregnancy, childbirth, congenital malformations, and chromosomal abnormalities. Then, learn about the factors influencing health status and contact with health services.

Risk Adjustment Models, Predictive Modeling, & Quality of Care

Learn about the various types of risk adjustment models including HCC, HHS, CDPS, and the hybrid model. You will understand CMS star ratings and how they relate to quality of care. You will also examine the physician quality reporting system (PQRS) and the healthcare effectiveness data and information set (HEDIS). Finally, you will survey how risk adjustment relates to medical financial matters while learning about beneficiary calculations, audits, and ACOs.

Diagnosis Documentation, Clinical Documentation Barriers, & Coding

Learn about data collection sources and coding in a DOS. You will discover how to code from medical documentation and consider credential issues. You will also learn about potential documentation barriers like uncertain diagnosis and differential diagnosis. You will survey risk adjustment diagnosis coding steps, learn the difference between acute and chronic, and consider risk factors and comorbidities.

Details
  1. Business of Medicine
    1. Coding as a Profession
    2. The Difference Between Hospital and Provider Services
    3. How a Provider Office Works and How the Coder Fits into It
    4. Understanding the Hierarchy of Providers
    5. The Different Types of Payers
    6. The Medical Record
    7. Operative Report Coding Tips
    8. Medical Necessity
    9. The Advance Beneficiary Notice
    10. The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
    11. The Need for Compliance Rules and Audits
    12. The OIG Work Plan
    13. What AAPC Will Do for You
  2. Medical Terminology and Anatomy Review
    1. Introduction to Medical Terminology
    2. Introduction to Anatomy
    3. Integumentary System
    4. Musculoskeletal System
    5. Cardiovascular System
    6. Lymphatic System
    7. Respiratory System (Pulmonary System)
    8. Digestive System
    9. Urinary System
    10. Reproductive Systems
    11. Nervous System
    12. Organs of Sense — Eye
    13. Organs of Sense — Ear
    14. Endocrine System
    15. Hematologic (Hemic) System
    16. Immune System
  3. Introduction to ICD-10-CM
    1. Overview of ICD-10-CM Layout
    2. Steps to Look Up a Diagnosis Code
    3. ICD-10-CM Official Guidelines for Coding and Reporting
  4. ICD-10-CM Coding Chapters 1–11
    1. Chapter 1: Certain Infectious and Parasitic Diseases (Codes A00–B99)
    2. Chapter 2: Neoplasms (Codes C00–D49)
    3. Chapter 3: Diseases of the Blood and Blood-Forming Organs and Certain
    4. Disorders Involving the Immune Mechanism (D50-D89)
    5. Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)
    6. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
    7. Chapter 6: Diseases of the Nervous System (G00-G99)
    8. Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
    9. Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95)
    10. Chapter 9: Diseases of the Circulatory System (I00-I99)
    11. Chapter 10: Diseases of the Respiratory System (J00-J99)
    12. Chapter 11: Diseases of the Digestive System (K00-K95)
  5. ICD-10-CM Coding Chapters 12–21
    1. Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
    2. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)
    3. Chapter 14: Diseases of Genitourinary System (N00–N99)
    4. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00–O9A)
    5. Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96)
    6. Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99)
    7. Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00–R99)
    8. Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00–T88)
    9. Chapter 20: External Causes of Morbidity (V00-Y99)
    10. Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00–Z99)
  6. Risk Adjustment Models
    1. Types of Risk Adjustment Models
    2. Medicare Hierarchal Condition Categories (HCC)
    3. The Health and Human Services (HHS) Hierarchical Condition Category Model
    4. Medicaid Chronic Illness and Disability Payment System (CDPS)
    5. Hybrid Model
  7. Predictive Modeling & Quality of Care
    1. CMS Stars Ratings
    2. PQRS (Physician Quality Reporting System)
    3. HEDIS® (The Healthcare Effectiveness Data and Information Set)
  8. How Risk Adjustment Relates to Medical Financial Matters
    1. New Beneficiary Calculations
    2. Annual Risk Adjustment Audits
    3. ACO’s (Accountable Care Organizations)
    4. Placing Providers “At-Risk”
  9. Diagnosis Documentation & Coding
    1. Data Collection Sources
    2. Coding for All Diagnoses Noted in a Date of Service (DOS)
    3. ICD-10-CM Updates to the Conventions & Official Coding Guidelines that Affect Risk Adjustment Coding
    4. Coding Diagnoses from the medical documentation
    5. Signature or Credential Issues
  10. Clinical Documentation Barriers
    1. Signs and Symptoms
    2. Uncertain Diagnosis
    3. Coding Clinic Guidance
    4. Risk Adjustment Diagnosis Coding Steps
    5. Acute vs. Chronic
    6. Differential Diagnosis
    7. Risk Factors and Comorbidities
    8. Late Effects
  11. Frequently Coded Conditions in Risk Adjustment Models
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Instructors & Support

No instructor

This is not an instructor facilitated course; however, support will be provided through email, online forms, and phone.

Requirements

Prerequisites / Requirements

Prerequisites:

There are no prerequisites to take this course. However, knowledge of medical terminology and anatomy (or AAPC courses) is strongly recommended.

Requirements:

Hardware Requirements: 

  • This course can be taken on either a PC or Mac.

Software Requirements: 

  • PC: Windows XP or later.
  • Mac: OS X Snow Leopard 10.6 or later.
  • Browser: The latest version of Google Chrome or Mozilla Firefox are preferred. Microsoft Edge and Safari are also compatible.
  • Adobe Flash Player. Click here to download the Flash Player.
  • Adobe Acrobat Reader. Click here to download the Acrobat Reader.
  • Email capabilities and access to a personal email account.
  • Software must be installed and fully operational before the course begins.
Instructional Materials

The instructional materials required for this course are included in enrollment. The following textbooks will be shipped to you approximately 7-10 business days after enrollment:

  • Medical Coding Training: CRC™ 2016 (PDF Format)
  • ICD-10-CM

About Certification

american-academy-of-professional-coders-aapc

The American Academy of Professional Coders (AAPC) is one of the world’s most recognized institutions for professional medical coders, with more than 175,000 members. The AAPC offers more than 30 certifications that include medical billing and coding, compliance, and management, among other topics. These certifications are an excellent way to prove you have a working knowledge of specific aspects of healthcare, and the skills you need to practice in the field. All AAPC certifications share a common goal: help everyone from beginners to experienced professionals advance their careers and contribute positively to the industry.

FAQs

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Can I register for a course if I am an international student?

Yes, ed2go courses are online, so you never have to actually travel to the school. Most schools offer telephone or online registration.

Does this course prepare for a certification?

Yes, you will be prepared to sit for the Certified Risk Adjustment (CRC™) Certification Exam offered by the American Academy of Professional Coders (AAPC). You will receive an exam voucher and AAPC membership after successful completion of the course and financial obligation.

When can I start the course?

This course is open enrollment, so you can register and start the course as soon as you are ready. Access to your course can take 24-48 business hours.

How long does it take to complete this course?

This course is self-paced and open enrollment, so you can start when you want and finish at your own pace. When you register, you'll receive six (6) months to complete the course.

What if I don't have enough time to complete my course within the time frame provided?

The time allotted for course completion has been calculated based on the number of course hours. However, if you are unable to complete the course, contact your Student Advisor to help you work out a suitable completion date. Please note that an extension fee may be charged.

What kind of support will I receive?

You may be assigned with an instructor or team of industry experts for one-on-one course interaction. Your support will be available (via e-mail) to answer any questions you may have and to provide feedback on your performance. All of our instructors are successful working professionals in the fields in which they teach. You will be assigned to an Advisor for academic support.

What happens when I complete the course?

Upon successful completion of the course, you will be awarded a certificate of completion. In addition, you will receive an exam voucher for the Certified Risk Adjustment (CRC™) Certification Exam, offered by the American Academy of Professional Coders (AAPC) after successful completion of the course and financial obligation.

Am I guaranteed a job?

This course will provide you with the skills you need to obtain an entry-level position in most cases. Potential students should always do research on the job market in their area before registering.

Can I get financial assistance?

ed2go courses are non-credit, so they do not qualify for federal aid, FAFSA and Pell Grant. In some states, vocational rehab or workforce development boards will pay for qualified students to take our courses. Additionally, some students may qualify for financial assistance when they enroll, if they meet certain requirements. Financing is available from select schools. Learn more: https://www.ed2go.com/career/financial-assistance

How can I get more information about this course?

If you have questions that are not answered on our website, please feel free to contact us via LIVE CHAT or by calling us at (855) 520-6806. If you are visiting us during non-business hours, please feel free to send us a question using the Contact Us form.

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