Online CRC™ Certification Course Content

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The Business of Medicine

• The role of a risk adjustment coder

• The hierarchy of providers

• The different types of payers

• Medical necessity

• The need for privacy and security

• Fraud and abuse

• Need for compliance rules and audits

• The OIG Work Plan

Medical Terminology and Anatomy Review

• Root words, prefixes, and suffixes

• Integumentary system

• Musculoskeletal system

• Cardiovascular system

• Lymphatic system

• Respiratory system

• Digestive system

• Urinary system  

• Reproductive systems

• Nervous system

• Endocrine system

• Hematologic (hemic) system

• Immune system

Introduction to ICD-10-CM

• Overview of ICD-10-CM layout

• Steps to look up a diagnosis code

• ICD-10-CM Official Guidelines for Coding and Reporting

• Diagnosis coding guidelines for outpatient reporting

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Risk Adjustment Models

• Types of risk adjustment models

• Medicare hierarchal condition categories (HCC)

• The Health and Human Services (HHS) Hierarchical Condition Category Model

• Medicaid Chronic Illness and Disability Payment System (CDPS)

• Hybrid model

Predictive Modeling & Quality of Care

• CMS Stars Ratings Program

• Healthcare Effectiveness Data and Information Set (HEDIS®)

• National Quality Forum

• The Quality Payment Program

How Risk Adjustment Relates to Medical Financial Matters

• New beneficiary calculations

• Annual risk adjustment audits

• Accountable Care Organizations

• Placing providers “at-risk”

Diagnosis Documentation & Coding

• Data collection sources

• Coding for all diagnoses noted in a date of service (DOS)

• Evaluation and management coding

• Coding Diagnoses from chief complaint (CC) or history of present illness (HPI)

• Coding diagnoses from PMH and other historical lists

• Coding diagnoses from review of systems (ROS)

• Coding diagnoses from the exam portion of a record

• Coding from assessment and plan

Diagnosis Documentation & Coding

• Data collection sources

• Coding for all diagnoses noted in a date of service (DOS)

• Evaluation and management coding

• Coding Diagnoses from chief complaint (CC) or history of present illness (HPI)

• Coding diagnoses from PMH and other historical lists

• Coding diagnoses from review of systems (ROS)

• Coding diagnoses from the exam portion of a record

• Coding from assessment and plan

• Clinical Documentation Barriers

• Signature or credential issues

• Signatures in Risk Adjustment Data Validation (RADV or HRADV)

• Past medical history

• Lab and test results

• Status conditions

• Signs and symptoms

• Uncertain diagnosis

• Coding clinic guidance

• Risk adjustment diagnosis coding steps

Payment Options

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