CRC Risk Adjustment Coding study plan
CRC Risk Adjustment Coding · Give each week a clear focus.
8 weeks · About 6 hours per week
Core risk adjustment knowledge
Explain how hierarchical condition categories group diagnoses into risk-adjusting categories and why hierarchy and disease interactions change payment
Map the end-to-end flow from encounter documentation to diagnosis capture, coding, submission, and model calculation
Define key terms: risk score, coefficient, demographic factors, interaction terms, and normalization factor
Distinguish the roles of the coder, auditor, provider, and health plan in the risk adjustment cycle
Your checkpoint
A one-page diagram of the risk adjustment data flow with every handoff point labeled and a 15-term glossary in your own words
Core risk adjustment knowledge & Application of ICD-10-CM codes for chronic and complex conditions
Identify which condition categories are hierarchical and predict which codes will be trumped by a higher category
Calculate a simplified risk score for three sample members using given coefficients and demographic factors
Compare how a chronic condition documented in one year carries forward versus requiring annual recapture
Locate the official ICD-10-CM guidelines sections that govern chronic condition coding and summarize their key rules
Your checkpoint
Three worked risk-score calculations with written explanations of each hierarchy and interaction decision
Application of ICD-10-CM codes for chronic and complex conditions
Code diabetes with its documented complications and link the causal relationship correctly
Apply combination codes for heart failure, chronic kidney disease stages, and COPD with acute exacerbation
Select the correct code for major depressive disorder and other behavioral health conditions using documented severity and episode
Differentiate unspecified codes from specific codes and justify when unspecified is defensible
Your checkpoint
A 25-case coding worksheet with each answer, the guideline citation, and a one-line rationale
Application of ICD-10-CM codes for chronic and complex conditions & Documentation and compliance
Code complex vascular, neurologic, and metastatic cancer scenarios including laterality and site specificity
Identify documentation gaps that force an unspecified code and draft a query for each
Write compliant physician queries using open-ended, non-leading language
Apply the rule that codes must be supported by the medical record and never assigned from a problem list alone
Your checkpoint
Ten written queries paired with the documentation deficiency that prompted each, reviewed against query-compliance criteria
Documentation and compliance
Explain the legal and ethical boundaries of risk adjustment coding including fraud, abuse, and false claims exposure
Describe RADV audit mechanics: sampling, medical record requests, error rate calculation, and appeal paths
Identify documentation elements that support chronic conditions: status, severity, assessment, and plan
Recognize red flags such as cloned notes, unsupported diagnoses, and upcoded encounters
Your checkpoint
A two-page compliance quick-reference covering query rules, documentation requirements, and RADV response steps
Core risk adjustment knowledge & Auditing and data accuracy
Explain how HCCs map to payment year models and why model versions differ in category structure
Interpret a suspect-condition report and prioritize which members to review first
Distinguish first-pass coding accuracy from retrospective chart review findings
Apply a sampling approach to select charts for an internal audit
Your checkpoint
A prioritized review list of 20 hypothetical members with written justification for the ranking order
Auditing and data accuracy
Audit ten practice records end to end and record each discrepancy as overcoding, undercoding, or documentation failure
Calculate accuracy rates and error rates from your audit results
Trace root causes of recurring errors back to documentation, coder knowledge, or process gaps
Propose corrective actions with owners and measurable targets
Your checkpoint
A completed audit workbook with per-chart findings, accuracy rate, and a root-cause summary
Core risk adjustment knowledge & Application of ICD-10-CM codes for chronic and complex conditions & Documentation and compliance & Auditing and data accuracy
Complete a timed 100-question mixed-domain practice exam and score it by domain
Re-code your ten weakest missed items and document the guideline or concept behind each
Review your glossary, quick-reference, and audit workbook as a consolidated final review
Write a personal remediation plan for any domain scoring below 80 percent
Your checkpoint
A scored practice exam with a domain breakdown and a written remediation plan for weak areas
Milestones
Week 2: You can explain hierarchy and interaction terms to a colleague and correctly compute a simplified risk score without notes
Week 4: You score at least 80 percent on the 25-case coding worksheet and every query you wrote passes the non-leading language check
Week 6: You can describe RADV audit steps from memory and justify a chart-review prioritization in writing
Week 8: You score at least 80 percent overall on the timed practice exam with no single domain below 70 percent