CRC (Other exams) study plan
CRC · Give each week a clear focus.
8 weeks · About 7 hours per week
ICD-10-CM diagnosis coding for risk adjustment
Diagram the ICD-10-CM chapter structure and demonstrate the Alphabetic Index to Tabular List to Official Guidelines lookup sequence on 25 sample diagnoses
Assign complete ICD-10-CM codes to 40 endocrine, circulatory, and respiratory vignettes and score them against an answer key
Apply Official Guidelines conventions for diabetes, heart failure, COPD, and CKD across 15 combination-code and sequencing scenarios
Compile a one-page personal sequencing and combination-code reference sheet built from your own coding errors
Your checkpoint
Timed 40-code worksheet scored at 80% or better, with an error log sorted by which Official Guideline section each miss came from
ICD-10-CM diagnosis coding for risk adjustment & Hierarchical Condition Category (HCC) and risk adjustment models
Code 30 outpatient progress-note extracts end to end, from diagnosis extraction to final code, including five requiring laterality or 7th-character specificity
Diagram the HCC model architecture in your own words: data year versus payment year, model version differences, and community versus institutional segments
Map 20 ICD-10-CM codes to their HCC categories and flag any that map to RxHCC or are excluded from the model
Calculate a risk score from a supplied list of HCCs and coefficients and explain how each coefficient contributes
Your checkpoint
Code-to-HCC mapping table for 20 diagnoses plus one fully worked risk-score calculation with intermediate steps shown
Hierarchical Condition Category (HCC) and risk adjustment models & Medical record review, abstraction, and documentation capture
Compare the V24 and V28 category structures for 10 high-frequency chronic conditions and list the practical coding impact of each change
Resolve hierarchy and trumping in 15 HCC sets and state the rule that produced each outcome
Abstract 15 de-identified records using a structured tool, capturing date of service, provider type, and documented MEAT evidence for each condition
Draft five compliant, non-leading physician queries for records with ambiguous or unspecified diagnoses
Your checkpoint
Completed abstraction worksheet for 15 records with a second-pass self-audit showing 85% or better agreement
Chronic condition identification, MEAT criteria, and suspect/hierarchy logic & Medical record review, abstraction, and documentation capture
Define MEAT and locate each of its four elements inside 20 documentation excerpts, marking each element as present or absent
Separate suspected or probable conditions from confirmed diagnoses and apply code-first and excludes1 rules to 15 examples
Apply chronic-condition recapture requirements and identify which conditions in a sample panel require annual re-documentation
Complete a 50-question mixed quiz spanning domains 2 through 5 and log every missed item by root cause
Your checkpoint
MEAT evidence audit log covering 20 excerpts with pass/fail recorded for each element and a written summary of the three most common documentation gaps
Chronic condition identification, MEAT criteria, and suspect/hierarchy logic & Risk adjustment fundamentals and payment methodology
Write out the risk-adjustment payment pathway from diagnosis capture to risk score to benchmark to payment, using your own words and no source text
Contrast the Medicare Advantage HCC model with the ACA HHS-HCC model on population, model structure, and payment use
Apply hierarchy and trumping logic to 20 vignettes, including at least five where a manifestation code changes the outcome
Compute the risk-score effect of adding one condition and of dropping one condition from a fixed member profile
Your checkpoint
One-page written walkthrough of the MA risk-score calculation supported by a worked numeric example with a before-and-after comparison
Risk adjustment fundamentals and payment methodology & Compliance, fraud/abuse prevention, and program integrity (RADV)
Sequence the RADV audit process from selection through findings and describe how it differs from OIG and CERT reviews
Classify 10 documentation and coding practices as fraud, abuse, or honest error and justify each classification
Apply data-validation requirements, including lookback and acceptable source-document rules, to 10 record scenarios
Compute an audit error rate and explain how extrapolation to the full population changes the exposure estimate
Your checkpoint
Mock RADV audit of 10 records with a calculated error rate and a one-page corrective action plan
Compliance, fraud/abuse prevention, and program integrity (RADV) & Anatomy, pathophysiology, and medical terminology applied to risk adjustment
Explain the pathophysiology of 15 high-frequency chronic conditions and connect each to its required documentation elements
Build a glossary of 40 anatomy, pathophysiology, and medical-terminology terms with a plain-language definition for each
Apply anatomy and site-specificity knowledge to code 10 scenarios that hinge on laterality, vessel, or anatomic site detail
Describe the seven elements of an effective compliance program and show where chart review and query practice fit inside it
Your checkpoint
Annotated 40-term glossary plus a pathophysiology-to-HCC crosswalk table for 15 conditions
ICD-10-CM diagnosis coding for risk adjustment & Chronic condition identification, MEAT criteria, and suspect/hierarchy logic & Compliance, fraud/abuse prevention, and program integrity (RADV) & Risk adjustment fundamentals and payment methodology & Hierarchical Condition Category (HCC) and risk adjustment models & Medical record review, abstraction, and documentation capture & Anatomy, pathophysiology, and medical terminology applied to risk adjustment
Complete two full-length practice exams under timed conditions and record domain-level scores for each
Re-code the 25 items you missed most often across weeks 1 through 7 and verify the corrected rationale against guidelines
Produce a single condensed recall sheet per domain limited to one page each
Rank your weakest three subdomains and schedule targeted review blocks in the final days before the exam
Your checkpoint
Full-length practice exam scored at 85% or better accompanied by a remediation log showing each repeat-miss item resolved
Milestones
Week 2: Score 80% or better on the 40-code worksheet and correctly map all 20 diagnoses to HCC categories with no more than one error
Week 4: Complete the 50-question mixed quiz at 75% or better and submit the 15-record abstraction worksheet with a completed self-audit
Week 6: Finish the 10-record mock RADV audit with a defensible error-rate calculation and a written corrective action plan
Week 8: Score 85% or better on a timed full-length practice exam and confirm all previously missed items are re-coded correctly