The CPC® certification validates proficiency in the correct application of CPT®, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes used for coding and billing for medical claims in a physician’s office.
Without risk adjustment coding to ensure that a complete picture of each patient’s health is captured and reported on medical claims, health plans would lack appropriate funding and planning to cover treatment for high-risk patients. Certified Risk Adjustment Coders (CRCs) play a critical role in establishing accurate risk scores for patients, which promotes optimal patient care and ethical payer reimbursement for providers and health plans.
Healthcare professionals earning their CRCcredential possess demonstrated expertise in the complexity of diseases associated with chronic conditions and comorbidities, as well as mastery of ICD-10-CM guidelines and risk adjustment guidelines. As CRCs, they are equipped both to ensure clinical documentation accurately portrays the patient’s health status and to ensure all clinically documented diagnoses are properly reported.
