Certified Risk Adjustment Coder (CRC)

What is the purpose of risk adjustment values?

1. Develop statistical reports of diagnoses

2. Prepare budget for patient care

3. Monitor claims for up-coding

4. Identify providers with inappropriate coding patterns

The correct answer is: Prepare budget for patient care

Risk adjustment values are primarily used to prepare budgets for patient care. This financial framework is central to ensuring that healthcare providers receive appropriate reimbursement based on the health status of their patient population. By factoring in the risk adjustment values, healthcare organizations can allocate resources more effectively, ensuring that patients with higher healthcare needs are adequately funded. Statistical reports of diagnoses play an important role in understanding patient populations but do not directly address the financial mechanisms behind budget preparation. Monitoring claims for up-coding and identifying inappropriate coding patterns primarily focus on compliance and accuracy in billing rather than on budgetary considerations. Therefore, the focus of risk adjustment values is on supporting financial planning and resource allocation for patient care delivery.