Data Governance
17-20%of exam
Access + Disclosure
15-18%of exam
Patient AccessTPOAuthorizationMinimum NecessaryBreach
Analytics + Informatics
23-26%of exam
EHRReportsDatabasesInteroperabilitySDLC
Revenue Cycle
20-23%of exam
CodingCDIClaimsDenialsPayment Models
Management + Leadership
23-26%of exam
StrategyHRBudgetingProjectsAccreditation
Quick Facts
- Exam
- RHIA
- Owner
- AHIMA CCHIIM
- Questions
- 150 total
- Scored
- 130 scored
- Pretest
- 20 unscored
- Time
- 3 hr 30 min
- Pass
- 300 scaled
- Delivery
- Pearson VUE center
- Fee
- $229 / $299
- Retake
- 30 day wait
Data ACT
Good data is ACT-ready.
AccurateCompleteTimely
Duplicate vs Overlay
Duplicate
- One patient
- Multiple records
- Merge carefully
Overlay
- Multiple patients
- One record
- Patient safety risk
Overlay is higher risk
Data Integrity Picker
- Two charts one patient→Duplicate merge(MPI cleanup)
- Two patients one chart→Overlay correction(High risk)
- Field definitions vary→Data dictionary(Standardize)
- Missing required elements→Completeness audit(Quality gap)
- Old record disposal→Retention policy(Legal hold check)
- Entry changed→Audit trail(Trace history)
Record Integrity
- Legal health record
- Official disclosure set
- Designated record set
- Access rights scope
- Source system
- Originating application
- Data dictionary
- Standard element definitions
- Metadata
- Data about data
- Audit trail
- Access/change evidence
- Version control
- Change history
- Authentication
- Author validates entry
LHR vs DRS
LHR
- Legal disclosure
- Organization defined
- Litigation focus
DRS
- Patient access
- Decision records
- HIPAA scope
DRS drives access rights
Data Quality
- Accuracy
- Correct data
- Completeness
- All required data
- Consistency
- Same across systems
- Timeliness
- Available when needed
- Currency
- Up to date
- Granularity
- Right detail level
- Precision
- Exact enough
- Relevancy
- Useful for purpose
MPI + Retention
- MPI
- Patient identity index
- EMPI
- Enterprise identity index
- Duplicate
- Two records one patient
- Overlay
- Two patients one record
- Overlap
- Multi-facility duplicate
- Merge
- Combine duplicates
- Retention
- Keep per policy
- Destruction
- Documented disposal
TPO Safe Lane
TPO usually moves without authorization.
TreatmentPaymentOperations
Disclosure Picker
- Patient requests record→Access right(30 days)
- Treatment sharing→TPO(No authorization)
- Marketing PHI→Authorization(Usually required)
- Vendor handles PHI→BAA(Contract first)
- Nonroutine disclosure→Minimum necessary(Review request)
- Unsecured PHI breach→Breach protocol(Notify timely)
- Correction requested→Amendment workflow(Track decision)
- Portal access issue→Patient advocacy(Remove barriers)
Privacy Basics
- PHI
- Identifiable health data
- ePHI
- Electronic PHI
- Covered entity
- Plan/provider/clearinghouse
- Business associate
- PHI service vendor
- BAA
- Required vendor contract
- TPO
- Permitted without authorization
- Authorization
- Written permission
- NPP
- Privacy practices notice
Security APT
Security safeguards are APT.
AdministrativePhysicalTechnical
Privacy vs Security
Privacy
- PHI use/disclosure
- Individual rights
- Minimum necessary
Security
- ePHI safeguards
- Risk analysis
- Access controls
Privacy governs PHI flow
Access + Disclosure
- Patient access
- 30 calendar days
- Extension
- One 30-day extension
- Amendment
- Correction request
- Accounting
- Disclosure history
- Restriction
- Limit disclosure request
- Confidential comms
- Alternate contact request
- Minimum necessary
- Limit PHI used
- Treatment
- Minimum necessary excepted
Required vs Addressable
Required
- Must implement
- No substitution
- Security rule
Addressable
- Assess fit
- Implement alternative
- Document rationale
Addressable is not optional
Security + Breach
- Administrative
- Policies and risk
- Physical
- Facility/device controls
- Technical
- Access/audit controls
- Required spec
- Must implement
- Addressable spec
- Document decision
- Risk analysis
- Threat/vulnerability review
- Breach
- Unsecured PHI compromise
- Notification
- No later 60 days
SDLC ADIME
Systems move through ADIME.
AnalysisDesignImplementMaintainEvaluate
HL7 v2 vs FHIR
HL7 v2
- Message based
- Legacy interfaces
- Common feeds
FHIR
- Resource based
- API focused
- Modern exchange
FHIR favors APIs
Analytics Picker
- Need trend view→Dashboard(Visual KPIs)
- Need exchange API→FHIR(Modern standard)
- Lab terminology→LOINC(Observations)
- Medication terminology→RxNorm(Drugs)
- Clinical concepts→SNOMED CT(Terminology)
- New system build→SDLC(Phased work)
EHR + Informatics
- EHR
- Longitudinal clinical record
- CPOE
- Provider order entry
- CDS
- Decision support
- Portal
- Patient access tool
- HIE
- Exchange health information
- Interface
- System data connection
- Workflow
- Work sequence
- Downtime
- Continuity procedure
Standards + Terminology
- FHIR
- API exchange standard
- HL7 v2
- Message standard
- C-CDA
- Clinical document exchange
- X12
- Administrative transactions
- SNOMED CT
- Clinical terminology
- LOINC
- Labs/observations
- RxNorm
- Medication terminology
- DICOM
- Imaging standard
Analytics Tools
- Data mining
- Pattern discovery
- Dashboard
- Visual KPI display
- Benchmark
- Compare performance
- Mean
- Average
- Median
- Middle value
- Mode
- Most frequent
- Rate
- Frequency ratio
- Validity
- Measures intended concept
SDLC + Reporting
- Analysis
- Define requirements
- Design
- Specify solution
- Implementation
- Deploy change
- Maintenance
- Support system
- Evaluation
- Measure results
- Data validation
- Confirm correctness
- Report spec
- Define fields/logic
- Visualization
- Graphic data display
Clean Claim Chain
Documentation drives codes; codes drive payment.
DocumentationCodingGroupingClaimPayment
CDI vs Coding
CDI
- Documentation clarity
- Provider queries
- Quality/revenue support
Coding
- Code assignment
- Official guidelines
- Grouping impact
CDI improves source documentation
Revenue Picker
- Inpatient payment→MS-DRG(IPPS)
- Outpatient payment→APC(OPPS)
- Physician payment→RBRVS(PFS)
- Unbilled backlog→DNFB analysis(Cash delay)
- Payer refusal→Denial management(Appeal root)
- Weak documentation→CDI review(Provider query)
- Missing charge→Charge capture(Revenue leakage)
Coding + Reimbursement
- ICD-10-CM
- Diagnosis coding
- ICD-10-PCS
- Inpatient procedures
- CPT
- Physician procedures
- HCPCS II
- Supplies/services
- MS-DRG
- Inpatient grouping
- APC
- Outpatient grouping
- RBRVS
- Physician payment
- HCC
- Risk adjustment
IPPS vs OPPS
IPPS
- Inpatient hospital
- MS-DRG
- Per discharge
OPPS
- Hospital outpatient
- APC
- Ambulatory services
Setting drives payment system
Revenue Operations
- CDI
- Documentation integrity
- CDM
- Chargemaster
- DNFB
- Unbilled discharged accounts
- A/R
- Accounts receivable
- Clean claim
- Ready for payment
- Denial
- Payment refusal
- Appeal
- Challenge denial
- Charge capture
- Record billable services
Claims + Fraud
- 837I
- Institutional claim
- 837P
- Professional claim
- 835
- Remittance advice
- UB-04
- Facility claim form
- CMS-1500
- Professional claim form
- False Claims
- Improper billing liability
- Stark
- Physician self-referral
- AKS
- Kickback prohibition
Manager POC
Managers plan, organize, and control.
PlanOrganizeControl
Management vs Leadership
Management
- Plan/control
- Resources
- Processes
Leadership
- Vision
- Influence
- Change
Managers control; leaders align
Leadership Picker
- Long-term direction→Strategic plan(Goals)
- Staff skill gap→Training plan(Competency)
- Process failure→RCA(Cause first)
- Vendor selection→RFP(Compare bids)
- Expense control→Budget variance(Analyze drivers)
- Major transition→Change management(Stakeholders)
- Project timeline→Gantt chart(Schedule)
Exam Logistics
- Application
- MyAHIMA portal
- Scheduling
- Within 120 days
- Agreement
- 5 minutes
- Exam time
- 3 hr 25 min
- Total appointment
- 3 hr 30 min
- Move back
- Answer first
- Flagging
- Review before submit
- Resources
- None required
Eligibility
- Bachelor HIM
- CAHIIM route
- Master HIM
- CAHIIM route
- Post-bacc HIM
- CAHIIM approved
- Foreign HIM
- Reciprocity route
- Health informatics
- Not supported
- Transcript
- Required evidence
- Early testing
- Form allowed
- Recertification
- Two-year cycle
Management Tools
- Mission
- Purpose
- Vision
- Future state
- Strategy
- Long-term direction
- SWOT
- Internal/external scan
- Budget
- Financial plan
- Variance
- Actual versus budget
- RFP
- Vendor proposal request
- Contract
- Binding agreement
Quality + Projects
- PDCA
- Plan do check act
- DMAIC
- Improve existing process
- Lean
- Remove waste
- Six Sigma
- Reduce variation
- RCA
- Find root cause
- Fishbone
- Cause categories
- Gantt
- Project timeline
- Critical path
- Longest dependency chain
HR + Leadership
- Recruiting
- Attract candidates
- Job description
- Duties/responsibilities
- Orientation
- Initial onboarding
- Competency
- Skill verification
- Appraisal
- Performance review
- Progressive discipline
- Escalating correction
- Change management
- Structured transition
- Stakeholder
- Affected party
Common Traps
Old Exam Facts
180 questions ≠ 150 questions current
Timing Trap
4 hour appointment ≠ 3.5 hours current
Informatics Eligibility
Any informatics degree ≠ HIM route required
Pretest Handling
Ignore odd items ≠ Answer every item
Minimum Necessary
Always applies ≠ Treatment is excepted
Patient Access
Authorization required ≠ Access right applies
Overlay Risk
Simple duplicate ≠ Safety-critical error
Addressable Safeguards
Optional control ≠ Documented decision
CDI Scope
Coder-only task ≠ Provider documentation work
Leadership Questions
Do task yourself ≠ Fix process/system
Last Minute
- 1.150 items; 130 scored
- 2.20 pretest; all count mentally
- 3.Pass score is 300
- 4.Time: 3 hr 30 min
- 5.Blueprint effective Oct 2023
- 6.Largest domains: analytics, leadership
- 7.Access request: 30 days
- 8.TPO usually needs no authorization
- 9.Minimum necessary excludes treatment
- 10.Addressable does not mean optional
- 11.Duplicate: one patient, two records
- 12.Overlay: two patients, one record
- 13.FHIR is API-focused exchange
- 14.IPPS uses MS-DRGs
- 15.OPPS uses APCs
- 16.Lead with policy and data
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