by Alice M. Noblin, PhD, RHIA, CCS; Amanda Walden, MS-HSA, RHIA, CHDA; and Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I
The purpose of this study was to gauge the test-taking success of people who attended RHIA, RHIT, CCS, and CCS-P exam preparation workshops. Information available from the American Health Information Management Association (AHIMA) Newly Credentialed Professionals website includes names of people who have passed a credential exam as well as the date the exam was successfully completed. No information about unsuccessful exam attempts was available for comparison. Based on information from the AHIMA website, the following percentages of workshop attendees passed the respective exam: RHIA, 48.65 percent; RHIT, 43.02 percent; CCS, 22.49 percent; and CCS-P, 15.22 percent. Although no definitive correlation between workshop attendance and exam results can be determined, the outcomes support the value of in-person exam preparation workshops for some test takers. Future research into attendees’ motivation for testing (e.g., job requirement), planned examination date, grade point average, type of education program (e.g., online), other exam preparation methods, and native language could provide additional insight into the value of in-person exam preparation workshops.
Exam preparation activities are provided by various organizations in a variety of formats to prepare graduates of health information management (HIM) and coding programs for the Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), and Certified Coding Specialist–Physician-based (CCS-P) examinations. These certifications are a way to assure employers and peers that the individual is competent and well-informed in knowledge of the industry and able to perform certain professional duties.1 To assist graduates in preparing for these exams, the Florida Health Information Management Association (FHIMA) began providing face-to-face review workshops in April 2011 for the CCS and CCS-P examinations and in January 2013 for the RHIA and RHIT examinations. In an effort to meet expectations of members as well as the FHIMA board of directors, data were collected to assess workshop outcomes in terms of how many people attended a workshop and passed an exam, as well as the length of time between workshop attendance and test taking. An incentive for early testing in the form of a $200 rebate from FHIMA is available for Florida RHIA and RHIT candidates who pass the exam within six months of graduation. No such incentive is currently offered for the coding exams.
The US Bureau of Labor Statistics has predicted a 22 percent increase in employment of health information technicians from 2012 to 2022.2 The American Health Information Management Association (AHIMA) has also identified healthcare industry workforce shortages along with the need for increased skill levels and adaptation to technology.3 In response to these needs, additional education is essential for these professionals to increase their competency levels. AHIMA has supported the need for additional education with the change in CCS and CCS-P exam requirements effective January 1, 2013. Eligible testers must now have credentials, education, job experience, or a combination of the three. In the job market, the CCS credential, the RHIT credential, and experience are considered the most valuable characteristics of applicants by employers seeking to fill coding positions.4 Accredited RHIA and RHIT education programs and examinations also ensure that students are competent to enter HIM practice. Both HIM and coding education programs are designed to supply the necessary clinical and academic experiences to prepare students to pass these certification exams. Providing students with necessary tools and resources for successful certification exam completion is an ongoing challenge due to many factors, including the amount of time between graduation and testing, students’ knowledge of the US healthcare system, and students’ work experience.
The association of resources such as HIM and coding study guides, practice exams, and review courses with certification exam results has not been established in the literature. To better understand the effect of the use of these study aids on a potential tester’s outcome, this literature review ventured outside the HIM field, focusing on standardized exams that would be proctored in much the same way as the AHIMA exams are at Pearson Vue testing centers. For example, a study of the National Board of Medical Examiners exam found that students who took a review course “scored significantly higher on the examination than students with comparable basic science grade point averages,”5 while another study found that out of all the preparation methods, a review course offered the least effect on a tester’s score.6 The research is consistent, however, in that regardless of whether results indicate that review courses help individuals achieve increased scores on exams, many candidates are taking advantage of preparation courses. Examples include the LSAT, with 45 percent of test takers using a preparation course before taking the exam,6 and radiology certification, with 83 percent of radiology chief residents taking a review course before attempting a certification exam.7
The ultimate goal of RHIA, RHIT, and coding educational programs is to provide qualified professionals who are able to pass the certification examination(s) and meet the demands of the healthcare industry identified by the Bureau of Labor Statistics.8 New graduates entering the workforce with credentials such as RHIA, RHIT, CCS, and CCS-P demonstrate a higher competency level than other job applicants and will help to alleviate the predicted shortages of healthcare information, informatics, and coding professionals in the future. With this in mind, this study aimed to answer the following question: Do attendees benefit from FHIMA exam prep review courses by passing the AHIMA certification exams?
A brief analysis of exam prep workshop attendance and successful completion of the certification exam(s) was done. No information about unsuccessful exam attempts was available for comparison. FHIMA serves a large population of educational programs, with 22 CAHIIM-accredited RHIA and RHIT programs in addition to four AHIMA-approved coding certificate programs in the state. To assist new graduates and other professionals who seek additional credentials, FHIMA has provided CCS and CCS-P review workshops since 2011 and has provided RHIA and RHIT exam preparation workshops since 2013. Retrospective data obtained from FHIMA included all the workshop rosters from April 2011 to November 2014. Four RHIA/RHIT workshops, 11 CCS workshops, and four CCS-P workshops were provided during this time period. The AHIMA Newly Credentialed Professionals website (https://secure.ahima.org/certification/newly_credentialed.aspx) was queried to obtain names of all successful test takers in Florida from January 27, 2013 (the day after the first workshop), to June 1, 2015, for the RHIA and RHIT examinations, and between April 9, 2011, and June 6, 2015, for the CCS and CCS-P examinations. The workshop attendee list was compared with the list of successful Florida test takers, and matches were noted. The number of days between the date of the workshop and the date of successful exam completion was calculated and then divided by 30 to calculate time in months between workshop attendance and awarding of the credential.
Microsoft Excel was used to organize the data. The university institutional review board (IRB) approved the study as exempt human research.
Initially, the data were reviewed and adjusted to fit the scope of the study. A large number of students from the local university were given the opportunity to attend the RHIA prep workshop on November 1, 2014. Even with the ability to sit for the RHIA exam before graduation, their results would not have been available until after the end date of this study. Therefore, the students were removed from the data. The authors believe the data with the students excluded represents an accurate snapshot of the outcomes as of the cutoff date for data collection (e.g., if the entire group of November 1, 2014, RHIA workshop attendees were deleted, the overall pass rate would be 50.82 percent, compared to 48.65 percent with just the students deleted).
For RHIA, 48.65 percent of the remaining people who attended one of the RHIA exam prep workshops successfully passed the RHIA exam by the cutoff date for data collection. The average time between attendance at the workshop and successful completion of the RHIA exam was 7.2 months. As noted, no data are available for anyone who has not successfully passed the exam (this pertains to all exam data). Also, 36.67 percent of the people who passed the exam had at least one other credential, with Certified Coding Associate (CCA) being the most common.
For RHIT, 43.02 percent of those attending one of the RHIT exam prep workshops successfully passed the RHIT exam by the cutoff date. The average time between attendance and credential success was 4.3 months. Also, 15 percent of the people who passed the exam had at least one other credential, with CCS being the most common.
For CCS, 22.49 percent of the attendees successfully passed the CCS exam by the cutoff date. The average time between attendance at the workshop and successful completion of the CCS exam was 9.5 months. Also, 39 percent of the people who passed the exam had at least one other credential, with RHIT being the most common.
For CCS-P, 15.22 percent of the people who attended one of these workshops had successfully passed the exam. The average time between attendance and credentialing success was 8.7 months. Also, 42.86 percent of the people who passed the exam had at least one other credential, with CCA being the most common.
See Table 1 for details.
While 48.65 percent of the RHIA prep class attendees passed the RHIA exam, there is no way to ascertain what happened to the other 51.35 percent. The same can be said for the other exams. Several explanations are possible: they did not take the exam; they did not pass the exam; they were not eligible to sit for the exam (having never graduated from the CAHIIM or coding program in which they were enrolled); they did not give permission to post the exam results; their name changed (got married or divorced); they moved out of state; or other reasons that cannot be determined at this time.
For the RHIT, CCS, and CCS-P exams, pass rates are lower than those of RHIA prep attendees, at 43.02, 22.49, and 15.22 percent respectively. These differences are similar to those found in overall AHIMA pass rates (2012–2014), which are also less for those exams than for the RHIA exam: RHIA, 76.1 percent; RHIT, 74 percent; CCS, 58.6 percent; and CCS-P, 55.1 percent. We recognize that our results overall are not representative of all certification exam completers in Florida and that these results cannot be linked to any of the 26 CAHIIM-accredited and AHIMA-approved schools/programs in Florida.
We can also ponder reasons for the drop-off between the success rate of RHIA/RHIT workshop attendees and that of coding workshop attendees. The increased educational and/or work experience requirements since 2013 may have caused more people to be curious about the coding test content. CCS prep workshops are by far the most highly attended, with a total of 418 attendees to date. The workshop is designed as a final step in exam preparation, with attendees expected to take the exam shortly after the workshop. In reality, the range of time between workshop attendance and successful completion of the credentialing exam ranges from two weeks to three years, with an average of about 9.5 months. The CCS-P candidates averaged approximately 8.5 months, ranging from about 1.5 months to 22 months (total of 46 CCS-P attendees). Therefore, the coding attendees are apparently not ready to take the exam at the time of workshop attendance and delay taking the exam. Another scenario is that they are not successful on their first attempt, but are successful on a later attempt at the exam. The CCS exam was not available from March 3, 2014, to August 1, 2014, due to a security breach, and this four-month delay also could have affected the data.
RHIT candidates had the shortest average duration of four months between the review workshop and the exam, with a range of two days to 17 months, while RHIA candidates averaged approximately 7 months, ranging from two weeks to 19 months. It seemed that the RHIT candidates were closer to taking the exam at the time of attendance, and used the workshop as the last step. AHIMA has documented higher pass rates for students who take the RHIT and RHIA exam just before or just after graduation. While graduation dates were not available in this comparison, we used date of workshop attendance to exam completion as a marker, looking specifically at the averages of four to seven months. For the FHIMA leadership, this finding is also of importance, as the $200 rebate is only available to those who successfully complete the RHIT or RHIA exam within six months of graduation.
The literature review about other types of review courses revealed little data for comparison. In some fields, such as law and medicine, prep courses are used frequently, but no mechanism is available to tie these courses to actual exam results. For comparison, overall about 20 percent of Floridians who successfully completed an AHIMA exam have attended a FHIMA prep workshop. This figure is well below the 45 percent of law students and 83 percent of radiology chief residents who reported taking a prep class, as mentioned previously. It is also possible that a previously credentialed professional, such as the nearly 37 percent of RHIA test takers in Florida, may not be inclined to take a review course. The choice not to take a review course could be based on the test taker’s knowledge of the testing center, testing procedures, and confidence in the ability to navigate the testing process.
Limitations have been mentioned in terms of data that are not available for a more in-depth analysis. Much remains unknown about attendees who do not pass the exams or who never sit for the exams, which is a major limitation of this study. FHIMA currently collects minimal data on the attendees, and, to maximize privacy, no identifying demographic information was included in the results per IRB requirements. In the future, to improve data for research, additional questions could be included on the registration form for the workshops, including intention to test, length of time since graduation, GPA at graduation, type of education program, native language, and employment information (e.g., whether a credential is required for the current or potential job position). Also, information about other preparatory methods such as practice exams and review books could be gathered. Focus groups and other qualitative methods would also provide the opportunity to fill in some of the gaps regarding why many graduates of accredited and/or approved programs never obtain the credential after following the education track.
Alternatively, in the review class, electronic survey tools such as Poll Everywhere (polleverywhere.com) could be utilized to engage the class, gather data, and promote discussion about the value of credentials and early testing. A post-workshop evaluation form is currently e-mailed to all attendees as another way to collect additional information. However, both Poll Everywhere and the evaluation form are anonymous and therefore would be difficult to correlate to attendees.
Overall, in-person exam preparation workshops provide value to future HIM professionals. A variety of tools are available for exam preparation, including books, practice exams, and other online resources. Some candidates have specifically requested face-to-face opportunities to interact with instructors and other future test takers for networking and camaraderie. The instructors are usually faculty from a hosting or nearby school who currently teach in an accredited or approved HIM or coding program. To further motivate the attendees, candidates who have recently obtained certification are usually invited to describe their experience in exam preparation and completion. This experience, along with the additional confidence gained from a review course, may provide extra incentive for both recent and past graduates to take the important step of sitting for the examination to obtain the AHIMA credential.
Alice M. Noblin, PhD, RHIA, CCS, is the undergraduate health informatics and information management program director and assistant professor at the University of Central Florida in Orlando, FL.
Amanda Walden, MS-HSA, RHIA, CHDA, is a health informatics and information management instructor at the University of Central Florida in Orlando, FL.
Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I, is President at Safian Communications Services, Inc., in Longwood, FL.
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- Wightman, L. F. Self-reported Methods of Test Preparation Used by LSAT Takers: A Summary of Responses from June and September 1989 Test Takers. Newtown, PA: Law School Admission Council, 1990.
- Khan, F. A., S. Bhalla, and R. G. Jost. “Results of the 2001 Survey of the American Association of Academic Chief Residents in Radiology.” Academic Radiology 9, no. 1 (2002): 89–97.
- Bureau of Labor Statistics, US Department of Labor. “Occupational Outlook Handbook, 2014–15 Edition: Medical Records and Health Information Technicians.”
Alice M. Noblin, PhD, RHIA, CCS; Amanda Walden, MS-HSA, RHIA, CHDA; and Shelley C. Safian, PhD, RHIA, CCS-P, CPC-H, CPC-I. “The Value of In-Person Exam Preparation Workshops in Obtaining an AHIMA Credential.” Educational Perspectives in Health Informatics and Information Management (2015): 1-6.