RHIA Exam Prep: Study Guide, Practice Questions and 8-Week Plan
This RHIA exam prep guide is built on AHIMA's RHIA content outline in effect since October 1, 2023.
Start with a rate calculation
Worked example: combine counts, not percentages. Two departments audit separate records using the same definition. Department A finds 12 incomplete records out of 240 (5%). Department B finds 18 out of 60 (30%).
Combined rate = (12 + 18) ÷ (240 + 60) × 100 = 10%.
Averaging 5% and 30% gives 17.5%, which treats the 60-record department as if it were as big as the 240-record one.
By Castleport Test Prep Editorial Team
Start today:
- Open the official outline and mark each task: can explain it, can apply it, or need to relearn it.
- Work the 15 practice questions below without notes. Log every miss and every guess.
- Begin Week 1 of the 8-week plan.
Where to focus: the five RHIA domains
| Domain | Share of exam | Scored questions | Drill first |
|---|---|---|---|
| 1. Data and Information Governance | 17–20% | 22–26 | Record integrity, documentation standards, retention and destruction, data dictionaries, master patient index (MPI) integrity |
| 2. Compliance with Access, Use, and Disclosure of Health Information | 15–18% | 20–23 | Patient access and portals, release workflows, breach protocol, privacy and security, access monitoring (including health information exchange) |
| 3. Data Analytics and Informatics | 23–26% | 30–34 | Healthcare statistics, reports and charts, databases, EHR and HIE support, systems development life cycle |
| 4. Revenue Cycle Management | 20–23% | 26–30 | Reimbursement models, coding validation, clinical documentation integrity (CDI) and queries, claims, revenue integrity |
| 5. Management and Leadership | 23–26% | 30–34 | Budgets, staffing and productivity, process improvement, project management, compliance programs, change management |
Sources: domain weights from the 2023 content outline, pp. 1–2; scored-question ranges from AHIMA's 2018–2023 crosswalk, Table 1.
Domains 3 and 5 have the largest published weight ranges (23–26% each), and cover quantitative work such as healthcare statistics and budgets. Don't let Domain 2 eat your schedule just because privacy rules feel familiar.
Is your study material current?
If your book, app, or course says 180 questions, 4 hours, six domains, or uses the domain names "Information Governance," "Compliance with Uses and Disclosures of PHI," or "Revenue Management," it does not match the current RHIA specifications. Some older outline PDFs are still online, and some prep sites pair the new weights with the old task lists. Check against the file named "begin 10-01-2023."
| Area | Before Oct. 1, 2023 | Since Oct. 1, 2023 |
|---|---|---|
| Exam length | 4 hours, 170–200 questions | 3.5 hours, 150 questions (130 scored, 20 unscored pretest) |
| Domain 1 | "Information Governance," 25 scored items | "Data and Information Governance," 22–26; gained retention/ |
| Domain 2 | "Compliance with Uses and Disclosures of PHI," 34 items | "Compliance with Access, Use, and Disclosure of Health Information," 20–23; adds patient portals and access monitoring outside the organization (such as HIE); privacy and security combined; "monitor compliance with laws" moved to Domain 5 |
| Domain 3 | 31 items | 30–34; productivity and summary reports folded into "create reports and visual representations"; new task: systems development life cycle |
| Domain 4 | "Revenue Management," 21 items | "Revenue Cycle Management," 26–30; "various reimbursement models"; monitor HHS documentation requirements; claims examples now name the CDM, DNFB, and A/ |
| Domain 5 | 20 items | 30–34; change management, contracting/ |
Source: AHIMA's RHIA Content Outline Crosswalk 2018–2023, pp. 1–7.
RHIA study guide by domain
Each section below lists what the outline covers, then teaches the rules and methods that come up when you apply that content. The outline tells you what is tested. The cited regulations and guidance tell you why an answer is right.
Domain 1: Data and Information Governance
What the outline covers: evaluating the integrity of health record documentation, data elements for quality reporting, data dictionary standards, documentation and data standards, data analysis for management, governance policies, retention and destruction, and MPI integrity.
Documentation standards. Under the Medicare hospital Conditions of Participation (CoPs), every medical record entry must be legible, complete, dated, timed, and authenticated by the person responsible for the service (42 CFR 482.24(c)(1)). Three timing requirements from the same section:
- The history and physical (H&P) generally must be completed no more than 30 days before or 24 hours after admission or registration, placed in the record within 24 hours, and completed before surgery or a procedure requiring anesthesia. When it was completed before admission or registration, an updated examination must also be documented within 24 hours and before the procedure. A specified outpatient assessment may replace the full H&P and update when the medical-staff policy meets the regulation's exception (42 CFR 482.24(c)(4)(i)(A)–(C)).
- The final diagnosis and record completion are due within 30 days after discharge.
- Records must be kept at least 5 years in original or legally reproduced form.
That 5-year rule is a floor. If your state or your organization requires longer, the longer rule wins, and following it satisfies both.
Data dictionaries. A data dictionary pins down one meaning for each data element: its name, definition, allowed values, and source (AHIMA, Healthcare Data Governance, pp. 6, 10–11). When two departments report "record completion time" but one counts to final signature and the other counts to coding completion, they aren't measuring the same thing. Agree on the definition before you compare the numbers.
MPI integrity. A duplicate record means one patient ended up with two or more medical record numbers within the same facility. Track how often registration creates them:
Worked example: duplicate creation rate. In a quarter, a hospital logged 9,600 registration events that could create a new permanent patient record. A review confirmed that those events created 144 extra duplicate patient records.
Rate = 144 ÷ 9,600 × 100 = 1.5%.
The denominator is registration events in the period. Dividing the other way (9,600 ÷ 144 ≈ 66.7) answers a different question. This uses the registration-based creation-rate method in AHIMA's historical 2009 practice brief, pp. 5–6.
Domain 2: Compliance with Access, Use, and Disclosure of Health Information
What the outline covers: patient access (including portals), advocating for patients, processing requests under legal standards, monitoring access inside and outside the organization, request workflows, breach protocols, and privacy and security initiatives.
Start with the requester and the purpose. Most disclosure questions turn on who is asking and why. Practice these HIPAA rules:
- Patient access. A covered entity must act on an access request within 30 days of receiving it. If it can't, it may take one extension of up to 30 more days, but only by sending the patient a written explanation and a completion date within the first 30 days (45 CFR 164.524(b)(2)). Any fee must be reasonable and cost-based.
- Unpaid bills don't block access. HHS says a provider can't deny you a copy of your records because you haven't paid for the services you received (HHS, "Your Medical Records," Charges).
- Minimum necessary has exceptions. It doesn't apply to disclosures to a health care provider for treatment, to the patient, or under the patient's authorization (45 CFR 164.502(b)(2)). That treatment exception doesn't mean every employee can open every chart. Internal access still needs role-based limits (HHS minimum-necessary guidance).
- Accounting of disclosures. Patients can request an accounting covering six years. Treatment, payment, and operations disclosures, disclosures to the patient, and disclosures made under an authorization are excluded. A required public health report is not (45 CFR 164.528(a)(1)).
- Vendors acting as business associates need a written business associate agreement or other permitted written arrangement before handling PHI on the hospital's behalf (45 CFR 164.502(e)). Not every recipient is a business associate; treatment disclosures to another provider and mere transmission conduits have different rules (HHS business-associate guidance).
Breach notification has three audiences with different triggers (45 CFR 164.404–164.408):
| Who gets notified | When it applies | Deadline |
|---|---|---|
| Affected individuals | Every breach of unsecured PHI | Without unreasonable delay, no later than 60 calendar days after discovery |
| Prominent media serving the state or jurisdiction | More than 500 residents of one state or jurisdiction | Without unreasonable delay, no later than 60 calendar days after discovery |
| HHS | 500 or more individuals | At the same time as individual notices |
| HHS | Fewer than 500 | Logged, then reported within 60 days after the end of the calendar year in which the breach was discovered |
A law-enforcement statement that notification would impede a criminal investigation or damage national security can delay notices. A written statement specifies the delay; an oral statement must be documented and allows no more than 30 days unless written confirmation follows (45 CFR 164.412). State breach laws can add their own requirements.
Domain 3: Data Analytics and Informatics
What the outline covers: supporting EHR users, creating reports and visuals, database techniques, focused documentation audits, workflow optimization, health information exchange, software and integrations, the systems development life cycle (SDLC), and validating healthcare statistics.
Name the unit and the denominator before you calculate. Records, patients, encounters, claims: pick one, then define who belongs in the denominator.
Worked example: occupancy rate. Occupancy is the average daily census divided by beds (NCHS, Health, United States 2017, Table 91 note). A unit with 120 staffed beds throughout a 30-day month logs 3,240 inpatient days: 3,240 ÷ 30 = 108 average daily census; 108 ÷ 120 = 90%.
Average length of stay (ALOS) has more than one definition. NCHS, using American Hospital Association data, reports ALOS as inpatient days ÷ admissions (HUS 2016, Figure 20 notes). A discharge-based measure uses the total length of stay of discharged patients ÷ discharges (NCHS Data Brief 186, Definitions). For one month, 1,170 inpatient days ÷ 260 admissions = 4.5 days, while 1,225 total days of stay for the 250 discharged patients ÷ 250 discharges = 4.9 days. Both can be "right" for their stated definitions, but they describe different groups and are not interchangeable. Validating a statistic starts with checking which formula each report used.
Median vs. mean. Lengths of stay of 3, 3, 3, 4, 5, 5, 6, 7, and 31 days have a mean of 7.4 and a median of 5. The 31-day stay drags the mean up. CDC's epidemiology course notes that the median is generally preferred for summarizing skewed data and that a long right tail pulls the mean upward (CDC, Principles of Epidemiology, Lesson 2 answers 5 and 14). Don't delete the outlier unless a review shows it's an error.
Percent change uses the old value as the base. Denials falling from 250 to 200 is (200 − 250) ÷ 250 = −20%, not −25%.
Pick the chart for the question. Line graphs show trends over time, bar graphs compare categories, and histograms show a distribution (CDC data-visualization transcript).
SDLC. The outline names five phases: analysis, design/
Interoperability. Health IT certified to the standardized API for patient and population services criterion uses HL7 FHIR Release 4.0.1 as its API base standard (45 CFR 170.215(a)(1); 170.315(g)(10)). This is the relevant certification criterion for a patient-facing app requesting that patient's data.
Domain 4: Revenue Cycle Management
What the outline covers: educating providers on reimbursement models, validating coding accuracy, monitoring HHS documentation requirements, CDI activities, claims management (chargemaster or CDM maintenance, discharged-not-final-billed or DNFB analysis, accounts receivable), assigning codes and groupings, and revenue integrity (coding audits, denials, fraud prevention).
Case mix index (CMI) is the sum of MS-DRG relative weights divided by the number of discharges (California HCAI dataset definition). A rising CMI can reflect changes in patient complexity, documentation, or coding. You have to investigate to know which. CMS has documented increases from documentation and coding that did not reflect increased illness severity (CMS explanation of the FY 2011 adjustment).
Coding follows the provider's documentation. Under the FY 2027 ICD-10-CM Official Guidelines, code assignment rests on the provider's diagnostic statement, and conflicting documentation calls for a provider query (Section I.A.19). When no definitive diagnosis is established by the end of an outpatient encounter, report the highest degree of certainty, such as signs and symptoms (Section IV.H). The uncertain-diagnosis rule for short-term acute, long-term-care, and psychiatric hospital inpatient admissions is different: qualifying uncertain diagnoses documented at discharge are coded as established unless a specific exception applies (Section II.H). Some conditions, including COVID-19, are "code only confirmed": a "probable" COVID-19 diagnosis is not coded as COVID-19, even for an inpatient, because the guideline makes it an explicit exception to the inpatient uncertain-diagnosis rule (Section I.C.1.g.1). (FY 2027 guidelines PDF, pp. 12, 28–30, 109, 114; effective October 1, 2026–September 30, 2027.)
Compliant queries. The 2026 ACDIS/
Two Medicare rules worth memorizing:
- Two-midnight benchmark. An inpatient admission is generally appropriate for Part A payment when the admitting physician expects care to cross two midnights and documents why. An unforeseen death or transfer that shortens the stay may still support inpatient payment when the documented expectation was appropriate. The regulation also provides inpatient-only-procedure and supported case-by-case exceptions for expected stays shorter than two midnights (42 CFR 412.3(d)).
- Medicare Parts A and B overpayments. Report and return within 60 days after identification (or by the corresponding cost-report due date, if applicable and later). A timely, good-faith investigation into related overpayments from the same or similar cause suspends the deadline until the earlier of completing that investigation and calculating the aggregate amount, or 180 days after the initial overpayment was identified. The lookback is six years from receipt of the overpayment (42 CFR 401.301; 401.305).
Domain 5: Management and Leadership
What the outline covers: goals, strategy and change management; contracting and outsourcing; HR activities; work design and process improvement; training; budgets; accreditation and licensing support; monitoring compliance with laws; and project management.
Budgets. Variance = actual − budget. For an expense line, over budget is unfavorable. Express the percentage against the budget, not the actual.
Staffing. FTEs needed = work hours required ÷ productive hours per FTE. Work hours come from volume ÷ productivity standard.
Worked example: critical path. Task A (4 weeks) starts the project. B (3 weeks) and C (6 weeks) follow A. D (2 weeks) follows B. E (2 weeks) follows both C and D.
Path A-B-D-E = 11 weeks. Path A-C-E = 12 weeks.
With these finish-to-start dependencies and no other constraints, the longest path sets the minimum project length: 12 weeks. Without an offsetting change, a delay on A, C, or E delays the whole project. Adding all five tasks (17 weeks) ignores the work that runs in parallel.
Compliance programs. The OIG's General Compliance Program Guidance (November 2023) lists seven elements: written policies and procedures; compliance leadership and oversight; training and education; effective lines of communication and disclosure programs; enforcing standards through consequences and incentives; risk assessment, auditing, and monitoring; and responding to detected offenses with corrective action (pp. 32–59). These are OIG's voluntary compliance-program recommendations; the guidance itself is not binding law (p. 2). The guidance also says:
- The compliance officer should report to the CEO or the board and should not lead or report to the legal or financial functions (p. 39).
- Staff and contractors should be screened against OIG's exclusion list before appointment or engagement and monthly after that (pp. 26, 38).
- Board members, officers, employees, contractors, and medical staff should get compliance training at least annually (p. 46).
RHIA numbers sheet
| Rule | Number | Source |
|---|---|---|
| Patient access request | Act within 30 days; one 30-day extension, with written reason and date | 45 CFR 164.524(b)(2) |
| Accounting of disclosures | 6-year look-back; act within 60 days; one extension of up to 30 days with timely written reason and completion date; first accounting in 12 months free | 45 CFR 164.528 |
| Breach notice to individuals | Without unreasonable delay, no later than 60 calendar days after discovery | 45 CFR 164.404(b) |
| Breach notice to media | More than 500 residents of one state or jurisdiction; without unreasonable delay, no later than 60 calendar days after discovery | 45 CFR 164.406(a) |
| Breach notice to HHS | 500+: with individual notices; under 500: within 60 days after the end of the year of discovery | 45 CFR 164.408 |
| PHI of a deceased person | HIPAA privacy protection for 50 years after death; this is not a record-retention period | 45 CFR 164.502(f) |
| Hospital record retention (CoP) | At least 5 years | 42 CFR 482.24(b)(1) |
| History and physical | General rule: ≤30 days before or ≤24 hours after admission/ |
42 CFR 482.24(c)(4)(i)(A)–(C) |
| Record completion (CoP) | Within 30 days after discharge | 42 CFR 482.24(c)(4)(viii) |
| Two-midnight benchmark | General benchmark: expected hospital care across two midnights; exceptions apply | 42 CFR 412.3(d)(1) |
| Medicare Parts A/ |
60 days after identification or applicable later cost-report date; qualifying investigation suspension capped at 180 days from initial identification; 6-year lookback from receipt | 42 CFR 401.305 |
| Exclusion screening (OIG guidance) | Before appointment or engagement, then monthly | OIG GCPG, pp. 26, 38 |
| Compliance training (OIG guidance) | At least annually | OIG GCPG, p. 46 |
These are federal rules and federal guidance with different scopes. State law and organizational policy may add requirements; identify the controlling rule and applicable exceptions for the setting.
15 RHIA practice questions
Original, unofficial practice questions written by Castleport Test Prep. They aren't AHIMA exam questions. There are three per domain, which is a teaching choice and doesn't match the exam's weighting. Your score here is feedback on these 15 items, not an AHIMA scaled score or a prediction of passing. Three questions per domain cannot establish mastery of that domain.
Domain 1: Data and Information Governance
RHIA-EP-01. A hypothetical state requires hospitals to keep adult inpatient records for at least 10 years after discharge. Which retention minimum meets both the Medicare hospital CoP and this state rule?
Answer and explanation
C. At least 10 years. The CoP requires at least 5 years (42 CFR 482.24(b)(1)). That's a floor, so the stricter state rule controls, and meeting it satisfies both. Six years is the window for an accounting of disclosures, not a record-retention rule. Completing coding and billing does not replace a required retention period. (The 10-year state rule is hypothetical. Check your own state's law.)
RHIA-EP-02. At a Medicare-participating hospital, an audit of 80 inpatient records (none involving surgery or a procedure requiring anesthesia) finds the history and physical was placed in the record within 24 hours after admission in 68 of them. What is the compliance rate for that documentation-timing measure?
Answer and explanation
A. 85%. 68 ÷ 80 = 0.85. B is the noncompliance rate (12 ÷ 80). The CoP requires the H&P to be in the record within 24 hours after admission (42 CFR 482.24(c)(4)(i)(A)), so the 12 records that fail this timing measure are deficiencies to trend and correct.
RHIA-EP-03. At a Medicare-participating hospital, draft medical staff rules would give physicians 45 days after discharge to complete their records. What should the HIM director recommend?
Answer and explanation
B. The hospital CoP requires the final diagnosis and record completion within 30 days following discharge (42 CFR 482.24(c)(4)(viii)). Bylaws can be stricter than that, but not looser. Committee approval doesn't override a federal condition, the accounting timeline is unrelated, and tracking without a deadline doesn't meet the requirement.
Domain 2: Compliance with Access, Use, and Disclosure of Health Information
RHIA-EP-04. A patient's request for an electronic copy of their record arrives March 1. Archived records can't be retrieved by March 31. What does HIPAA allow?
Answer and explanation
D. A covered entity has 30 days from receipt, plus one extension of up to 30 days. It must give the patient written reasons and a completion date within the first 30 days (45 CFR 164.524(b)(2)). A fails because the notice must be written and the extension cannot exceed 30 days. C fails because repeated extensions are not allowed. Being archived isn't a ground for denial.
RHIA-EP-05. A verified patient asks a HIPAA-covered provider for a copy of their ordinary medical records. No access exception applies. The patient still owes the provider for earlier treatment. What should the provider do?
Answer and explanation
B. HHS states a provider cannot deny a patient a copy of their records because they haven't paid for the services they received (HHS, "Your Medical Records"). A and C make access depend on payment, and D invents a barrier. A reasonable, cost-based fee for producing the copy is a separate question from the treatment debt (45 CFR 164.524(c)(4)).
RHIA-EP-06. A breach of unsecured PHI at a HIPAA-covered hospital affects 620 residents of one state. No law-enforcement delay applies. Besides the affected individuals, who must the hospital notify under HIPAA, and when?
Answer and explanation
A. More than 500 residents of a state triggers media notice (45 CFR 164.406(a)), and 500 or more individuals triggers HHS notice at the same time as individual notices (45 CFR 164.408(b)). Media and individual notices are due without unreasonable delay and no later than 60 calendar days after discovery. The annual log is only for breaches affecting fewer than 500. State notification laws may add requirements, but they don't replace HHS.
Domain 3: Data Analytics and Informatics
RHIA-EP-07. A unit has 150 staffed beds throughout June (30 days) and recorded 3,780 inpatient days that month. What was its occupancy rate?
Answer and explanation
C. 84%. Average daily census = 3,780 ÷ 30 = 126. Occupancy = 126 ÷ 150 = 0.84 (NCHS definition). A treats the census (126) as a percentage. The same answer comes from 3,780 ÷ (150 beds × 30 days) = 3,780 ÷ 4,500.
RHIA-EP-08. Two departments audited nonoverlapping sets containing every record they had for the same month, using the same deficiency definition. Department A found 8 deficient records out of 80. Department B found 18 out of 360. What is the combined deficiency rate, rounded to one decimal?
Answer and explanation
B. 5.9%. Add the counts first: (8 + 18) ÷ (80 + 360) = 26 ÷ 440 ≈ 5.9%. A averages the two department rates (10% and 5%) even though the departments are different sizes. C adds the rates. D divides by 400, which isn't the number of records reviewed.
RHIA-EP-09. A patient wants a smartphone app to pull their data through the hospital's EHR application programming interface (API), certified under 45 CFR 170.315(g)(10). Which standard does 45 CFR 170.215(a)(1) adopt as the API base standard?
Answer and explanation
D. 45 CFR 170.215(a)(1) adopts HL7 FHIR Release 4.0.1 as the API base standard for this standardized API criterion. None of the other options is the standard named there. A PDF or fax can deliver a copy, but neither is an API.
Domain 4: Revenue Cycle Management
RHIA-EP-10. Five discharges have MS-DRG relative weights of 0.9, 1.1, 1.6, 2.0, and 0.9. What is the case mix index?
Answer and explanation
A. 1.30. CMI = sum of relative weights ÷ number of discharges = 6.5 ÷ 5 (HCAI definition). B is the sum before dividing. C is the median weight, not the average. D does not equal the total weight divided by five discharges.
RHIA-EP-11. The discharge summary and a consultant's note disagree about whether a diagnosis was present during the same admission. The conflict affects code assignment and needs clarification. Which action best follows the 2026 ACDIS/
Answer and explanation
C. The query should clarify the clinical record without steering the answer. Presenting the conflicting documentation and relevant evidence lets the attending resolve the discrepancy using clinical judgment (2026 ACDIS/
RHIA-EP-12. An inpatient discharged on October 15, 2026 has a discharge summary reading "probable COVID-19; test pending at discharge." Fever and cough are documented, and no known or suspected exposure is documented. Under the FY 2027 ICD-10-CM guidelines, what should the coder do?
Answer and explanation
D. The guidelines say to code only a confirmed COVID-19 diagnosis and, for "suspected," "possible," "probable," or "inconclusive" COVID-19, to code the signs and symptoms instead. They state this is an exception to the inpatient uncertain-diagnosis guideline (FY 2027 Guidelines, Section I.C.1.g.1.(a) and (g), pp. 28–30). A applies the general rule this exception overrides, and C codes the same unconfirmed condition in a different position. B is for screening, which doesn't fit a symptomatic patient. A positive test is not required when the provider documents confirmed COVID-19; here the diagnosis remains probable.
Domain 5: Management and Leadership
RHIA-EP-13. A project budget included 200 direct-labor hours at $30 per hour. Actual direct labor was 220 hours at $32 per hour. Ignoring benefits, overtime premiums, and all other costs, how does actual direct-labor expense compare with the budget?
Answer and explanation
B. $1,040 above budget. Budget = 200 × $30 = $6,000. Actual = 220 × $32 = $7,040. Actual − budget = $1,040 over, which is unfavorable for an expense. A counts only the extra hours at the budgeted rate (20 × $30), and D counts only the rate increase on the budgeted hours (200 × $2). C reverses the direction. The variance tells you spending was higher, not whether the extra work was justified.
RHIA-EP-14. The coding team handles 9,100 charts a month. The productivity standard is 4 charts per productive hour, and each full-time equivalent (FTE) provides 140 productive hours a month. How many FTEs are needed?
Answer and explanation
A. 16.25. Hours needed = 9,100 ÷ 4 = 2,275. FTEs = 2,275 ÷ 140 = 16.25. D divides the chart volume by 140 and skips the productivity standard. B and C use productivity or hours figures the question didn't give.
RHIA-EP-15. Leadership proposes that the CFO also serve as the hospital's compliance officer. Based on OIG's General Compliance Program Guidance, what should you recommend?
Answer and explanation
C. OIG says the compliance officer should not lead or report to the legal or financial functions and should report directly to the CEO or the board (OIG GCPG, p. 39). A and B leave the compliance officer leading finance. D keeps the compliance function reporting through the CFO.
Your 8-week RHIA study plan
Assumptions: you've finished (or nearly finished) an HIM bachelor's or master's program, and you can do six one-hour sessions a week, for 48 hours in total. This is our editorial plan, not an AHIMA requirement, and no number of hours guarantees a pass. Add time wherever the outline check turns up real gaps.
| Week | Focus | Sessions (1 hour each) | Done when you have |
|---|---|---|---|
| 1 | Baseline and Domain 2 | 1) Mark every outline task. 2) Work all 15 practice questions untimed. 3) Start your error log. 4–5) HIPAA access, disclosures, accounting, breach. 6) Learn the numbers sheet. | A marked outline and your first error-log entries |
| 2 | Domain 1 | 1) Documentation standards and authentication. 2) Retention and destruction. 3) Data dictionaries and quality reporting elements. 4) MPI integrity and duplicate-rate math. 5) Governance policies. 6) Redo the Domain 1 questions without looking. | One written data definition and corrected Domain 1 answers |
| 3 | Domain 3: statistics | 1–2) Occupancy, ALOS (both definitions), rates. 3) Mean, median, percent change. 4) Pooled rates and denominators. 5) Chart choice and reports. 6) Rework every Domain 3 calculation from a blank page. | A formula sheet you wrote yourself, with denominators defined |
| 4 | Domain 3: informatics, plus Domain 2 review | 1) SDLC phases. 2) EHR support and workflow optimization. 3) HIE, FHIR, interfaces. 4) Database basics and focused audits. 5–6) Redo missed Domain 2 items and reread their rules. | A one-page SDLC map and a clean Domain 2 error log |
| 5 | Domain 4 | 1) Reimbursement models and CMI. 2) Coding guidelines and validation. 3) CDI and compliant queries. 4) Claims: CDM, DNFB, A/ |
A claim-flow map from documentation to payment |
| 6 | Domain 5 | 1) Budgets and variance. 2) FTEs and productivity. 3) Project management and critical path. 4) HR, training, contracting and BAAs. 5) Compliance program elements. 6) Change management and process improvement. | Every Domain 5 calculation done by hand |
| 7 | Timed practice and mixed review | 1) Rework the 15 questions in 20 minutes 30 seconds without notes; use the rest of the hour to log misses and guesses. 2) Explain the rule behind each answer without looking at the explanation. 3) Rework the worked calculations from a blank page, naming each denominator. 4) Review the numbers sheet and its exceptions. 5–6) Revisit the outline tasks your error log identifies as gaps. | A domain-by-domain list of gaps and corrected reasoning |
| 8 | Targeted review | 1–2) Your weakest domain. 3) Your next weakest. 4) Error log, start to finish. 5) Numbers sheet and formulas, from memory. 6) Confirm your appointment, ID, and route to the test center. | A short remaining-gaps list and a confirmed test day |
If you already have a separate, legitimate 150-question practice exam based on the current outline, you can use a single 205-minute sitting for Week 7 sessions 1–4, then use sessions 5–6 to review it. The 15 questions here provide a short pacing exercise; repeating them does not measure full-exam stamina or fresh-question performance.
Adapt it:
- 3 hours a week: stretch each week across two weeks (16 weeks, still 48 hours).
- 10–12 hours a week: finish in about 4–5 weeks, but keep the Week 7 practice and review.
- Returning after time away: add a relearning week after Week 1 rather than compressing the content weeks.
- Retaking: start with the lowest domain percentages on your score report, but still cover the whole outline. AHIMA's sample reports note domain scores vary between attempts, especially in smaller domains (Candidate Guide, Appendix D).
Pacing math: after the 5-minute agreement screen, you get 3 hours 25 minutes of exam time, which includes reading the instructions. That's 205 minutes ÷ 150 questions ≈ 82 seconds per question before saving any time for review. The clock doesn't stop for breaks (AHIMA timing FAQ). There's no penalty for wrong answers, so never leave one blank (AHIMA, About the Exams).
Turn mistakes into your next study session
For every miss and every guess, name what changed the answer: a rule you didn't know, a detail you misread, a calculation set up wrong, or an assumption the question didn't support. Write the fix in your own words.
| Date | Question | Domain | My answer → correct | Why I missed it | The rule or method | Source | Review on |
|---|---|---|---|---|---|---|---|
| (your date) | RHIA-EP-08 | 3 | A → B | Averaged the two rates | Add the counts, then divide by all records reviewed | Q8 explanation | (next session) |
Re-answering a question you've already seen can reward memory of the answer. When you revisit a topic, explain the rule out loud before you look at any answer.
RHIA exam facts
The exam has 150 questions (130 scored), a 3½-hour appointment, a passing score of 300 on a 100–400 scale, and it's taken at a Pearson VUE test center.
| Question | Answer |
|---|---|
| How many questions? | 150: 130 scored and 20 unscored pretest items mixed throughout. After selecting an answer, you can move back and forth and flag items for review. (AHIMA RHIA page) |
| How long? | A 3½-hour appointment: 5 minutes for the confidentiality agreement, then 3 hours 25 minutes for instructions and questions. No planned breaks, and the clock keeps running if you take one. (AHIMA timing FAQ) |
| What score passes? | 300 on AHIMA's 100–400 scale. It's a scaled score, not a percentage. (About the Exams) |
| When do I get results? | Right after the exam, with a percent-correct breakdown by domain (except during beta periods). (AHIMA results FAQ; Candidate Guide, Appendix D) |
| Can I take it at home? | No. RHIA is given at Pearson VUE test centers. AHIMA lists remote proctoring only for CDIP, CHDA, and CHPS. (RHIA page; Pearson VUE delivery options) |
| What can I bring? | No books or resources are required. Personal calculators are on the prohibited-items list, and the test center provides materials for notes and calculations. (Candidate Guide, pp. 12–13 and Appendix B) |
| What does it cost? | $229 for AHIMA members and $299 for nonmembers. A retake costs the same. (RHIA page) |
| How soon can I retake? | After a 30-day wait, with a new application, fee, and new Authorization to Test before scheduling. (RHIA page) |
Who can apply. AHIMA currently accepts candidates who have completed the academic requirements of a CAHIIM-accredited HIM program at the bachelor's or master's level, a CAHIIM-approved post-baccalaureate HIM certificate, or a foreign HIM program covered by a reciprocity agreement. Health informatics programs don't currently qualify. (RHIA page)
Testing before you graduate. Students in the final term of a CAHIIM-accredited program can test early using the early tester form (effective November 18, 2025), signed by you and your program director and submitted through AHIMA's secure inquiry form. The form can be submitted only twice per exam. If you pass, you have one year to get your official transcript to AHIMA, or the result is nullified. You can't use the credential until AHIMA verifies everything.
A proposed RHIT pathway, not yet in effect. CCHIIM has proposed an additional RHIA route for people with an active RHIT, a bachelor's or master's degree in a healthcare, health informatics, or business-related field, and at least 3 years of HIM or health informatics experience. AHIMA says the effective date will be announced after formal approval and implementation planning. (AHIMA announcement)
Next steps: how to register for an AHIMA exam · reading your AHIMA results · AHIMA retake rules · keeping your RHIA after you pass
RHIA pass rates
| Year | First-time testers | First-time pass rate |
|---|---|---|
| 2025 | 860 | 67% |
| 2024 | 727 | 71% |
| 2023 | 760 | 64% |
Source: AHIMA RHIA page, "Certified Professionals and Pass Rates." AHIMA reported 13,848 certified RHIAs as of December 31, 2025.
These are AHIMA's reported first-attempt rates. They describe a group of candidates and can't predict your result.
RHIA exam prep FAQ
How long should I study for the RHIA? Our plan assumes 48 hours over 8 weeks for a recent graduate. If the outline check shows big gaps, or you've been out of school a while, plan longer. AHIMA doesn't set a required study time.
Does passing the RHIA replace my RHIT? Yes. AHIMA says the RHIT is superseded once you pass the RHIA, so you stop using it. (AHIMA credential-use FAQ)
Is the 300 passing score the same as 75%? No. AHIMA converts every exam's cut score to 300 on a 100–400 scale. The number isn't a percent or a count of correct answers. (About the Exams)
How do I keep the RHIA once I have it? It renews on a two-year cycle with continuing education and a fee (AHIMA, Maintain Your RHIA Credential). See our AHIMA certification renewal guide.
Sources and how we checked
Last verified: October 22, 2026 (UTC). We checked AHIMA's RHIA page, the current content outline and 2018–2023 crosswalk, the About the Exams page, the certification FAQ, the Candidate Guide, the early tester form, and the RHIT-pathway announcement. The cited exam rules, regulations, teaching definitions, and coding/
AI tools assisted with drafting and source checks, following our editorial standards.
- AHIMA: RHIA certification page · RHIA Exam Content Outline, effective 10/01/2023 · Content Outline Crosswalk 2018–2023 · About the Exams · Certification FAQs · Candidate Guide · Early Tester Form · Proposed RHIT-to-RHIA pathway
- HIPAA: 45 CFR 164.524 · 164.528 · 164.502 · Subpart D, breach notification · HHS, Your Medical Records
- Medicare: 42 CFR 482.24 · 42 CFR 412.3 · 42 CFR 401.305
- Health IT: 45 CFR 170.215 · 45 CFR 170.315(g)(10) · AHRQ EHR transition timeline
- Coding and CDI: ICD-10-CM Official Guidelines FY 2027 · ACDIS/
AHIMA Compliant Query Practice, August 2026 - Statistics: NCHS HUS 2017, Table 91 · NCHS HUS 2016, Figure 20 · NCHS Data Brief 186, discharge-based ALOS definition · CDC Principles of Epidemiology, Lesson 2 · CDC data visualization transcript · California HCAI Case Mix Index
- Compliance: OIG General Compliance Program Guidance (Nov. 2023)
More guides: Health information exam resources
Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the American Health Information Management Association (AHIMA), its Commission on Certification for Health Informatics and Information Management (CCHIIM), or Pearson VUE. Exam and credential names identify their subjects; trademarks belong to their respective owners. The practice questions on this page are original and unofficial, and nothing here guarantees a passing score.