The RHIA (Registered Health Information Administrator) is a medical coding and health-information credential awarded by AHIMA.
AHIMA publishes the official exam outline, eligibility rules and fees — see AHIMA's official page before you book.
Twenty RHIA (Registered Health Information Administrator) questions, with the answers hidden until you want them — covering Legal, Analytics, Revenue, Management and more. They are real cards from our 1000-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. AHIMA publishes the official exam outline — check it for the real blueprint.
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Under the HIPAA Privacy Rule, when must a healthcare provider with a direct treatment relationship first provide the Notice of Privacy Practices (NPP) to a patient?
Show answer →Providers must provide the NPP no later than the date of the first service delivery. For electronic service delivery, it must be provided as soon as practicable. A provider must also make a good faith effort to obtain a written acknowledgment of receipt. Strategy Tip: AHIMA often tests the timing (first service) and the good faith effort requirement. Note: Failure to obtain acknowledgment does not prevent treatment, but the effort must be documented.
Following the 2024 HHS Final Rule aligning 42 CFR Part 2 with HIPAA, what specific language must now be included in the NPP regarding Substance Use Disorder (SUD) records?
Show answer →The NPP must now include specific language describing the protections for SUD records, including the need for written consent for most disclosures for TPO (Treatment, Payment, Operations) unless an exception applies. It must also include a statement that SUD records may not be used in criminal, civil, or administrative proceedings against the patient without specific consent or a court order. Strategy Tip: This is a high-yield 2026 exam topic following the CARES Act alignment.
A facility updates its NPP. Which specific patient right regarding out-of-pocket payments must be explicitly stated to remain compliant with HITECH/HIPAA standards?
Show answer →The NPP must state that a patient has the right to restrict certain disclosures of PHI to a health plan if the disclosure is for payment or healthcare operations and pertains solely to a service for which the patient has paid the covered entity in full out-of-pocket. Strategy Tip: Distinguish this from the general Right to Request Restrictions, which the CE is not required to agree to; the out-of-pocket restriction is mandatory if criteria are met.
A HIM manager needs to extract the Patient Name and Date of Birth from the Master_Patient_Index table for all patients born before 1960. Which SQL statement correctly identifies the source and filter?
Show answer →SELECT PatientName, DOB FROM Master_Patient_Index WHERE DOB < '1960-01-01'. Rationale: SELECT identifies columns, FROM identifies the table, and WHERE applies the filter. In RHIA exams, remember that date formats must be quoted. Distractor: Using WHERE PatientName instead of DOB for the filter. Clinical Pearl: Always ensure the date format matches the database schema (ISO 8601 is standard).
You are tasked with identifying all patients with any form of Type 2 Diabetes (ICD-10-CM code E11) in the Diagnosis_Table. Which WHERE clause should be used to capture all subcodes?
Show answer →WHERE DiagnosisCode LIKE 'E11%'. Rationale: The percent sign (%) is a wildcard that represents zero or more characters. Using 'E11%' captures E11.9, E11.65, etc. AHIMA Tip: Ensure the wildcard is inside the single quotes. Avoid using '=' when searching for patterns, as '=' requires an exact match. This is high-yield for clinical registry reporting.
When auditing the Discharge_Summary table, you want to find records where the Physician_Sign_Date is missing. Which WHERE clause accurately identifies these incomplete records?
Show answer →WHERE Physician_Sign_Date IS NULL. Rationale: In SQL, NULL represents unknown or missing data. You cannot use = NULL because NULL does not equal anything, including itself. Use the IS NULL or IS NOT NULL operator. Exam Tip: AHIMA often tests data integrity and quality; identifying missing values is a core HIM competency for MU/MACRA reporting.
A facility's DNFB is increasing despite stable discharge volumes. The HIM Director notes a high volume of 'Physician Query' holds. What is the most effective management strategy to address this specific backlog root cause?
Show answer →The most effective strategy is implementing a formal Query Management Program with defined response timeframes (e.g., 48-72 hours) and automated escalations to Medical Staff leadership. Exam Strategy: AHIMA emphasizes that backlogs aren't always a 'coder speed' issue. If the bottleneck is documentation, adding coders won't help. Look for 'Root Cause Analysis' (RCA) in options. The DNFB (Discharged Not Final Billed) is a key RCM metric; high query rates often point to poor clinical documentation integrity (CDI) at the point of care.
A Coding Manager is transitioning the department to an AI-driven Computer-Assisted Coding (CAC) environment. How should the existing productivity standards (charts per hour) be adjusted to remain valid and fair?
Show answer →Productivity standards must be re-baselined using a time-motion study or 'Work Sampling' after the learning curve (typically 3-6 months). With CAC, quantitative standards usually increase (e.g., 20-30% higher volume), but the focus must shift to 'Verification Productivity' rather than 'Entry Productivity.' Exam Tip: AHIMA focuses on the manager's role in change management. Standards must be 'attainable' and 'measurable.' If CAC is used, the coder becomes an editor; therefore, standards based on manual entry are obsolete.
The HIM Director monitors a 'Coding Productivity Report' showing Coder A averages 4 inpatient charts/hour (98% accuracy) while Coder B averages 7 charts/hour (82% accuracy). What is the priority management intervention?
Show answer →The priority is addressing Coder B's quality through targeted education and a Performance Improvement Plan (PIP). High productivity at the expense of accuracy (below the 95% industry standard) leads to increased denials, RAC audits, and potential compliance risks. Clinical Pearl: Quality must always outweigh quantity in HIM. RHIA questions often pit high-volume against low-accuracy. A 'weighted productivity' formula (Quality % x Quantity) is often the best way to evaluate overall performance fairly.
A Director of HIM is defining the department's reason for existence and its core values to guide long-term decision-making. Which component of the strategic plan is being addressed?
Show answer →The Mission Statement describes the organization's current purpose, what it does, and whom it serves. It provides the why for the department's existence. Strategic Pearl: Differentiate Mission from Vision. Vision is future-oriented (aspiration), while Mission is present-oriented (purpose). AHIMA emphasizes that all tactical goals must align with the Mission to ensure organizational integrity. Common Distractor: Vision statement (focuses on the where in 5-10 years).
A facility identifies that a new 2026 state law mandates stricter patient data privacy than HIPAA. In a SWOT analysis, where should this legislative change be categorized?
Show answer →Threat (External). Strategic planning distinguishes between internal (Strengths/Weaknesses) and external (Opportunities/Threats) factors. Legislative changes, such as new privacy mandates, are external. While it creates a compliance burden (Threat), it is outside the organization's direct control. Exam Strategy: If the scenario highlights the facility's advanced encryption technology to meet this law, that specific asset is a Strength. The law itself remains a Threat or Opportunity depending on market positioning.
To improve ROI for a new 2026 AI-assisted CDI program, the HIM manager performs a Gap Analysis. What is the primary purpose of this tool in the strategic planning process?
Show answer →Gap Analysis compares the current state to the desired future state to identify what is missing (the gap). It determines the specific steps, resources, and technological upgrades needed to reach strategic objectives. Exam Strategy: AHIMA focuses on Gap Analysis as the bridge between high-level strategy and tactical implementation. In 2026, this is frequently applied to AI integration and data governance Maturity Models.
Explain the structural relationship between concepts, descriptions, and relationships in SNOMED CT as applied in an EHR.
Show answer →SNOMED CT is a polyhierarchical clinical terminology. Concepts are unique numerical identifiers (codes); Descriptions are human-readable terms (Fully Specified Name and Synonyms) linked to concepts; Relationships link concepts (e.g., Pneumonia IS A Infectious disease). Exam Tip: AHIMA focuses on the IS A relationship for hierarchical navigation and data aggregation.
A lab manager must standardize COVID-19 PCR results for HIE reporting. Which standard is most appropriate, and what are its six core axes?
Show answer →LOINC (Logical Observation Identifiers Names and Codes). The six axes are: 1. Component (analyte), 2. Property (e.g., mass vs. substance), 3. Time (point vs. duration), 4. System (specimen), 5. Scale (quant/qual), 6. Method. Exam Tip: Remember the Question/Answer rule—LOINC is for the question (the test ordered), while SNOMED is often the answer (the result).
Under the HIPAA Privacy Rule, a covered entity may disclose PHI without patient authorization to public health authorities for what primary purpose?
Show answer →For the purpose of preventing or controlling disease, injury, or disability. This includes reporting of disease, injury, vital events (birth/death), and public health surveillance/investigations. AHIMA Tip: Remember that while HIPAA permits this, state laws may be more stringent. The HIM professional must ensure the request is from a legitimate public health authority. Key Exam Point: Public health reporting is a labeled Public Interest and Benefit exception to the authorization requirement.
A facility records a fetal death at 22 weeks gestation. What are the specific HIM compliance requirements regarding the Fetal Death Report compared to a standard Death Certificate?
Show answer →Requirements vary by state, but most follow the Model State Vital Statistics Act. Fetal death reporting is generally required for gestations ≥20 weeks or weights ≥350g. Unlike a death certificate (which requires a birth certificate first if the infant breathed), a fetal death report is a single document. HIM Role: Ensure the clinical record supports the gestational age/weight to avoid over-reporting. Exam Distractor: Do not confuse fetal death with induced termination of pregnancy (ITOP) reporting, which has different legal mandates.
During the SDLC Planning Phase, an HIM director evaluates if the proposed ROI software can integrate with the existing EHR. Which component of the TELOS feasibility study is being addressed?
Show answer →Technical Feasibility. TELOS stands for Technical, Economic, Legal, Operational, and Scheduling feasibility. Technical feasibility assesses if the organization has the infrastructure or if the technology exists to support the project. Exam Tip: AHIMA often tests Operational (will it be used/accepted?) vs Technical (can it work?). Technical feasibility is the most common hurdle for legacy system integration.
A health system is initiating a transition to a new Enterprise Master Patient Index (EMPI). Which document, created in Phase 1 (Planning), formally recognizes the project and grants the HIM manager authority to use resources?
Show answer →Project Charter. This document is the cornerstone of Phase 1. It outlines project objectives, identifies the project manager, defines the scope at a high level, and provides the go-ahead from executive leadership. Exam Tip: Distinguish this from the Project Plan; the Charter is the authorization while the Plan is the execution roadmap. Without a signed charter, a project lacks official organizational standing.
An HIM Director notices a 15% increase in unbilled accounts due to missing physician signatures. In the Plan phase of PDCA, what is the most critical task before implementing a solution?
Show answer →The Plan phase requires identifying the root cause and establishing baseline metrics. The director must perform a root cause analysis (e.g., using a Fishbone diagram) to determine why signatures are missing (e.g., EHR technical error vs. workflow issue) and define the expected outcome. RHIA Strategy: AHIMA stresses that jumping to solutions without data-driven planning is a common failure in QI. Distractors often suggest implementing a pilot, which is actually the Do phase.
A facility is testing a new AI-assisted coding tool. The HIM manager decides to let two outpatient coders use the tool for one week to identify potential workflow disruptions. Which phase of the PDSA cycle does this represent?
Show answer →This represents the Do phase. In PDSA/PDCA, the Do phase is characterized by small-scale testing or a pilot study rather than full-scale implementation. This allows the organization to gather data on the change's impact without risking department-wide productivity. Exam Tip: AHIMA often tests the concept that Do is for testing a hypothesis, not for final rollout.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Legal questions
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Analytics questions
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Revenue questions
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Management questions
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Governance questions
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Compliance questions
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Try 30 free RHIA cards firstIt is 20 real question-and-answer cards from our 1000-card RHIA deck, mixed across topics so it feels like the breadth of the exam. It is not the official AHIMA exam and is not endorsed by AHIMA — for the official outline and any official practice material, go to AHIMA directly.
Use the bands on this page as study guidance, not as a pass mark: we do not publish a passing score for the RHIA because AHIMA sets it, and it can change. Confirm the current standard in the official handbook.
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