How an AHIMA Credential is Born

By Mary Butler

When you see a list of letters after a health information management (HIM) professional’s last name, it’s sometimes too easy to take for granted all the long, hard hours that went into earning and creating those acronyms. For both the credential earner and the certification creator (AHIMA), a certification is an investment.

It can take three to five years to launch a certification in the marketplace, depending on how quickly change is happening in the industry. For example, with the clinical documentation improvement practitioner (CDIP) credential, CDI experts convene to make annual changes to the exam and constantly re-evaluate the skills and knowledge that they think credential holders should have.

Certification creation is a story that isn’t told very often, according to Terrence Wright, AHIMA’s director of certification, but is important to understand so that credential holders know just what they are getting with that list of letters. AHIMA’s certification process is considered the “gold standard” based on several factors—one of which is the fact that AHIMA credentials are created using a scientific process. AHIMA works with the Commission on Certification for Health Informatics and Information Management (CCHIIM), which helps ensure that the appropriate processes are used to develop exams. Additionally, AHIMA’s CCS, CCA, RHIA, and RHIT credentials are accredited by the National Commission of Certifying Agencies (NCCA). According to Desla Mancilla, DHA, RHIA, vice president of academic affairs at AHIMA, NCCA accreditation for credential development “is like getting a gold seal that tells the industry that all appropriate exam development activities took place.” Even though only four AHIMA credentials are NCCA-accredited, AHIMA still applies the same level of rigor required by the NCCA to every credential it develops.

The CDIP credential is designed to demonstrate competence and efficiency in medical record review, coding principles, reimbursement methodologies, regulatory compliance, management of CDI program metrics, and record management. With this understanding in mind, AHIMA developed a high-quality exam to ascertain a candidate’s ability to perform the necessary duties.

Lifecycle of the CDIP

Before there could be a CDI credential, a job task analysis—which involves a three-step process—was undertaken by a panel of subject matter experts in CDI, Wright explains. The job task analysis first outlined the duties related to working as a CDI specialist, and the knowledge, skills, and abilities needed to competently perform them. Through guided discussion, the group of experts created a list of content domains in which measurable tasks were placed. These tasks informed the survey that was developed and disseminated during the second phase of the job task analysis process—which was to send that survey to subject matter experts and practicing CDI specialists. That survey group was able to add knowledge, skills, and abilities that might be missing from the job task analysis, Wright says.

Next, the survey group sent their feedback to the initial job task analysis team who held a meeting to create recommendations for the development of the credentialing exam. That test plan document becomes a blueprint for what appears on an exam. These recommendations were taken under consideration by CCHIIM, an AHIMA commission dedicated to ensuring the competency of professionals practicing health information and informatics, and was then voted on. The document CCHIIM voted on became the new CDIP exam blueprint. All of the reports, studies, and surveys were then made public on AHIMA’s website.

“The difference between AHIMA’s process and what I’ve seen with some of our competitors is that we openly make all of our reports attached to these processes available to the public,” Wright says. “It’s important to do that…When somebody has a question about why AHIMA has a survey in the certification area, we can always point back to this knowledge base.”

CDIP Credentialing Exam

To ensure the exam is measuring topics that it is designed to measure, the exam blueprint (found on the AHIMA website) is used in all aspects of exam development. Item writers and reviewers are recruited from professionals currently working in the field. These subject matter experts meet as groups to develop and review items. All items used to determine competence are pre-tested before being used as operational items.

“It always surprises people in the credentialing world, but we do ongoing development so we have this constant review going on behind the scenes on [exam] items. We have different workshops where item writers sit and look at items all day, and they’re usually dog tired when it’s over,” Wright says. “Then we update our forms [exams] annually or as needed.”

AHIMA works with Pearson Vue to administer the exams in testing sites located around the world. The AHIMA website also contains information concerning application processes, testing fee structure, and registration at Pearson testing centers. Having a website that fully conveys information related to the exam offers candidates the ability to be fully informed during the entire testing process, which helps relieve stress as candidates prepare to sit for important exams. Simply earning the CDIP credential is not a one-and-done endeavor. Credential holders must continue to recertify on a two-year cycle. To maintain just the CDIP, credential holders must earn 30 continuing education units over a two-year period.

Value of the CDIP Credential

According to Wright, individuals who sit for the exam already are considered to be leaders in their field and experts in proper clinical documentation, as evidenced by the fact that so many physicians and individuals who already hold several other professional credentials take the exam. AHIMA credentials carry more weight throughout the industry in part, says Wright, because it is so transparent about what goes into the credential’s creation.

“There’s a right way and a wrong way to develop exams if you want to be scientifically rigorous and be defensible legally. AHIMA makes sure the letter of the law is followed… It’s one of the positives of working here [at AHIMA],” Wright says. “I know in the end that if I have to defend the exam, I have a lot of evidence to stand on.”

Challenges can come in the form of people who fail the exam and attempt to make the case that they failed because the exam was poorly written. This is a big reason that all of the materials that informed the exam’s creation are publicly available—which is simply not the case with other non-AHIMA credentials. Full details on the CDIP exam domains are available at www.ahima.org/certification.

Anny Yuen, RHIA, CCS, CCDS, CDIP, co-chair of AHIMA’s Clinical Documentation Improvement Practice Council, first sat for the CDIP exam approximately six years ago.

“I personally thought it would at least make myself and my career more marketable… show that I really do know what I’m doing,” Yuen says. “I take pride in what AHIMA has done. I’ve been very active in trying to change traditional CDI programs to accept the HIM professional’s knowledge and demonstrate the importance of the CDIP credential in the industry.”

Yuen’s practice council co-chair, Chinedum Mogbo, MD, MS, RHIA, CDIP, CCS, manager of CDI at Tenet Healthcare, was a practicing physician in Nigeria before she came to the United States but chose not to continue practicing medicine. The CDIP was the first HIM credential she acquired in addition to the CCS, in part because AHIMA provided the flexibility to sit for the exam because of her prior medical background. Like Yuen, she sat for the exam about six years ago, and also like Yuen volunteered to do item writing for the CDIP exam. Mogbo says the credential has “opened more doors” for her.

“When you apply for jobs, you want to be able to have a credential that says, ‘Hey, not only do I have this clinical background, but I also know the nuances around clinical documentation and integrity and how to practice it.’” Mogbo says. “It kind of gives weight to whatever you’re doing. It’s a good credential to have—it gives you more bargaining power and it launched my career in the CDI world. It gave me that edge.”

Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of AHIMA.