NHA Certified Electronic Health Records Specialist (CEHRS) — Questions and Answers

Question 1: The ONC's Trusted Exchange Framework and Common Agreement (TEFCA) is designed to:

Mandate specific EHR vendor contracts
Define reimbursement rates for interoperability
Replace all state HIE regulations
Establish a common set of principles and terms for nationwide health information exchange (Correct answer)

Correct answer: Establish a common set of principles and terms for nationwide health information exchange

TEFCA establishes a common framework of principles, terms, and conditions to enable nationwide health information exchange across networks.

Question 2: What is a Remittance Advice (RA) in the context of the revenue cycle?

A prior authorization confirmation from an insurer
A document sent to patients explaining their financial responsibility
A report generated by the EHR showing scheduled procedures
An explanation from the payer detailing how a claim was adjudicated and payment amounts (Correct answer)

Correct answer: An explanation from the payer detailing how a claim was adjudicated and payment amounts

The Remittance Advice (electronic version: ERA/835) details each claim line's adjudication, including paid amounts, adjustments, and denial reasons.

Question 3: In an EHR contract, a 'data portability' clause is important because it:

Permits the organization to resell access to its EHR data
Allows the vendor to use de-identified patient data for product development
Limits the organization's liability for data breaches
Ensures the organization can extract its patient data in a usable format if it switches vendors or the contract ends (Correct answer)

Correct answer: Ensures the organization can extract its patient data in a usable format if it switches vendors or the contract ends

Data portability clauses prevent vendor lock-in by guaranteeing the organization's right to receive its own data in a standard, machine-readable format upon contract termination.

Question 4: What does 'patient matching' refer to in health information exchange (HIE)?

The process of accurately identifying that records from different systems belong to the same individual (Correct answer)
Pairing patients with compatible organ donors
Assigning patients to specific insurance networks
Matching patients to available appointment slots in a scheduling module

Correct answer: The process of accurately identifying that records from different systems belong to the same individual

Patient matching algorithms compare demographic data across systems to correctly link records belonging to the same person, preventing dangerous data fragmentation or mix-ups.

Question 5: What is the MAIN purpose of a training needs analysis before EHR implementation?

Identify skill gaps and tailor training content to each user role (Correct answer)
Establish penalties for staff who fail training assessments
Determine the total cost of training delivery
Select the EHR vendor's preferred training platform

Correct answer: Identify skill gaps and tailor training content to each user role

A training needs analysis ensures that training addresses actual skill gaps specific to each role, making the program more effective and efficient.

Question 6: EPCS regulations require two-factor authentication. Which combination satisfies this requirement?

A hard token plus a biometric (something you have + something you are) (Correct answer)
Electronic signature and digital certificate
DEA number and NPI number
Username and password only

Correct answer: A hard token plus a biometric (something you have + something you are)

DEA EPCS rules require two of the three authentication factors—something you know, something you have, or something you are—such as a hard token combined with a biometric scan.

Question 7: A hospital wants to compare its 30-day mortality rates fairly against national benchmarks. Which analytical approach is required?

Risk adjustment (Correct answer)
Raw rate comparison
Seasonal smoothing
Cohort elimination

Correct answer: Risk adjustment

Risk adjustment accounts for differences in patient severity and case mix so that comparisons across hospitals are clinically fair.

Question 8: Which CDS tool helps ensure that all required components of a clinical process (e.g., sepsis bundle) are completed?

Patient education module
Passive reference tool
Drug–drug interaction alert
Checklist or protocol reminder (Correct answer)

Correct answer: Checklist or protocol reminder

Checklists and protocol reminders ensure adherence to multi-step care bundles by prompting completion of each required action.

Question 9: When a EHR professional encounters an unfamiliar challenge in disaster recovery & data backup, what is the recommended first course of action?

Apply the solution used for the most recent similar problem without adaptation
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Postpone addressing the issue indefinitely
Proceed based on personal intuition alone

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 10: A hospital receives a C-CDA document from a referring physician. Which section would contain the patient's current medication list?

Problems Section
Medications Section (Correct answer)
Plan of Treatment Section
Results Section

Correct answer: Medications Section

The Medications Section in a C-CDA document is the designated location for listing a patient's current medications.

Question 11: Which code set is used to report diagnoses on inpatient hospital claims in the United States?

CDT
HCPCS Level II
CPT-4
ICD-10-CM (Correct answer)

Correct answer: ICD-10-CM

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the standard for diagnosis coding on all US claims.

Question 12: When a EHR professional encounters an unfamiliar challenge in meaningful use & mips requirements, what is the recommended first course of action?

Proceed based on personal intuition alone
Apply the solution used for the most recent similar problem without adaptation
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Postpone addressing the issue indefinitely

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 13: Which EHR training delivery format is MOST appropriate for a physician with limited availability but a need to learn complex documentation workflows?

Weekly one-hour lecture series over three months
Printed quick reference cards only
Microlearning modules with scenario-based simulations accessible on demand (Correct answer)
Full-day classroom sessions with all departments combined

Correct answer: Microlearning modules with scenario-based simulations accessible on demand

On-demand microlearning with scenario-based simulations accommodates scheduling constraints while providing realistic, relevant practice for complex workflows.

Question 14: Which federal regulation requires EHR systems to include specific CDS functionality to qualify for Promoting Interoperability incentives?

DEA Controlled Substance Act
ONC Health IT Certification Program (Correct answer)
HIPAA Privacy Rule
Stark Law

Correct answer: ONC Health IT Certification Program

The ONC Health IT Certification Program defines certification criteria, including CDS capabilities required for Promoting Interoperability (formerly Meaningful Use) incentive eligibility.

Question 15: Which HL7 standard is most commonly used for exchanging laboratory results electronically between a lab system and an EHR?

DICOM SR (Structured Report)
FHIR R4 Appointment resource
X12 837 transaction set
HL7 v2 ORU (Observation Result Unsolicited) message (Correct answer)

Correct answer: HL7 v2 ORU (Observation Result Unsolicited) message

The HL7 v2 ORU^R01 message is the industry-standard transaction for transmitting lab results from laboratory information systems to EHRs.

Question 16: What is the purpose of the 'revenue code' on a UB-04 claim form?

To indicate the patient's primary diagnosis
To specify which physician performed the procedure
To identify the billing provider's tax ID number
To classify the type of service or accommodation provided in a facility setting (Correct answer)

Correct answer: To classify the type of service or accommodation provided in a facility setting

Revenue codes are 3-digit codes used on institutional claims to classify categories of service (e.g., room and board, pharmacy, radiology) for facility billing.

Question 17: In EHR project management, a 'steering committee' differs from a 'project team' in that the steering committee:

Conducts user acceptance testing
Manages the technical build of the system
Provides executive-level oversight and makes high-level strategic decisions (Correct answer)
Performs daily implementation tasks

Correct answer: Provides executive-level oversight and makes high-level strategic decisions

The steering committee provides executive sponsorship and strategic direction, while the project team handles day-to-day implementation activities.

Question 18: What does the term 'upcoding' refer to in healthcare billing compliance?

Billing for a higher-level or more complex service than was actually documented or performed (Correct answer)
Assigning a code that accurately reflects the highest level of service provided
Adding modifier codes to increase specificity on a claim
Using updated ICD-10 codes from the most recent code year

Correct answer: Billing for a higher-level or more complex service than was actually documented or performed

Upcoding is a form of healthcare fraud where providers bill for more expensive services than delivered, violating the False Claims Act and OIG guidelines.

Question 19: Which portal engagement metric best measures whether patients are actively using the portal after initial enrollment?

Portal enrollment rate
Number of patient demographics updated
Active user rate (logins per enrolled patient) (Correct answer)
Patient satisfaction score

Correct answer: Active user rate (logins per enrolled patient)

Active user rate tracks how many enrolled patients actually log in and use the portal, distinguishing true engagement from mere sign-up.

Question 20: What is a 'shared care plan' in an EHR context?

A collaborative document accessible to the patient and all members of their care team that outlines goals, tasks, and responsibilities (Correct answer)
A financial plan shared between a patient and their insurance provider
A template shared between two competing hospitals for data standardization
A schedule shared among nursing staff for shift coverage

Correct answer: A collaborative document accessible to the patient and all members of their care team that outlines goals, tasks, and responsibilities

A shared care plan coordinates multi-disciplinary and patient-engaged care by making goals, interventions, and responsibilities transparent to everyone involved.

Question 21: Which statistical measure is most appropriate for describing the central tendency of skewed clinical data distributions?

Median (Correct answer)
Standard deviation
Mode
Mean

Correct answer: Median

The median is preferred over the mean for skewed distributions because it is not influenced by extreme outliers.

Question 22: What is the primary goal of data encryption during transmission (data in transit)?

To ensure data is stored in a HIPAA-compliant format
To compress the data to reduce bandwidth
To prevent unauthorized interception from reading the data (Correct answer)
To verify the identity of the sender

Correct answer: To prevent unauthorized interception from reading the data

Encrypting data in transit ensures that even if the transmission is intercepted, the data cannot be read without the decryption key.

Question 23: What does 'workflow mapping' accomplish during EHR implementation?

It generates a geographical map of the hospital's network infrastructure
It creates a patient routing plan for the emergency department
It documents current clinical processes to identify inefficiencies and design optimized EHR workflows (Correct answer)
It tracks which staff members log in and out of the system

Correct answer: It documents current clinical processes to identify inefficiencies and design optimized EHR workflows

Workflow mapping visualizes existing processes, exposing redundancies and bottlenecks so the EHR can be configured to improve—not just replicate—current workflows.

Question 24: What does 'system downtime procedure' refer to in EHR management?

The steps to permanently decommission a module
Scheduled vendor maintenance windows
Pre-planned workflows using paper or backup systems when EHR is unavailable (Correct answer)
The process for terminating employee EHR access

Correct answer: Pre-planned workflows using paper or backup systems when EHR is unavailable

Downtime procedures are pre-defined workflows allowing clinical operations to continue using paper or backup systems when the EHR is unavailable.

Question 25: A facility plans to implement the EHR in one department first before expanding hospital-wide. This is an example of:

Pilot or phased implementation (Correct answer)
Parallel conversion
Forced migration
Big bang implementation

Correct answer: Pilot or phased implementation

A pilot or phased approach deploys the system in a limited area first, allowing issues to be resolved before full-scale rollout.

Question 26: What is the purpose of a 'system stress test' before EHR go-live?

To train end users on all system modules
To simulate peak load conditions and identify performance bottlenecks (Correct answer)
To evaluate vendor contract terms
To review billing codes for compliance

Correct answer: To simulate peak load conditions and identify performance bottlenecks

Stress testing simulates high concurrent user loads to ensure the system can handle peak usage without degraded performance.

Question 27: Which evaluation tool is commonly used to score and rank EHR vendors objectively during the selection process?

Simple majority vote among department heads
Alphabetical ranking of vendor names
Selection of the vendor with the lowest initial price quote
Weighted scoring matrix that assigns importance scores to predefined criteria and rates each vendor against them (Correct answer)

Correct answer: Weighted scoring matrix that assigns importance scores to predefined criteria and rates each vendor against them

A weighted scoring matrix quantifies subjective evaluations by assigning weights to criteria based on organizational priorities, enabling defensible, data-driven vendor comparisons.

Question 28: Under HIPAA, which of the following is NOT considered Protected Health Information (PHI)?

De-identified data that cannot reasonably identify an individual (Correct answer)
Lab results associated with a patient's date of birth
A patient's prescription history linked to their name
A patient's medical diagnosis stored in the EHR

Correct answer: De-identified data that cannot reasonably identify an individual

De-identified health information that cannot reasonably be used to identify an individual is not considered PHI under HIPAA.

Question 29: What role does continuous improvement play in ehr customization & workflow design for EHR certified professionals?

It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation (Correct answer)
It applies only to new professionals in their first year
It focuses exclusively on cost reduction
It is optional and only necessary during certification renewal

Correct answer: It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation

Continuous improvement is fundamental to professional practice in ehr customization & workflow design, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 30: Which HL7 FHIR resource is used to represent a patient's allergy or intolerance information when exchanging data between systems?

AllergyIntolerance (Correct answer)
MedicationStatement
Observation
Condition

Correct answer: AllergyIntolerance

The HL7 FHIR AllergyIntolerance resource is specifically designed to capture and exchange allergy and intolerance data.

Question 31: A claim is returned with a 'duplicate claim' denial. What is the most appropriate first step?

Resubmit the claim immediately with a new date
Bill the patient for the full amount
Write off the balance as uncollectable
Verify whether the original claim was paid, pending, or denied before taking action (Correct answer)

Correct answer: Verify whether the original claim was paid, pending, or denied before taking action

Before taking any action on a duplicate denial, staff must check the original claim's status to avoid creating additional duplicates or losing reimbursement.

Question 32: Which Stage of Meaningful Use introduced the concept of Care Coordination as a core objective?

Stage 4
Stage 2 (Correct answer)
Stage 3
Stage 1

Correct answer: Stage 2

Stage 2 Meaningful Use placed significant emphasis on care coordination, including transitions of care and patient engagement.

Question 33: What is the role of a 'steering committee' in an EHR vendor selection process?

Deliver end-user training
Negotiate contract terms directly with the vendor
Provide executive oversight, resolve escalated decisions, and ensure the selection aligns with organizational strategy (Correct answer)
Manage day-to-day project tasks and timelines

Correct answer: Provide executive oversight, resolve escalated decisions, and ensure the selection aligns with organizational strategy

A steering committee provides high-level governance, removes organizational barriers, and ensures the EHR selection supports broader strategic goals such as value-based care objectives.

NHA Certified Electronic Health Records Specialist (CEHRS)

The CEHRS certification exam validates competency in electronic health records systems, covering clinical and non-clinical EHR operations, revenue cycle management, regulatory compliance, and healthcare data reporting.

Questions

35 min

Time Limit

70%

To Pass

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