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Test takers offer their perspective on the credentialing exam

Association of Clinical Documentation Improvement Specialists, November 2, 2010

Shortly after the association’s inception, ACDIS members began to ask about the creation of a credential. Something special. Something that represented the unique skill sets they possessed, which no other existing credential (RN, RHIA, CCS, etc.) truly represented. Something just for the CDI profession.
Before the end of the first annual ACDIS conference in 2008, a 12-member committee formed to  establish the Certified Clinical Documentation Specialist (CCDS) credential.

The group joined with a national testing administration company, Applied Measurement Professionals (AMP), Inc., to develop a comprehensive test designed to capture the skill sets and knowledge base of this unique profession. On Saturday, May 16, 2009, 123 individuals took their seats in a Las Vegas conference room, prepared to take the first administration of the CCDS exam. Mark LeBlanc, RN, MBA, CCDS, CDMP specialist at Park Nicollet Health Services in Minneapolis, was among them.

“It was my first professional conference and it was the first administration of the exam. I figured it was as good a time as any to take the test,” LeBlanc says.

A certified credential
Those first test takers had no exam study guide except for the CCDS Certification Handbook (available as a free download on the ACDIS website), suggestions from the CCDS committee, and requirements posted on the website. (The CCDS Exam Study Guide, designed as a review of basic CDI core principles, was published in April.) Few outside the ACDIS membership knew of the credential at all, and fewer accepted it or looked for it when hiring new candidates.

“There was a lot of hesitancy among those I was speaking with [regarding whether to register to take the exam] because there wasn’t a lot of information out there about how the test is, who took it, or what it was like. So it was stressful. You sort of felt alone in being one of the few who had taken the exam,” says Jennifer Woodworth, RN, BSN, CCDS, manager of CDI at MultiCare Health System in Tacoma, WA.

Woodworth sat for the second paper administration of the exam following the Chicago conference this past June. At that time, less than 300 people had taken the exam and passed. As of September 1, nearly 600 people had taken the test. (See a complete list of recently credentialed professionals on p. 15.)

“As more people take the exam, newcomers can go to those who are more experienced and ask them about it,” she says. Talking with others about their firsthand experiences with preparing for and taking the exam provides a measure of comfort not easily found in the pages of test preparation materials, says Woodworth. (Read an account of the exam experience on p. 14.)

Furthermore, ACDIS is in the process of applying for approval from the National Commission for Certifying Agencies (NCCA). The NCCA requires that an association’s certification process be in place for at least one year or that at least 500 individuals pass the exam. The NCCA will conduct a comprehensive review of the CCDS exam process, which may take up to five months to complete, according to the NCCA website.As part of the process, the CCDS committee conducts regular reviews of the exam questions, ensuring that the content remains up to date and reflects the changing nature of the CDI profession.

Exam trouble spots
The exam consists of 120 multiple-choice questions designed to test candidates’ multidisciplinary knowledge of clinical, coding, and healthcare regulations, as well as the roles and responsibilities of a CDI specialist. Questions test candidates’ ability to recall and analyze information as well as apply particular rules to specific examples. The test covers seven basic proficiency levels:

1. Regulations, reimbursement, and documentation requirements related to the inpatient prospective payment system
2. Anatomy and physiology, pathophysiology, pharmacology, and medical terminology
3. Medical record documentation
4. CDI program analysis
5. Communication skills
6. ICD-9-CM Official Guidelines for Coding and Reporting
7. Professionalism, ethics, and compliance

At first, LeBlanc was a little surprised by the limited number of questions regarding clinical/coding translations compared to questions regarding coding guidelines and statistical analysis of CDI programs.

“Many CDI specialists do not get involved in that aspect of the program,” he says.

That’s where Janine Daniel, RN, BSN, CCDS, DRG resource reviewer at Community Memorial Healthcenter in South Hill, VA, had difficulty too. “I had trouble with situations that we do not perform in our facility,” she says. For example, Daniel doesn’t regularly provide physician education, and data analysis comes directly from 3M reports. Further, there were “ethical questions that I thought really could have gone either way, so that was difficult, too,” she says.

There were more regulatory questions on the exam than Woodworth anticipated, as well. Two days of intensive educational sessions in Chicago, however, gave her more insight into the compliance and regulatory aspects of CDI than she might have otherwise been aware of, she says. This awareness could either work for or against the examinee, Woodworth notes. An overabundance of information could be confusing; on the other hand, conference sessions can serve as a refresher prior to the exam.

“Either way, I’d say to go with what you know, not what you think the creators of the test may have wanted you to answer, and not what you think the politically correct answer might be,” Woodworth says. “I tried to remember that this isn’t a trick test and went with my gut instinct on those questions I wasn’t 100% sure about.”

The test has since been revised, and slightly more emphasis has been placed on clinical scenarios and appropriate diagnoses for which a CDI specialist may query. But test takers are still expected to know how to benchmark the performance of a CDI program and the basics of data mining and reporting, says ACDIS Director Brian Murphy.

A mark of distinction
Daniel has worked as a CDI specialist at a 90-bed facility in the care management department for five years, having started at her facility in October 2005. She previously worked in dialysis and was “ready for something different,” she says.

So when she saw an advertisement for the CDI staff spot, she took a chance, got the job, and fell in love with her new career. Each patient encounter is like a puzzle, Daniel says.

“As a CDI specialist, you get to help to put the pieces together in terms of their clinical record and the resolution of their healthcare difficulties—and that’s really rewarding.”

LeBlanc and Woodworth have also been in CDI roles for more than five years. A measure of professional experience is one of the prerequisites of the CCDS test.

“I know [some level of experience as a CDI specialist] is a requirement” for taking the test, says LeBlanc, “but you really do need to have been doing the work for at least two or three years to be a CCDS.”

There are four “routes” or potential qualifications needed before a prospective examinee may sit for the test. Under the first route, test takers must show that they have at least two years’ full-time experience as a documentation specialist, as well as formal training in human anatomy and/ or physiology, medical terminology, and disease processes. The second route requires a minimum of one year’s fulltime experience as a documentation specialist and successful completion of at least an associate’s degree in an approved college-level curriculum in a recognized allied health field. The third route requires a minimum of one year’s full-time experience, successful completion of an associate’s degree, and
a license or certification in a recognized allied health field. The fourth route is a minimum of one year’s full-time experience, successful completion of a baccalaureate degree or higher college-level curriculum, and formal training (accredited, college-level course work) in human anatomy and/or physiology, medical terminology, and disease processes.

“Achieving this credential recognizes that a clinical documentation specialist possesses prerequisite educational requirements as well as proven, hands-on experience performing the function of a clinical documentation specialist,” according to the program requirements page of the certification website
(www.cdiassociation.com/certification).

“The credential is a mark of distinction,” says Woodworth. RNs, she explains, take their exam upon completion of their school coursework and either pass or fail the exam. Conversely, “the CCDS credential gauges your experiential understanding of the CDI specialist’s job as well as your institutional understanding of the role,” she says.

Location, location, location
Whether it’s a high school geography exam or the CCDS, any test-taking experience can be stressful. Some people are simply better at test-taking than others. Some do well in the relative silence of a classroom setting with a paper-andpencil exam, whereas others prefer the solitary experience of remote testing. The CCDS provides both.

ACDIS staff administer a paper-and-pencil version of the test on the Saturday following its annual conference. In addition, there are more than 170 remote testing centers located all over the country. Each option offers benefits and drawbacks.

“The paper test was the worst. Why did I do that? All the drama?” jokes Woodworth, referring to the stress of taking the exam after the intense Chicago program. “But was it worth it? For me, sure; I have my CCDS now.”

Another drawback of the paper exam is the lag time in receiving test results. Generally, paper tallies take four to six weeks due to the additional analysis and revision of the questions. These changes to the exam are rolled out first in the paper administration of the test. AMP then provides an analysis of the exam’s efficacy and advises the board on further adjustments.

“The wait time for results is probably the most difficult thing about the paper test,” says Woodworth. Those who take the exam electronically can schedule the test at their convenience and receive the results immediately.

Daniel opted to take the exam at an H&R Block testing site in Richmond, VA. The site was a room in an outlet mall with three computers in it. “The best part about taking the test remotely was that I knew right away whether I’d passed or not,” Daniel says.

If they had it to do over again, LeBlanc and Woodworth both say they’d take the electronic version of the test.

“I prefer the computer,” LeBlanc says. “But when I took it, it was the first administration of the exam, so it was really something to be a part of that whole experience.”

The whole experience
Once a CDI specialist meets the basic requirements to sit for the exam and sets his or her testing date, the time for preparation comes. Review all the materials on the website, advises LeBlanc, whose only review option came from the initial material packages.

Because there was no formal book available, Leah Taylor, RN, CCDS, clinical documentation specialist at Iredell Memorial Hospital in Statesville, NC, created her own study packet based on the ACDIS website. Taylor, who serves as president of the North Carolina ACDIS chapter, later formed a study group to help those in her chapter prepare for the test.

“It is a hard exam, but fair, I think,” Taylor says.

“On the whole, it was very professionally done,” says LeBlanc.

The CCDS credential adds another level to being a career oriented CDI specialist, Woodworth says.

This new level includes follow-through on data analysis, educational work with coders and physicians, and maintaining an understanding of the latest information regarding regulatory news and coding legislation, says Woodworth. “The CCDS credential and exam makes sure people know these things,” she says. “It is a test to make truly sure that you take what you do seriously and that you’re going to continue to take your profession seriously.”

“The credential gives you that backing that ‘yes, I do have the knowledge and the experience to do this profession.’ I have my CCDS now, and it feels good,” says Daniel.

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