NHA certification exams are moderately difficult, especially if you’re coming in without structured preparation. The passing threshold is a scaled score of 390 out of 500, and the questions are designed to test applied knowledge rather than simple memorization. Most candidates who complete a training program and use practice tests pass on their first attempt, but the exams are far from automatic.
How the Scoring Works
All NHA exams use a scaled scoring system that ranges from 200 to 500. You need a 390 or higher to pass. Because the scoring is scaled, a 390 doesn’t mean you got 78% of the questions right. Scaled scoring adjusts for the difficulty of the specific questions on your version of the test, so two people could answer a slightly different number of questions correctly and both land at 390. What this means practically: you need to have a solid grasp of the material across all content areas, not just a few.
What the CCMA Exam Looks Like
The Certified Clinical Medical Assistant exam, NHA’s most popular certification, has 150 scored multiple-choice questions plus 30 unscored “pretest” questions mixed in. You won’t know which 30 are unscored, so you need to treat all 180 questions seriously. You get 3 hours to finish, which works out to about one minute per question. That’s enough time for most people, but it doesn’t leave much room for getting stuck on lengthy scenarios.
The content leans heavily toward clinical skills. Expect questions on anatomy and physiology, infection control, phlebotomy, EKG procedures, medical terminology, patient care, and medical ethics. There’s also an administrative component covering office procedures and workflow. Compared to the AAMA’s CMA exam, which splits its focus more evenly between clinical and administrative topics, the NHA CCMA puts a stronger emphasis on hands-on clinical competencies. If you’re stronger on the administrative side and weaker on clinical procedures, you’ll find the CCMA more challenging.
What Makes the CBCS Exam Tricky
The Certified Billing and Coding Specialist exam is a different kind of hard. It’s 100 questions total, and 32 of those fall under coding and coding guidelines alone. You’ll need working knowledge of three separate code sets: CPT (procedure codes), ICD-10-CM (diagnosis codes), and HCPCS Level II (supplies and equipment codes). Each system has its own logic, structure, and rules, and the exam tests your ability to apply them to real scenarios rather than just recognize definitions.
Many candidates find the coding section the most difficult because it requires precision. Selecting the wrong modifier or misreading a code hierarchy can lead you to an answer that looks almost right but isn’t. The remaining questions cover claims processing, compliance, revenue cycle management, and payer types. If you don’t have hands-on experience with billing software or insurance workflows, plan for extra study time on the administrative portions too.
Why Some People Fail
The most common reason candidates struggle is relying on memorization without understanding the reasoning behind clinical or coding decisions. NHA questions are often scenario-based: you’ll read a brief patient situation and choose the best action, the correct code, or the most appropriate next step. Knowing that “standard precautions” exist isn’t enough. You need to identify which precautions apply to a specific situation described in the question.
Another stumbling block is underestimating the breadth of content. The CCMA exam, for example, covers everything from how to perform a 12-lead EKG to proper documentation of patient allergies to HIPAA compliance. Candidates who focus narrowly on one or two areas and skim the rest often come up short. The exam is built to verify that you’re ready for the full scope of the job, not just the parts you’re most comfortable with.
NHA vs. AAMA: Which Is Harder
If you’re choosing between the NHA CCMA and the AAMA CMA for medical assisting, the difficulty comparison depends on your strengths. The NHA CCMA is designed for entry-level positions and prioritizes clinical skills like phlebotomy, EKG administration, and direct patient care. The AAMA CMA covers a broader mix of clinical, administrative, and general healthcare knowledge, including more pharmacology and medical office management.
Neither exam is universally “easier.” The CCMA tends to feel more approachable for people coming out of clinical externships where they’ve drawn blood and taken vitals. The CMA can feel harder for those same people because it tests more administrative and pharmacological knowledge. Your training background matters more than any inherent difference in difficulty between the two.
How to Prepare Effectively
Most candidates who pass dedicate 4 to 8 weeks of focused study time, assuming they’ve already completed a training program. If you’re self-studying without a formal program behind you, expect to spend longer. NHA offers its own study guides and practice tests through its website, and these are worth using because they mirror the format and style of the real exam questions.
Practice tests are especially valuable for two reasons. First, they reveal your weak areas so you can adjust your study plan instead of reviewing topics you already know. Second, they get you used to the scenario-based question format, which trips up candidates who’ve only studied from flashcards or textbook summaries. Aim to score consistently above 80% on practice exams before scheduling your test date.
Focus your heaviest study sessions on the content areas with the most questions. For the CCMA, that means clinical procedures, patient care, and infection control. For the CBCS, coding and coding guidelines carry the most weight at 32 out of 100 questions. Prioritize accordingly, but don’t skip any section entirely.
Taking the Exam Remotely
NHA offers live remote proctoring, which lets you test from home instead of going to a testing center. This sounds convenient, but it comes with technical requirements that can add stress if you’re not prepared. You need a computer (not a tablet or phone) with at least 8GB of RAM, a multi-core processor running at 2.5 GHz or faster, and a 256GB SSD. NHA recommends a wired internet connection with download speeds of at least 10 Mbps, since Wi-Fi can be unreliable during proctored sessions. Satellite internet connections aren’t guaranteed to work at all.
If your home setup doesn’t meet these specs, or if you’re worried about interruptions, testing at a proctored center is the safer choice. Technical issues during a remote exam can disrupt your focus and eat into your time, which is the last thing you need on test day.
If You Don’t Pass the First Time
Failing an NHA exam isn’t the end of the road. You can retake it, though there may be a waiting period and an additional fee. When you receive your score report, it breaks down your performance by content domain, so you can see exactly where you fell short. Use that information to target your studying before attempting again. Many candidates who fail the first time pass comfortably on their second attempt simply because they now know what the test actually emphasizes.
The bottom line: the NHA exam is a legitimate professional certification, not a rubber stamp. It requires real preparation and a working understanding of the material. But it’s not designed to trick you or weed people out. If you put in focused study time, use practice tests to identify gaps, and go in familiar with the question format, you’re in a strong position to pass.