Are You Certifiable Too? — THE ACCOUNTANTS’ EIGHT

• Accounting & Finance Specialty Examination = 100%
• Core Examination = 59%
• Managed Care Specialty Examination = 85%
• Patient Financial Services Specialty Examination = 53%
• Physician Practice Management Specialty Examination = 53%

The Accounting & Finance Specialty Examination points-out a specific, and fundamental, flaw in HFMA’s general approach to professional development and its specific approach to certification. From a general standpoint, HFMA has attempted to promote the combination of Core and at least one specialty exam to distinguish itself from its roots as the American Association of Hospital Accountants (Ironically, I believe that’s an actual question on the Core exam!), as well as to differentiate from single-track certification approaches taken by ACMPE, ACHE, HIMSS, AHIMA, MGMA, to name but a few. As the above overlap of such other exam syllabi with the current A&F Exam clearly shows, such efforts have very far to go!

The Truth about CORE- & Cross-Specialty Overlaps

From the time I sat on BOE in the Managed Care Specialty Group (1999-2002), I was asked to completely rewrite the managed care examination. At that time, I asked the 1999-2000 BOE Executive Committee (Core and Specialty Group members in their last respective years on BOE, with the only overlap being the Chair-Elect) a fundamental question: What percentage of my managed care exam’s content should be duplicative of the CORE Exam? The answer I was told was “zero” (0%), based mostly on the premise that CORE covers core knowledge and specialty exams represented a specific level of specialized content above and beyond that of a core level. I also asked the same panel: What % of my managed care exam questions should involve word problems and other synthetic content, rather than simply pulling answers directly from the Guide? I was told that 25% of questions should be synthetic. The obvious inference at that time was that all of the other examinations (including Core) were being held to the same 25% standard.

No certification candidate passed my re-written / restructured Managed Care Specialty Examination when it was first offered in the Spring of 2001, and the 2001-2002 BOE Executive Committee (of which I was then a member) was shocked to hear that 25% of its content was synthetic (All other exams were then – and I believe actually remain – less than about 5% synthetic) and that none of its content duplicated Core. Incidentally, as my BOE colleagues were sitting there, the next-lowest Core overlap was ~25% and highest overlap was 72% (Yes, the A&F Exam).

The response by BOE’s 2001-2002 Executive Committee was to urge me to eliminate synthetic content questions with low RPB scores (notwithstanding validity issues with low numbers of candidates taking the exam, once word-of-mouth spread) and to “dumb-down” both questions and their distractors. (Originally, stem questions involving calculations had distractors from incorrect problem-solving procedures, like multiplying instead of dividing.) I was asked to give away certain distractors to make it easier for candidates to pass them. Most of all, I was asked to make the MC Exam more duplicative of Core. You can therefore appreciate my shock to learn that nearly a decade later, the Managed Care Exam overlaps Core Exam by 75% and overlaps A&F by a whopping 85%.

One can clearly see that a certification candidate who prepares only for the 75 questions found on the A&F Specialty Exam (which the BOE reports on page 0-3 as “typically” requiring only 10-20 hours of study time) has better than a 50% chance of passing EVERY OTHER EXAM, INCLUDING CORE! Regardless of how much HFMA is trying to branch-out from its hospital accounting roots, the message appears to be lost on BoE, which still believes that any certification candidate must receive a passing score on at least 50% of the respective content that overlaps with the A&F Exam.

How Planning for Cut-Points Helps Focus Your Preparation

Unlike other types of exams you may have encountered in the past, such as scales and curves, BoE assesses successful completion of HFMA certification exams based on “Z-Scores,” which are used to compare one candidate’s score against the average of all candidates’ scores on the same exam. In this methodology, each exam has a “cut-point” (which is a psychometric measurement of how high a Z-Score’s attainment must be to be considered to have passed the exam). While the exact cut-point for each exam is a closely-guarded secret that varies once every 3 years (ensuring that each non-Chair BoE member participates in setting cut-points, but no more than once during their 3-year appointment). So I’ll say this diplomatically: The approximate average cut-point on each certification exam is about 70. Using z-scores, BoE can set z-scores against the same 100-point scale, even though the Core is 150 questions and each specialty exam is 75 questions.

When you prepare for certification exams, aim for being comfortable with at least 70% of an exam’s content areas. Here are some specific tips, regardless of exam to be taken:

0. DO NOT rely upon any of the “Self-Assessment Exercises” at the back of each chapter or on the “End-Of-Course Test” questions at the back of the A&F Guide or any other of HFMA’s Certification Study Guides. The questions are all decoys. Remember, these questions would not have been published if they were in any way valid representations of questions on any HFMA examination. Trust me on this! Many of the questions rely upon formats BOE has eliminated (such as where correct answers represent a combination or exclusion of response choices) or test for content that has already been ruled obsolete (even though a different part of the stem may actually pertain to Study Guide content). When I wrote test questions for HFMA, a question was ruled invalid if its content is not covered in the respective study guide (sourced to an actual page, paragraph & sentence). If the question is no longer being used, then there’s a good chance the question refers to obsolete Study Guide content.
   
   
0. Take the 8-Question Examination presented that reflects 100% of the A&F Content Areas (but are not at all known to be representative of actual questions found on A&F). While I contributed and revised A&F questions only prior to, and during, my first year on BOE, any such question is now more than 10 years old and has probably been replaced, tweaked, or revised since then. Again (and this is directly to BOE), I am not relying upon any previous questions I may have written, and all 8 questions were created and programmed for an Internet-based CBT in September of 2009.
   
   
0. Each of the eight questions is asked one at a time. Like its predecessor “Power Of Five” CBT, please attempt the same question no more than twice.
   
   
0. If you can’t get the question right from your two best answers, you obviously don’t know that concept, and by all means THEN you should crack the books.
   
   
   0. The A&F and other exams’ self study guide chapter references are provided for your convenience after each wrong answer.
   0. This is also a general test-taking strategy: don’t attempt to answer any question that you can’t narrow down to your two best guesses; rather, go to the next question in the same test unit and return later.
      
      
0. Don’t overlook opportunities to receive clues about questions of which you’re unsure from other exam stems or from their possible distractors within the same unit.
   
   
   0. While I’ve taken great pains in only 8 questions to avoid such an opportunity, HFMA exams create this potential by randomly-ordering their questions’ stems.
   0. Therefore, don’t assume that the first question in a section refers to a topic found earlier in the Self-Study Guide.
   0. Quick-scan all of each unit’s questions, answering easiest stems first.
      
      
0. If you ace the exam, or get through all 8 questions with no more than 3 wrong attempts (each incorrect response represents an “attempt”), you should feel comfortable that you could pass the A&F Exam’s cut-point. You will be presented with a link to select a proctor so that you can schedule your exam date. Because of the duplicative content of the A&F Exam to Core and all other specialty exams, please make the choice to schedule both Core and A&F during the same seating, and even consider a 3-fer, throwing-in the new (and 85% overlapping) Managed Care Exam, too.

How the A&F Study Guide Helps You Pass A&F Exam and CORE in One Sitting

First of all, “The Accountants’ Eight Questions” CBT covers 100% of the Accounting & Finance Specialty Examination. If you’re able to pass it with no more than 3 wrong attempts of no more than 2 stems, you can reasonably rest assured that you’d hit a cut-point of 70 on A&F.

Since CORE overlaps A&F by 59%, you can ensure you exceed a cut-point of 70 on this second examination simply by reviewing A&F content areas and supplementing only TWO (2) additional chapters of the Core Self-Study Guide:

• Physician Practice (Chapter 20, representing 6% of Core content) and
• PFS / Revenue Cycle (Chapter 11, also representing 6% of Core content).

Add these two additional sections, and you’ll hit 71% of Core, 90% of Managed Care, 85% of PFS, and 73% of PPM.

Add the relatively simple overview chapters – “Healthcare Industry Overview” (Chapter 1 @5%) and “HFMA Overview (Chapter 21 @2%) – of the Core Self-Study Guide, and you push your preparation toward a CORE cut-point of 78.

MBAs & CPAs Take Notice

As before-noted, these 8 questions also serve a second purpose: in helping all of you MBA graduates, CPAs, accountants, controllers and CFOs in the Nevada Chapter (and elsewhere within HFMA – shh!!) gain confidence that by reviewing (again no more than 2-4 hours at the end of each workday in a single week) A&F Exam content, you can pass both it and the Core Exams in one sitting, with minimal prior study, and cracking the Core Exam Self-Study Guide for only two extra chapters (adding no more than 1-2 hours to your exam preparation). Of course, such a study plan assumes you can’t pass all 8 questions & have to devote A&F’s full 10-20 hrs.

Without further ado, here are The Accountants’ Eight. Good luck!