Are You Certifiable? (2009 Yerger Award Winning Innovation)

Here?s the one simple step: You can't become certified if you don?t take the test. This isn?t a Zen statement but a truism. It's sort of like not being able to win the lottery if you didn't spend a buck to buy the lottery ticket. Linking the analogy back to HFMA, the hardest part is biting the bullet and taking the test. But don?t wait to do it. In reality, committing to as much as a 2-year-long effort to plow through the Core or any single Specialty Exam Self-Study Guide before committing to take the exam is the worst strategy you can adopt, regardless of well-meaning the advice you may have heard to date. The reason why is because by the time you're ready to take the test, the Guide and the test themselves will have already been re-written. So, no matter how well you crafted a 1- or 2-year study regimen, it?s pointless if you waited too long to actually take the test. In fact, most people who commit to longer-range study efforts don't even get that far. Few committing to a 1- or 2-year self-study program actually finish it, let alone actually take the test in time before the newly-revised Core or Specialty exam is released and put in use.

So the real fear in becoming more than Certifiable isn't of failing a particular test, it's of losing the benefit of all of that studying if you?ve procrastinated even one week too long.

I've taken a lot of heat from HFMA National for sharing these truisms over the last two years about this strategy of just taking the test. "You really should study before taking the test," I was told by more than a couple staff and Board Of Examiners members. In fact, this is also "the party line" that I was instructed to tell others when I was on BOE.

So let's be honest: National HFMA never knows who studies for the tests but never end up taking them. Rather, all National or BOE knows are the passing rates of those who do take them. But these statistics apply to only the small minority of us who can get past the fear of failing to simply take the test. More specifically, it applies only to those who timed their taking of the tests to do so before the middle of December during an even-numbered year (e.g., 12/15/08), as the deadline to take the tests for which you?ve studied is December 31 of that same year. The Core and Specialty Exam questions are re-written based on revised Self-Study Guides starting January 1 of odd-numbered years (e.g. 1/1/09)..

But the barrier to actually becoming certified is the fear of failure, not the act of plunking down the application fee or scheduling a proctor. So one would naturally think that one of the great secrets of BOE members is knowing who failed the exam and how many times. Again, I'm here to tell you the truth: This is utter nonsense. Even BOE chairs of the respective exams don?t routinely know the actual names of people who fail, but more routinely know only the nationwide numbers who passed the tests they attempted. But no matter what the official passage rate of a test is, it?s probably overstated by at least 100% when considering those who studied for it, and/or intended to take it, but never got around to doing so in time.

But even failing a certification exam shouldn?t be viewed as a deterrent to the attempt but as a valuable learning aid in becoming certified. We learn best from our own mistakes. Why does this not apply to becoming certified? My friend advised me that the best preparation is to actually take the test and fail. Because, even if you fail ? and I, David Samuels, actually did fail my first certification exam, back when I first got the itch (in 1993) ? you realize what areas you need to study in order to pass the exam on the next attempt. So if the exams change every two years, the best coaching I can give is to take the test as soon as it's first updated. (That would be from 1/1 to ANI in odd-numbered years, like 2009.) This way, when you develop the strategy of retaking a failed exam before the end of an even year (like 12/31/2010), you'll be dealing with a similar examination that you had already taken, and learned from, in order to retake the exam and pass it. As of this writing, the new 2011-2012 certification exams will be going into effect on 1/10/2011 for candidates who had failed to register prior to December 31, 2010 to first take their tests.

One more thing about studying vs. taking Certification tests: the overriding goal is to become Certified, not just to pass the Core Exam. In order to become certified, you need to pass BOTH the Core Exam and at least one single Specialty Exam. In other words, to become certified, you need to pass at least TWO tests. Here?s a novel thought: take both tests on a single registration. That way, if you pass both and complete the red tape (application, bachelors degree transcripts, a letter of reference, a notarized affidavit) you become certified. If you spend a year studying for Core and then another 6-9 months to take a Specialty exam, you risk falling into a new testing cycle should you fail and need to retake either examination (after the required 90-day waiting period). And if you?re ready to take Core but you haven?t studied-for, let alone even chosen, a Specialty Exam, choose Accounting & Finance. If you have a decent background in general healthcare finance, this test is definitely your best bet. Over the last 8 years, A&F has remained some 70% duplicative of Core subject matter; during the 2009-10 cycle, that ratio jumped to 100%. If you're a CPA already, Core and A&F together are less than 50% as rigorous as passing your CPA exam. Being able to add CHFP next to your title, with or without a CPA, gives you significant and documented additional marketability in today's employment and consulting markets.

A word of caution for those of you who are managed care gurus: It remains particularly unwise to take the Managed Care Specialty if you have never reviewed its Self-Study Guide, even cursorily. But, and I'm speaking as someone who wrote two of the managed care exams, here's a trick if you're taking the Managed Care exam (which also works for PFS): If a question seems vague in terms of applying to practitioners, payers, or provider organizations, ALWAYS CHOOSE THE ANSWER THAT BEST APPLIES TO HOSPITALS. HFMA's certification exams are intended to be reflective of its members (see RPB and Rasch benchmarking below), and since general acute care hospitals and hospital systems remain HFMA's single-greatest employer segment, its Core and non-PPM specialties will continue to reflect this bias in its exam questions. 

Pearls of Wisdom in Taking Certification Tests

First of all, don't rely on "sample tests" included in HFMA's certification website. The BOE does not write the questions for the particular "sample tests." The reason why the questions are shared as being part of a "sample test" is because they were previously invalidated by the respective specialty or Core section of BOE, or were vetted by them for exam writers who chose to remove test questions due to obsolescence or factual inaccuracies. BOE will rarely remove questions as being factually inaccurate (To do so would be to admit the invalidity of an entire examination!). but rather those questions that are statistically non-comparable to test takers.

The practice of using test questions to make inferences about candidates taking tests reflects the field of psychometrics. There are three types of psychometrics that HFMA uses in its examinations: Angoff, RPB and Rasch. The Angoff method is used to set the "cut-point" of each exam: in other words, what overall score determines if a candidate has passed a given exam. Using Angoff, each member of BOE rates the importance of each question to their overall importance in determining whether candidates pass or fail. To get at least 4 sets of cut point ratings, Angoff scoring is done in approximately May, every two years. Angoff assures inter-rater reliability in setting cut points.

Here?s how RPB Scoring helps you:

If you?re reasonably knowledgeable about the subject matter of the test you?re taking, it?s comforting to know that the questions are tailored to your level of knowledge. If you can look at a question and readily identify two distractors ? that is, answer choices that are clearly incorrect ? then you should feel comfortable in knowing that the exam was written to your level of knowledge and preparation. In all likelihood, such test-takers will pass their respective exams. That's the same reason why an A&F certification exam may be flawed if CPAs in good standing can't pass such a test using their best efforts to do so.

Rasch Questions ? Another BOE effort is to protect "Rasch Questions," which are questions psychometrically deemed to be intrinsic to a particular field of study. These are no-nonsense questions that seem rather generalized to the particular content area, and HFMA goes to great lengths to keep as many Rasch questions on subsequent exams, despite changes to the Self-Study Guide and later to the test itself. When I re-wrote the Managed Care exam in 2000, I was the first to eliminate 5 Rasch questions on the basis of become obsolete, whether in the question?s stem or even in any single one of its distractors.

Here?s how Rasch Questions help you:

You can easily spot Rasch questions on the exam you take. Out of some 65 scored questions on a specialty exam, at least 5 of them will be Rasch questions. Rasch questions have extremely strong RPB scores. Also, a Rasch question becomes invalid if either its stem (the part of the question before the possible answer choices) or any one of its possible answers (the single correct answer or one of the 3 incorrect "distractors") is later changed in any manner. So a Rasch question may have archaic ? but not obsolete ? terms in both its stem and possible answers. If the question references any archaic terms like "prepaid group practices," you have most likely stumbled upon a Rasch question. On these questions, always go with your first instinct and DO NOT over-think the question stem, particularly in situations where recent developments have occurred or an agency name had somewhat recently changed (e.g., from HCFA to CMS). In fact, a question that references HCFA and not CMS has to be a Rasch Question, otherwise the Board of Examiners for that specialty (or Core) would surely have edited it by now. So if you make the transition from one who failed to one who passed, the questions themselves will become more intuitive, and especially so for the smattering of Rasch questions.