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CIFPOIssues the CFPO credential
Certification

Preparing for the examination

Prepare against the standard, not against a provider. Every accepted route, the reference list, and ten sample items with rationales.

Four accepted routes

CIFPO neither requires nor recommends a specific course. Any of the routes below can satisfy a candidate; only Pathway B requires a completion record.

Self-study from the reference list

The examination is written from public sources. A practitioner with the experience pathway can prepare from the reference list alone, using the task statements as the syllabus.

Employer or contractor training

In-house training on federal payer programs counts toward preparation and, if it meets the 40-hour and six-domain test, toward Pathway B. Ask the employer for a completion record that names hours and domains.

Any preparation provider

Programs from associations, colleges and commercial providers qualify for Pathway B when they cover all six domains in at least 40 instructional hours. CIFPO evaluates the syllabus against the outline, not the provider against anyone.

DutyPath Academy

DutyPath LLC operates a Federal Payer Operations program that is one qualifying Pathway B route. Disclosure: DutyPath LLC and CIFPO share a founder. Completing this program earns no advantage in review or on the examination, and its tuition does not include the $295 examination fee, which every candidate pays to CIFPO directly.

How to use the content outline

Weight your time by domain weight, and work each task statement against the sources in the reference list. Forty hours, allocated by weight, looks like this:

DomainWeightOf 40 hours
D1 — VA Community Care referral and authorization25%10 hours
D2 — TRICARE East and West20%8 hours
D3 — CHAMPVA and other-health-insurance primacy15%6 hours
D4 — Divergence from Medicare and commercial15%6 hours
D5 — Documentation and record standards15%6 hours
D6 — Denials, appeals and remediation10%4 hours

Most unsuccessful candidates lose items in Domains 4 and 6 — not from ignorance of the federal rules, but from answering a federal question with a commercial habit. Study those two domains as a list of things you would do at a commercial practice that you must not do here.

Sample items

The ten items below are representative of the examination's form and difficulty. They are retired or illustrative items and do not appear on a live form. Each shows the correct answer and the reasoning an item writer would give for it.

Sample item 1 — D1

A VA referral for physical therapy lists a Standardized Episode of Care with 12 visits over 180 days. At visit 10 the therapist documents that eight more visits are medically necessary. What should the practice do?

  1. Continue treatment and bill the third-party administrator; medical necessity is documented.
  2. Submit a Request for Service to VA for the additional visits before they are rendered.
  3. Bill the Veteran's private insurance for the visits beyond the SEOC.
  4. Ask the Veteran to sign a financial-responsibility waiver for visits 13 through 20.
Answer and rationale

B. Care outside the SEOC requires VA's approval, requested on the Request for Service, before it is rendered. Medical-necessity documentation supports the request; it does not replace it. The Veteran is never billed for authorized community care, and a waiver would neither be enforceable nor permitted.

Sample item 2 — D1

A Veteran's care was authorized under a Veterans Care Agreement rather than the Community Care Network. Where is the claim submitted?

  1. To the regional third-party administrator named for the Veteran's state.
  2. To VA under the community care claims process for non-CCN care.
  3. To the Veteran's Medicare Administrative Contractor, with VA as secondary.
  4. To the VA medical center's business office by mail only.
Answer and rationale

B. Claims for care under a Veterans Care Agreement are submitted to VA, not to a Community Care Network third-party administrator. Routing the claim by the authorizing instrument — CCN, VCA or local contract — is the first decision in every VA community care claim.

Sample item 3 — D2

A TRICARE Prime family member self-refers to a network dermatologist for a non-emergency condition without a primary care manager referral. What follows?

  1. The claim is denied and the beneficiary owes nothing.
  2. Point-of-service charges apply: a deductible and a 50 percent cost-share of the allowable amount.
  3. The claim is paid at the Prime rate because the provider is in network.
  4. The provider must refund any payment because Prime prohibits self-referral.
Answer and rationale

B. Prime beneficiaries who obtain non-emergency care without the required referral use the point-of-service option. The care is covered, but the beneficiary pays a point-of-service deductible and a 50 percent cost-share, and the amounts do not count toward the Prime catastrophic cap in the ordinary way. Active duty service members do not have a point-of-service option.

Sample item 4 — D2

An active duty service member presents to a civilian specialty practice for non-emergency care. Which statement is correct?

  1. Active duty members may self-refer to network specialists under the point-of-service option.
  2. Civilian care for active duty members generally requires a referral and authorization; emergency care is the exception.
  3. Civilian care for active duty members is paid directly by the member's unit.
  4. Claims for active duty members are submitted to CHAMPVA.
Answer and rationale

B. Active duty service members are enrolled in Prime and must obtain civilian care through a referral and, where required, an authorization; the point-of-service option is not available to them. Emergency care is the standing exception, subject to the notification rules.

Sample item 5 — D3

A CHAMPVA beneficiary also has an employer group health plan. What is the order of payment?

  1. CHAMPVA pays first; the employer plan pays second.
  2. The employer plan pays first; CHAMPVA pays second.
  3. Only CHAMPVA may be billed; the employer plan is excluded.
  4. The beneficiary chooses which plan is billed first.
Answer and rationale

B. CHAMPVA is secondary to other health insurance, with limited exceptions such as Medicaid, State Victims of Crime Compensation programs, Indian Health Service and supplemental CHAMPVA policies. The claim to CHAMPVA must include the other plan's explanation of benefits.

Sample item 6 — D3

A CHAMPVA beneficiary turns 65 and becomes eligible for Medicare Part A. To keep CHAMPVA coverage, what must she do?

  1. Nothing; CHAMPVA continues as her primary coverage.
  2. Enroll in Medicare Part B; CHAMPVA then pays after Medicare.
  3. Drop CHAMPVA and enroll in TRICARE For Life.
  4. Enroll in a Medicare Part D plan only.
Answer and rationale

B. A beneficiary eligible for Medicare Part A must be enrolled in Part B to remain CHAMPVA-eligible, and CHAMPVA pays secondary to Medicare. TRICARE For Life is not available to a CHAMPVA beneficiary; the two programs are mutually exclusive.

Sample item 7 — D4

A Veteran seen under an authorized VA community care referral asks at checkout what his copayment is. What is the correct response?

  1. Collect the copayment shown on his private insurance card.
  2. Collect the VA copayment that matches his priority group.
  3. Collect nothing; VA bills any applicable copayment to the Veteran directly.
  4. Collect a deposit, refundable after VA pays the claim.
Answer and rationale

C. For authorized community care the provider is paid by VA or its third-party administrator and accepts that payment in full. Any VA copayment is determined and billed by VA to the Veteran. The provider collects nothing from the Veteran and does not bill the Veteran's other insurance for the authorized care.

Sample item 8 — D5

A claim for authorized VA community care was rejected because the rendering provider's NPI did not match. Which record settles which provider was authorized?

  1. The practice's internal credentialing file.
  2. The referral and authorization as issued in the third-party administrator's portal.
  3. The Veteran's account of who treated him.
  4. The provider's Medicare enrollment record.
Answer and rationale

B. The authorization identifies the provider or group approved to render the care. When the practice's record and the payer's record disagree, the authorization as issued is the record the payer treats as authoritative; the fix is to align the claim with the authorization or to obtain a corrected authorization before resubmitting.

Sample item 9 — D6

A TRICARE claim is denied with the reason "no referral on file," but a valid referral number exists in the contractor portal for the date of service. What is the best next action?

  1. File an appeal with the Defense Health Agency.
  2. Bill the beneficiary for the service.
  3. Submit a corrected claim that includes the referral number, within the timely-filing period.
  4. Ask the primary care manager to issue a new referral.
Answer and rationale

C. This is a claim-data omission, not an adverse determination on the merits. A corrected claim resolves it; an appeal is the wrong instrument and a new referral is unnecessary. The corrected claim must still be filed within the timely-filing limit.

Sample item 10 — D6

A practice billed TRICARE for a patient whose care was authorized under VA community care. The denial reads "patient not eligible." What happened, and what next?

  1. The patient's TRICARE eligibility lapsed; contact the regional contractor.
  2. The claim went to the wrong payer; submit it to the VA third-party administrator on the VA authorization, watching VA's timely-filing clock.
  3. Appeal the TRICARE denial with the VA authorization attached.
  4. Bill the Veteran, since neither program has paid.
Answer and rationale

B. A denial from a program that never authorized the care is a routing error, not a coverage decision. The remedy is to submit the claim to the payer named in the authorization before VA's timely-filing limit runs. Appealing the wrong payer's denial wastes the deadline, and the Veteran is never billed.

The week before

  • Confirm the authorization-to-test dates and the appointment time; the window does not extend for a missed sitting.
  • Test the webcam, microphone and connection in the room you will use, at the time of day you will sit.
  • Have the photo identification that matches the application name at the desk.
  • Read the examination rules once more. The sitting ends for a phone on the desk, not for a wrong answer.

Ready to be measured against the standard?

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