insightsArticles

In today's rapidly evolving business landscape, boards of directors are more than just stewards of governance—they are the strategic compass guiding an organization toward enduring success. As the challenges facing companies grow increasingly complex, from disruptive technological trends to shifting societal expectations, the board's role has never been more critical.  

This series is designed to empower board members with the insights and tools necessary to navigate change with confidence. Our experts, each a leader in their respective fields, will share real-world examples, practical frameworks, and actionable advice in a Q&A format, and lessons learned from their personal and professional journeys.   

Human Resources: Onboarding new hires and bridging generations   

For the latest installment of our board leadership series, BerryDunn’s HR Generalist, Maddie Stevens, shares insights on onboarding, engaging, and fostering connections for new employees, as well as leveraging generational gaps in the workforce.   

Q: What trends or challenges do you see impacting the future of your field, and how are you preparing to address them?   

A: Managing information overload and ensuring that employees feel engaged are common challenges when working with new hires. To prevent information overload, we are constantly auditing our new hire process, reviewing the who, what, where, and why for every communication. It is important to be mindful of what needs to be communicated on day one versus what can wait until week two, week three, etc. This is why we strongly rely on an 8- to 12-week onboarding plan.   

Q: How do you help new hires build relationships with their team members and other departments, as well as understand and integrate into company culture during the onboarding phase?   

A: We start by creating opportunities for connections. During orientation, new hires have the opportunity to connect online with several different employees on the operations side of the firm, including HR, IT, Payroll, Accounting, and Well-being. We facilitate virtual social connections and networking events for employees to attend, which include workout classes, employee resource groups, book socials, a monthly new hire social, and a coffee break where we talk about what we are reading, watching, and listening to. These are available to all staff—regardless of whether they are in-house or remote.  

 Another method we use to help facilitate connections is by publishing a monthly new hire announcement, which incorporates photos, LinkedIn profiles, and biographical information to introduce each new hire. To integrate new employees into the BerryDunn culture, we pair each with an onboarding partner. The partner’s role is to make the new hire feel welcome, track their progress, and serve as an advocate and resource during the first eight weeks of employment.  

Q: What metrics do you use to measure the success of an onboarding program, and how do you collect feedback from new hires?   

A: Our team measures the success of our onboarding program with metrics from online surveys at the end of an employee’s first week. We also conduct 90-day, six-month, and one-year surveys. The surveys include questions related to engagement such as:   

• I have met senior leaders in my practice/department.  

• I feel connected to my team.  

• I am satisfied with my relationship with my supervisor/reviewer.   

We also ask questions to help ensure employees feel informed, including:   

• Is there anything from your onboarding experience we should change/add to help new hires get acclimated?  

• I feel confident about describing the services my group provides.  

• What additional information or training would be helpful during your first six months?  

We track response rates and share monthly results with the BerryDunn leadership team and those involved with the onboarding program. Having a team that is committed to the success of an onboarding program is essential.  

Q: What role does efficiency and automation play in your onboarding process, and where do you believe it is most effective or inefficient?   

A: Employees have the same efficient online onboarding process regardless of whether they start at an office or remotely. This includes our benefits enrollment, informational sessions, and compliance training. We're always looking for ways to be more efficient with tasks, as many of those related to onboarding are manual (i.e., sending the same email communication, creating calendar invites, preparing agendas). We currently use automation for launching surveys based on an employee’s start date and for sending an occasional mail merge when it comes to bigger orientation classes like intern orientation.  

Q: How can organizations ensure that employees from different generations are equally comfortable with digital tools and platforms?   

A: It's important to make sure there are digital resources available for any learning style. The first resource we provide for new employees is an IT session at the end of their first day. This provides the opportunity to have an expert available to help with any day-one struggles, as well as an overview of different software. We also have articles and videos in our online resource center and our technology training center that provide self-service materials for different platforms.    

Q: How do you suggest companies customize their employee engagement strategies to meet the diverse needs of different generations and what advice would you give employers struggling to bridge generational gaps within their teams?   

A: Companies can tailor their employee engagement strategies to meet the diverse needs of different generations by offering different opportunities to support various interests and to meet others. One recommendation for those who are struggling to bridge generational gaps within their teams is to focus on communication and collaboration. Encouraging both can help provide a sense of belonging and understanding. Another recommendation is to reach out to your HR team for ideas to help bridge generational gaps.   

About Maddie  

Maddie Stevens is an HR Generalist at BerryDunn, based in Maine. She is certified as both a SHRM-Certified Professional (SHRM-CP) and a Professional in Human Resources (PHR). Maddie’s interest in HR developed through an internship her senior year of college, ultimately inspiring her to pursue her MBA with a focus on HR. Studying for her SHRM-CP exam while in graduate school solidified her interest in the field and helped her gain confidence. Maddie believes professional growth comes from a willingness to explore new opportunities, seek out informal informational interviews, and job shadowing. She is motivated by fulfilling work, which is often when she can improve a process. Maddie appreciates receiving feedback and collaborating with others to figure out how to improve a process. She holds a bachelor's degree in marketing and tourism & hospitality from the University of Southern Maine and an MBA in Human Resource Management from Thomas College. 

BerryDunn partners with organizations to create work environments where business success and personal growth coexist and where people are confident knowing their workplace positively contributes to their well-being. We take a comprehensive approach to our workforce and well-being work, considering how business needs, organizational capacity, and the employee experience work together to drive your business forward. Learn more about our workforce and well-being team and services.   

Anyone involved in international operations, finance, or compliance should pay attention to duty drawback—here’s why.  

This article is the last in a series to help businesses navigate trade strategies amidst tariff changes.

Tariffs remain a significant cost factor for US importers and exporters. Understanding and leveraging trade programs is more critical than ever. One underutilized but highly valuable strategic tool is duty drawback.  

With global supply chains in flux and tariffs remaining a significant cost factor for US importers and exporters, understanding and leveraging trade programs is more critical than ever. One such underutilized but highly valuable program is duty drawback—a strategic tool that can return up to 99% of duties paid on imported goods that are later exported. 

What is duty drawback? 

Duty drawback is a US Customs and Border Protection (CBP) program that allows companies to claim refunds on duties, taxes, and fees paid on imported merchandise that is subsequently exported, destroyed, or used in the manufacture of exported products. This includes: 

• Unused merchandise drawback: Re-exported goods 
• Manufacturing drawback: Goods incorporated into exported items 
• Rejected merchandise drawback: Goods returned to the seller or destroyed 

Why it matters now more than ever 

As tariffs remain a volatile component of trade policy, businesses paying duties on goods that eventually leave the US are leaving money on the table if they’re not filing for drawback. With the passage of the Trade Facilitation and Trade Enforcement Act (TFTEA), CBP has modernized the drawback process, expanded eligibility, and simplified recordkeeping—making it more accessible for businesses of all sizes. 

Key considerations 

To take advantage of duty drawback, companies must: 

• Maintain detailed records of import and export transactions 
• Meet strict timelines (generally within five years of import) 
• File through the CBP’s Automated Commercial Environment (ACE) 
• Ensure that exported products can be traced to the original imports 

While the potential refunds are substantial, the compliance and documentation requirements can be complex. 

How our firm can help 

At BerryDunn, we help clients uncover and realize significant cost savings through strategic deliveries such as duty drawback programs.  

Don’t overpay on tariffs 

In an environment of evolving trade regulations and escalating duty costs, duty drawback offers a rare opportunity to recover sunk costs and strengthen your competitive edge. 

Let’s talk strategy 

Contact us to explore how a proactive drawback strategy can benefit your business. We’ll help you connect with the experts to turn complexity into clarity—and duty into dollars. 

Read the other articles in our series about tariffs.  

Read this if you’re a CFO, billing manager, or revenue cycle professional at an FQHC or RHC. 

On July 1, 2025, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) transitioned from cost report-based to claim-based Medicare reimbursement for influenza, pneumococcal, COVID-19, and Hepatitis B vaccines. This important policy change enables real-time payment, improving cash flow and making vaccine administration more financially viable for health centers and clinics.

Importantly, while the billing method is changing, reimbursement for these vaccines remains based on reasonable cost principles. Health centers and clinics must still track vaccine-related costs and report them in the annual Medicare cost report, which will be used to reconcile reasonable costs to the payments received through claims processing. 

Why the change matters 

Prior to the change, Medicare reimbursed FQHCs and RHCs for vaccines and their administration through the annual cost report and they were not allowed to be billed and reimbursed when the services were provided.  

As a result, health centers and clinics had to cover both the vaccine and administration costs upfront, potentially waiting up to 18 months or more for reimbursement due to the timing of cost report submissions and Medicare contractor settlement processes.   

This delay posed a significant challenge for FQHCs and RHCs, which typically operate with tight cash flow and limited working capital. 

Real-time payments improve cash flow 

The July change allows FQHCs and RHCs to bill Medicare for vaccines and their administration on a claim-by-claim basis. Health centers will now receive payment shortly after submitting the claim, rather than waiting for year-end cost report settlements to come through.  

Claims must include: 

• CPT or HCPCS codes for each vaccine administered 

• Corresponding administration codes 

• Other billable services rendered during the visit, if any 

Notably, vaccines and administration can be billed regardless of whether a face‑to‑face encounter with a provider occurs. Services provided by qualified staff, such as nurses, are billable even without a provider visit on the same day. 

Accurate and timely claim submission will be critical to support compliant reimbursement and minimize processing delays or denials.  

New reimbursement for Hepatitis B vaccines 

Effective January 1, 2025, Medicare began allowing FQHCs and RHCs to be reimbursed for Hepatitis B vaccines and their administration. This is a change from prior policy, which did not permit payment for these vaccines in these settings.  

From January 1 through June 30, 2025, reimbursement for Hepatitis B vaccines will occur via the cost report, the same as the other reimbursable vaccines. Health centers and clinics should accumulate and report these costs accordingly when filing their 2025 cost report. Starting July 1, 2025, Hepatitis B vaccines will transition to claim-based reimbursement, joining influenza, pneumococcal, and COVID-19 vaccines in the new billing structure. 

Making on-site vaccinations financially feasible 

The long delay in Medicare reimbursement for vaccines has led some health centers and clinics to refer Medicare beneficiaries to local pharmacies for their vaccinations. With this regulatory change, providing vaccines on-site becomes much more viable, both financially and operationally. 

Medicare reimbursement will be as follows: 

• 95% of the Average Wholesale Price (AWP) for the vaccine itself 

• A fixed administration fee per dose, per the Medicare Physician Fee Schedule 

For most FQHCs and RHCs, claim-based reimbursements are comparable with amounts received through the cost settlements, with the key difference of quicker cash payment.  

What about the reconciliation process? 

Because vaccine reimbursement remains cost-based, FQHCs and RHCs must continue to track and report vaccine costs in their Medicare cost reports. The real-time payments received through claims will be reconciled against the actual reasonable costs reported annually.  

If total claim-based reimbursements exceed reasonable costs calculated in the cost report, the excess reimbursement will be required to be repaid to Medicare with the submission of the cost report. For most health centers and clinics, this variance is expected to be minimal. However, larger clinics with high vaccination volume could experience larger variances. Periodically throughout the year, FQHCs and RHCs should compare the vaccine acquisition price to the AWP and if acquisition prices are less than AWP, consider the need to complete an interim cost settlement and establish a reserve for amounts due to Medicare. 

A win for FQHCs, RHCs, and patients 

Real-time reimbursement reduces administrative burden, improves financial predictability, and enables health centers and clinics to better manage care for Medicare patients. Offering vaccines in-house enhances convenience, increases vaccine uptake, and improves public health outcomes.  

Health centers and clinics are better positioned to integrate vaccination into routine care, eliminating the need to refer patients elsewhere and strengthening continuity of care. 

How BerryDunn can help 

As the healthcare landscape evolves, FQHCs and RHCs must adapt to policy changes while continuing to meet the needs of their communities. BerryDunn’s healthcare consultants work closely with FQHCs and RHCs to: 

• Streamline operations and billing workflows 

• Ensure compliant claim submission 

• Plan strategically for cost report reconciliation 

• Integrate best practices for financial and operational performance 

Whether you need support implementing these changes or optimizing broader business strategies, BerryDunn is here to help. Learn more about BerryDunn’s team and services. 

Artificial Intelligence (AI) applications in healthcare have become ubiquitous and pervasive, and their adoption is accelerating. A recent American Medical Association survey disclosed physicians’ confidence in AI’s advantage for patient care is on the rise and their enthusiasm for its use is increasing.  

AI applications in healthcare 

AI applications have proved beneficial in a variety of ways in healthcare settings, including: 

• Managing hospital operations and patient flows 

• Assisting with resource allocation 

• Automating administrative tasks  

• Reducing clinicians’ repetitive tasks 

• Assisting in clinical decision-making 

• Detecting disease states 

• Aiding in clinical documentation 

Considerations for AI adoption 

This era of widespread AI-based application adoption represents a new phase of AI and presents new questions and challenges for healthcare organizations.  

A 2023 Center for Connected Medicine KLAS survey of healthcare systems disclosed only 16% have a system-wide policy for governance of AI usage. Organizations need to consider issues of data protection and privacy, patient consent, physician oversight and review, integration of workflows, and equitable access.  

Healthcare organizations should stay current on the emerging and evolving regulatory framework. For example, the US House bill (H.R. 1) passed in May 2025 proposes to block states from regulating AI models, shifting to federal oversight. It will warrant close monitoring, as the ultimate outcome will undoubtedly impact organizational compliance efforts.   

AI oversight 

Oversight is essential when implementing AI. We recommend that organizations consider forming AI committees composed of executives, information technology officers, legal advisors, clinicians, and cybersecurity specialists. These committees should establish and review institutional policies surrounding: 

• Patient privacy 

• Security measures, including encryption, secure storage, and security audits 

• Physician review of AI-based diagnoses and clinical decisions 

• Patient consent for use of their data, data sharing among applications, risks/benefits of AI-based applications 

• Staff education surrounding application use 

• Workflow integration with EHRs 

• Adoption of new applications 

• Clinician review of AI-generated notes and ambient listening technology documentation 

BerryDunn’s healthcare compliance team incorporates deep, hands-on knowledge with industry best practices to help ensure your operation is compliant and efficient. Learn more about BerryDunn’s team and services. 

This article is part of a series detailing meaningful proposed tax law changes. Read the previous article on key individual tax changes. 

The "Big Beautiful Bill" introduces a new savings vehicle for American families called the Trump Account. This novel provision has largely been overshadowed by other headline items including the SALT cap—and perhaps understandably so. This article will explain what these accounts are, how they would work, and their tax implications, so that if the legislation passes, you can be informed on whether they fit into your family's financial future.

What are Trump Accounts? 

Trump Accounts are specialized savings accounts designed for parents to invest in the futures of their children. 

• Account requirements: These accounts must be established as either a trust or custodial account before the child (the beneficiary) turns eight years old. 
• Contributions: Contributions are limited to cash only, with an annual cap of $5,000 per child (indexed for inflation), and can continue until the beneficiary reaches age 18. 
• Account limit: Each child is allowed only one Trump Account. If multiple accounts are created for the same beneficiary, only the first one qualifies as legitimate; any additional accounts are subject to a steep 100% excise tax on any income they generate. 
• Investment options: Funds can only be invested in stock of a regulated investment company that tracks a "well-established index" or a portfolio composed exclusively of US equities. While this restriction aims to promote long-term, stable growth through proven market indexes, it may limit flexibility compared to other savings options. 

Tax implications and distributions 

The rules governing distributions from Trump Accounts are somewhat intricate, but the overall tax benefits appear limited.

• Return of investment: Any portion of a distribution that represents a return of the original contributions is not subject to tax, which aligns with the fact that contributions are made with after-tax dollars and are not deductible. 
• Earnings: Any earnings or investment gains within the account are taxable to the beneficiary, regardless of how the funds are used. 
• Qualified purposes: If the funds are used for qualified purposes (defined as higher education expenses, a small business or farm loan taken out by the beneficiary, or a first-time home purchase), then the resulting gains are taxed at capital gains rates rather than as ordinary income. 
• Penalties: There is an additional 10% penalty on distributions to beneficiaries under the age of 31 which are not attributable to qualified expenses. 

Encouraging participation: The federal credit 

To encourage participation, the legislation includes a one-time federal credit of $1,000 for beneficiaries born between 2025 and 2028. 

• Automatic deposit: This credit is automatically deposited into a Trump Account unless the taxpayer opts out on their tax return. 
• IRS establishment: If no account has been created and no election out has been indicated, the IRS will establish an account on the beneficiary's behalf, following the processing of the parent's tax return. This automatic enrollment feature could jumpstart savings for many families, particularly those who might not otherwise take the initiative to open an account. 

Comparing Trump Accounts to other savings options 

While Trump Accounts offer some advantages, they have limitations when compared to existing savings plans like 529 plans. 

• Advantages: Trump Accounts offer potential rate arbitrage, tax deferral, and a degree of investment security due to regulatory constraints. They also expand the definition of qualified expenses to include small business loans and first-time home purchases. 
• Disadvantages: They fall short of the full tax-free growth and withdrawal benefits associated with 529 plans. Additionally, they lack some of the flexibility of 529 plans, such as the ability to repay student loans or roll over unused funds into a Roth IRA. The annual contribution cap of $5,000, even when adjusted for inflation, may also limit the long-term impact of these accounts compared to the more generous limits available under 529 plans. 

For families considering how best to invest in their children’s futures, it is important to weigh the novelty of Trump Accounts against the proven advantages of existing plans. If you have questions about your unique situation or would like more information on how these accounts would fit into your family’s financial picture, please do not hesitate to reach out to the BerryDunn Tax Team. We are here to help you navigate these important decisions and ensure a bright financial future for your loved ones.

As artificial intelligence (AI) becomes increasingly woven into nonprofit operations, boards are stepping into a new and critical role. Traditionally focused on mission oversight and fiscal responsibility, today's boards must also shape how AI is introduced, governed, and aligned with the organization’s values. Below are the seven most important actions a board can take to ensure responsible and strategic AI implementation. 

1. Build board-level AI fluency  

To offer meaningful oversight, board members must first understand the terrain. That means going beyond buzzwords to grasp AI’s potential and pitfalls in a nonprofit context—especially its ethical implications, financial impact, and accessibility concerns. 

Boards should: 

• Encourage ongoing education through trainings, industry briefings, or podcasts 
• Appoint an AI lead or champion to coordinate learning 
• Create space for dialogue between board and staff on emerging AI use cases 

2. Articulate a mission-driven AI vision  

Boards help define the “why” behind AI adoption. A strong vision ensures that tech decisions enhance the mission—not distract from it. 

This vision should: 

• Align AI use with organizational values and goals 
• Clearly state which uses are appropriate or off-limits 
• Address equity, inclusion, and accessibility for staff and stakeholders 

3. Establish policies and oversight structures  

Governance must evolve alongside innovation. Whether through an AI subcommittee or embedded into existing ones, boards should define oversight mechanisms early. 

Key actions: 

• Develop policies that address privacy, accountability, and ethical standards 
• Work with leadership to implement those policies organization-wide 
• Determine how and when AI performance and risks are reported to the board 

4. Invest in readiness across the organization  

AI implementation requires buy-in, training, and trust. Boards can champion a culture of learning that empowers both staff and leadership. 

That includes: 

• Encouraging staff-wide AI literacy, not just executive-level understanding 
• Supporting leaders in preparing their teams for workflow changes 
• Framing AI as a tool for empowerment, not displacement 

5. Prioritize responsible resource allocation  

AI can be expensive and time-consuming to deploy. Boards with financial oversight should evaluate whether investments are sustainable and impact-driven. 

Questions to ask: 

• What specific problems will this AI tool help solve? 
• How will outcomes be measured? 
• Are there grant opportunities or partnerships to offset costs? 

6. Promote transparency and communication  

Successful AI implementation thrives on trust. Boards can support transparency by encouraging open communication with internal teams and external stakeholders. 

Consider: 

• Creating dashboards or reports that track AI performance and risks 
• Soliciting feedback from staff and community members 
• Sharing learnings and ethical commitments publicly, when appropriate 

7. Extend impact to the community  

Nonprofits don't just implement technology—they model inclusive access to it. Boards can advocate for ways AI can serve not only the organization but the broader population. 

Ideas include: 

• Supporting community-based AI training or literacy initiatives 
• Partnering with peer nonprofits to share resources or lessons learned 
• Ensuring AI solutions serve marginalized and underrepresented groups 

Looking forward  

AI implementation is a journey, not a quick fix. Nonprofit boards play a critical role in making sure this journey is rooted in strategy, equity, and mission. With the right vision and structure, AI can become a powerful ally in expanding impact—and the board can be the compass that keeps it on course. 

BerryDunn’s nonprofit tax team works exclusively with tax-exempt organizations throughout New England and beyond. We understand and embrace the unique challenges faced by nonprofits—and recognize the vital importance of putting the mission first. Our team has deep expertise in partnering with nonprofits to develop strategies for success. Learn more about our team and services. 

Newly appointed to lead BerryDunn’s Healthcare Practice Group, Lisa Trundy-Whitten is closely attuned to the healthcare industry. From challenges faced by healthcare organizations to the solutions BerryDunn’s experts can provide, Lisa shares her vision for the team as she takes the helm, as well as thoughtful insights for today’s healthcare leaders. 

Today’s healthcare leaders face historic challenges that require innovative strategies to successfully navigate. From the impact of the proposed $880 billion cuts to Medicaid to redefining the model for employing primary care providers to be more sustainable for health systems, there is a path forward.  

It’s not surprising that BerryDunn’s fastest-growing services are those being shaped by economic uncertainty, regulatory compliance, financial strategy, IT strategy, and sustainability initiatives. As I consider the healthcare landscape today, there are a couple of key areas I’d like to highlight. First, the regulatory changes at the federal level are putting tremendous pressure on healthcare organizations, and second, quickly advancing technology is forcing the industry to evolve rapidly to remain sustainable.  

Impacts of federal regulatory changes 

Proposed shifts in federal policies and laws are creating uncertainty around reimbursement and regulatory compliance. At the top of the list are the Medicaid cuts in the "One Big Beautiful Bill Act,” which passed the US House of Representatives in May and is now up for consideration in the Senate, and the impact of possible changes to provider taxes.  

Major consequences of these possible Medicaid cuts include reimbursement and financial sustainability for organizations. My team and I know you have concerns. You’re wondering how you will make up for the potential lost reimbursement and whether entire programs will need to be eliminated.  

One way BerryDunn is staying ahead of the regulatory curve to support you is by closely monitoring regulatory changes, determining possible impacts, and developing strategies to inform and support our clients.  

Embracing and adapting to new technology 

One challenge with technology is determining how to best leverage it to improve accuracy and efficiency. Uncovering ways to align new tools with existing resources, the ethical use of technology, and governance models all come to mind when I think of the effects of technology on the healthcare industry. AI is one such tool that is constantly emerging and is prompting organizations to seek ways to advantageously employ it.  

Healthcare organizations like yours are working through how to supplement the workforce with technology to create a positive outcome. Technology needs to be integrated in a way that reduces the burden instead of adding to it.  

Our team has professionals skilled at strategic IT analysis and change management. We can assist with IT consulting to guide you on technology planning, EHR, and other system selections for your organization. We have expert advisors who can collaborate with you on the latest technology to help optimize your operations, including AI. 

Our Healthcare Practice Group  

My vision for our Healthcare Practice Group is to continually elevate our team and how we work with—and for—our valued clients. We want to help you integrate financial strategy and innovation to support operations and thrive in a climate of rapid change. To quote Tammy Brunetti, my predecessor in this role, "We are Better Together.”  

BerryDunn has an incredibly full breadth of services, and our team works across healthcare practices to provide a full complement of services. Considering our firm’s early roots in healthcare, we take tremendous pride in being large enough to provide a depth of resources but small and personal enough that we can provide services that fit your unique needs.  

I urge you to learn more about our services and team. We look forward to working with you to create the innovative solutions you require in today’s ever-changing climate. 

Best, 

Lisa Trundy-Whitten 

The Medicare Payment Advisory Commission (MedPAC) recently released its June 2025 Report to Congress, highlighting critical developments in Medicare Advantage (MA). Several key insights emerged with important implications for home health and supplemental benefit policy. 

Home health utilization patterns 

While overall home health use was similar between Medicare Advantage (8.3%) and Fee-for-Service (FFS) beneficiaries (8.6%), MA enrollees were 3.2 percentage points more likely to use home health following hospital discharge. This trend suggests that MA plans may be encouraging the use of home health as a lower-cost alternative to skilled nursing facility (SNF) care. 

Even more notably, MA enrollees received fewer visits on average—approximately 18 visits per year compared to 20 visits for FFS beneficiaries, representing an 11% reduction in service intensity. This occurred even when care was delivered by the same home health agencies, indicating plan-driven differences in utilization management. 

Supplemental benefits and transparency gaps 

Supplemental benefits—such as transportation, groceries, and fitness programs—remain a major draw for MA enrollment. In 2025, MA plans are projected to receive approximately $86 billion in Medicare rebates to fund these benefits, a dramatic rise from $21 billion in 2018. 

However, despite the scale of these investments, critical gaps remain in transparency and accountability. There is limited data on: 

• How frequently these benefits are used 
• How much plans actually spend per benefit  
• Whether they improve health outcomes 

As scrutiny over MA payment intensifies, the lack of reliable data prevents a meaningful assessment of value and impact. Without improved oversight and reporting, policymakers and stakeholders cannot determine whether MA plans are delivering better care or simply redistributing federal funds without measurable benefit. 

Implications for home health 

In the home health sector, providers continue to struggle with constrained reimbursement from MA plans, even as demand for post-acute care alternatives rises. To ensure that MA spending leads to meaningful improvements in care, greater transparency is urgently needed—both in how dollars are allocated and in whether they drive measurable health outcomes. Only with clearer insight into MA spending can we ensure investments are made in areas that deliver true value to patients and the healthcare system. 

BerryDunn’s home health and hospice team is comprised of respected industry leaders and professionals who have dedicated their careers to advancing patient care and navigating core challenges. We partner with clients on a variety of financial, outsourced, and consulting services. Learn more about our team and services.    

Read this if you are a healthcare financial leader, such as a CFO, revenue cycle executive, HIM director, or compliance professional.

Healthcare providers face increasing administrative and financial pressure due to the high volume and complexity of payer claim denials. Artificial Intelligence (AI) offers healthcare finance professionals powerful tools to shift denial management from reactive to proactive, significantly enhancing operational efficiency and financial performance. This article explores the use of AI technologies in preventing and managing denials, outlines an implementation strategy, presents case studies, and discusses challenges and future trends.  

Leveraging AI for claim denial management 

Claim denials continue to erode hospital and physician practice margins. According to HFMA and the AMA, denial rates can exceed 10% of submitted claims, with manual rework costing upwards of $25 per denial. The transition to value-based care and payer policy complexity make it difficult to maintain clean claims without significant investments in administrative labor. 

AI, including Machine Learning (ML), Natural Language Processing (NLP), Robotic Process Automation (RPA), and predictive analytics, offers finance leaders scalable, data-driven solutions to mitigate these risks. Leveraging AI across the revenue cycle enables better first-pass yield, reduces days in A/R, and drives sustainable improvements in net revenue. 

Denial landscape and financial implications  

Denials can be broadly placed into two categories:  

• Hard denials are typically irreversible and often result from issues such as contractual non-coverage. 

• Soft denials are potentially recoverable through resubmission or appeals.  

Understanding the nature of these denials is critical for devising effective mitigation strategies. 

What to consider for denials prevention: 

• A lack of prior authorization 

• Medical necessity disputes 

• Eligibility or benefit mismatches 

• Documentation or coding errors 

• Timely filing issues 

These denials often result in a 3–5% reduction in potential revenue—a significant financial impact for large health systems. Moreover, the manual effort required to rework and resubmit denied claims increases the cost-to-collect and diverts valuable resources from more strategic tasks. The resulting financial strain and workflow inefficiencies ultimately affect patient satisfaction and organizational sustainability. 

AI in revenue cycle management 

AI technologies enable healthcare organizations to optimize their revenue cycle operations through automation and intelligence.  

• Machine learning models: Trained on historical denial data, they can predict the likelihood of future denials and suggest interventions to avoid them. By proactively identifying high-risk claims, organizations can reduce rejection rates before claims are even submitted. An example is a decision tree classifier used to predict whether a hospital claim will be denied or approved. 

• Natural Language Processing tools: Play a pivotal role in understanding and extracting value from unstructured data sources such as EHRs, claim notes, and Explanations of Benefits (EOBs). They can identify missing or inconsistent information, automate appeal letter generation, and improve overall documentation quality. An example of NLP is a tool that extracts diagnoses, medications, and procedures from unstructured clinical notes to support accurate coding and streamline billing workflows. 

• Robotic Process Automation: Complements AI by handling repetitive, rule-based tasks such as eligibility verification, claim submission, and payer portal interactions. This frees up human resources for more complex and judgment-based activities. An example of an RPA is a bot that automatically retrieves claim status updates from payer portals and inputs the results into the billing system. 

• Predictive analytics tools: Offer powerful dashboards and forecasting capabilities, helping revenue cycle leaders identify trends, prioritize improvement initiatives, and continuously monitor performance metrics. An example of this tool is a model that analyzes historical claim data to forecast which submitted claims are most likely to be denied. 

Strategic benefits for finance executives 

AI adoption offers a multifaceted return on investment for healthcare finance executives. One of the most direct benefits is revenue enhancement through reduced denial-related leakage. By identifying and addressing risks before claims are submitted, organizations can significantly increase their clean claim rates. 

Operational productivity is also improved. Staff previously tasked with manual denial follow-up can be reallocated to higher-value roles, such as analytics or payer negotiation. This shift not only improves morale but also increases efficiency. 

In terms of compliance, AI helps organizations stay audit-ready by flagging inconsistencies in documentation and coding that may trigger payer audits or regulatory scrutiny. Furthermore, fewer denials and faster resolution cycles contribute to improved cash flow and reduced accounts receivable aging—key metrics for any finance leader. 

Implementation roadmap  

A successful AI implementation begins with defining clear, ROI-based goals. Finance leaders should align projects with measurable KPIs such as denial rate reduction, net revenue uplift, or staffing efficiency improvements. These goals serve as the foundation for all subsequent decision-making. 

Data readiness is a crucial prerequisite. Effective AI models require clean, structured, and integrated clinical and financial data. Organizations must assess their data infrastructure and invest in necessary improvements to ensure a successful deployment. Piloting the AI solution in specific payer segments or service lines allows for early value demonstration and helps build internal support. Positive results from these pilots can then inform a broader rollout strategy. 

Vendor selection should be driven by a thorough evaluation process, focusing on healthcare-specific experience, integration capabilities, and the vendor’s ability to maintain a comprehensive payer rule library. Equally important is preparing the organization for change. Successful adoption depends on cross-functional buy-in, robust training programs, and transparent communication about the benefits of AI. 

Case examples 

Several healthcare organizations have demonstrated the transformative potential of AI in denial management. Here are a few examples: 

• A 900-bed hospital implemented AI-based denial prediction models integrated with its Epic system. The result was a 40% reduction in manual claim rework and an increase in the clean claim rate to 94%. 

• A 400-provider medical services organization deployed NLP-enhanced Clinical Documentation Improvement (CDI) tools. This led to better capture of Hierarchical Condition Categories (HCCs) and a marked decrease in documentation-related payer inquiries. 

• A large, multi-state health system leveraged predictive analytics to identify and address root causes of denials across departments. By retraining staff based on data-driven insights, the system achieved a 33% year-over-year decrease in denials and gained an $8 million boost in net revenue. 

Challenges and mitigation strategies 

Despite the promise of AI, implementation comes with challenges. One major obstacle is the presence of data silos that limit the effectiveness of AI models. Integrating clinical, financial, and administrative systems is essential to create a unified view of the patient and claim lifecycle. 

Another concern is model bias and accuracy. AI tools must be regularly validated and adjusted to ensure their predictions remain reliable and do not inadvertently reinforce systemic issues. Overfitting and underfitting can both lead to misleading outputs if not properly managed. 

Regulatory compliance must also be prioritized. Organizations should only engage with HIPAA-compliant vendors who implement strong data protection measures. Moreover, staff should be trained on the appropriate use of AI outputs to prevent misuse or misinterpretation. 

Cultural resistance can slow or derail implementation. It is important to position AI not as a replacement for human expertise but as a tool that augments and enhances decision-making. Early wins, peer testimonials, and leadership support can help build momentum and buy-in. 

The future: AI as an RCM standard 

The future of revenue cycle management lies in the widespread adoption of AI tools as standard practice. Emerging technologies such as Explainable AI (XAI) will provide transparency into how decisions are made, making it easier to comply with audits and build trust with clinicians and payers. 

Federated learning is another promising development, enabling healthcare organizations to train AI models collaboratively without sharing sensitive patient data. This approach enhances model performance while preserving privacy. 

Real-time denial adjudication engines represent the next frontier, offering the ability to detect and resolve issues as claims are being prepared before submission. Such capabilities will transform denial management from a reactive function into a proactive, dynamic process embedded across the revenue cycle. 

AI: A strategic imperative 

AI adoption is no longer experimental—it's essential. Finance leaders must lead cross-functional efforts to deploy AI solutions that streamline operations, protect margins, and improve payer-provider collaboration. When implemented strategically, AI transforms denial management from a reactive cost center into a predictive, revenue-generating function. 

The future success of healthcare organizations depends on their ability to adapt to evolving reimbursement models, manage cost pressures, and improve data governance. AI serves as a strategic asset in achieving these objectives. As the industry embraces more digital health tools, those who proactively integrate AI into their revenue cycle operations will emerge as leaders, better equipped to deliver financial stability and enhance patient-centered care. In the end, the organizations that view AI not just as a technology but as a business imperative will be best positioned to thrive in the next era of healthcare delivery. 

BerryDunn’s revenue cycle consultants engage with your healthcare organization to objectively review existing processes and develop actionable strategies for short- and long-term performance improvement. Learn more about our team and services.