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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.

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

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. 

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. 

For healthcare finance professionals, Artificial Intelligence (AI) has become a strategic imperative. With a strong implementation strategy, AI can be implemented to prevent and manage denials, reducing the financial and administrative pressures on an organization. 

The debate and negotiations over tax reform are taking shape in the United States Congress. The United States Senate is reviewing the ‘One Big Beautiful Bill Act’ (OBBBA) passed by the US House of Representatives in late May. The House-passed legislation contains meaningful tax reforms with potentially significant impact to businesses and individuals.

Credit, purchase, and debit cards each offer convenience for small-dollar purchases, but carry varying levels of risk. Strong internal controls are essential to prevent fraud, misuse, and compliance violations.

In the complex world of international trade, businesses are constantly seeking ways to optimize their supply chains and reduce costs. One often-overlooked strategy that can yield significant savings is the use of first sale declarations.  

Nonprofit leaders must assess the risks and strategically position their organizations to adapt to changing funding landscapes. This article outlines key steps to help your organization proactively evaluate funding vulnerabilities, mitigate risks, and plan for sustainable operations. 

CAPRA accreditation is more than a “stamp of approval” for parks and recreation agencies. It is the foundation of a well-run parks and recreation department, offering proof that an agency is operating at the highest standards. In a competitive municipal environment where funding is tight and priorities shift, accreditation gives departments the credibility they need to advocate for resources and drive innovation. 

The proposed “One Big Beautiful Bill Act” includes several provisions that would directly impact tax-exempt organizations. BerryDunn’s experts provide a breakdown of how the bill could affect nonprofits.

Federally Qualified Health Centers (FQHCs) face a perfect storm—level grant funding, shrinking 340B drug pricing savings, and rising expenses. Staying sustainable requires identifying ways to maximize operations and revenue while controlling costs. That’s where site- and program-specific accounting become essential. 

The proposed $880 billion cuts to Medicaid, along with recently imposed tariffs and funding freezes, have placed healthcare organizations directly in the crosshairs of federal funding reductions. The result is an unprecedented threat that would profoundly affect the financial stability of organizations providing care.

The US Department of Health and Human Services Office of Inspector General has been actively enforcing healthcare compliance and fraud prevention in 2025. Are you ready? 

When it’s time to change auditors, it’s important to find a firm that feels like a long-term partner. Start by asking the right questions up front. 

With default federal student loan collections now resumed by the Department of Education, higher education institutions and other effected nonprofits need a strategy to ensure compliance. 

After an intense overnight session, the US House of Representatives narrowly passed the "One Big Beautiful Bill Act" with a 215-214 vote, marking a significant milestone in fiscal policy reform. The bill, which now heads to the Senate for further consideration, proposes extensive tax changes alongside broader regulatory shifts. While House Republicans and the current administration champion the bill as a legislative victory, Democratic opposition remains strong, and modifications are expected before it reaches the president’s desk.

Public health agencies have a powerful opportunity to inspire the next generation of professionals to join the governmental workforce. To build a pipeline of committed talent, agencies must take proactive steps—establishing dynamic mentorship programs, creating hands-on internship opportunities, and sharing compelling success stories that highlight the profound impact and fulfillment of serving in public health.

The Supporting Affordability and Fairness with Every Bet (SAFE) Act is a proposed federal legislation aimed at establishing minimum standards for sports betting across the United States. The SAFE Bet Act aims to help ensure minimum standards at in place throughout the United States for responsible gambling, protection of consumers, and maintaining the integrity of sports betting.

In today's globalized economy, businesses face an ever-changing landscape of tariffs, trade policies, and international supply chain challenges. For companies navigating these complexities, foreign trade zones (FTZs) present a strategic opportunity to reduce costs, improve logistical efficiency, and enhance overall competitiveness. 

As hospitals strive to balance their budgets and sustain primary care, there are options for hospitals to take that could ease financial burdens while preserving provider presence in the communities they serve. This article explores actionable models and strategies to reimagine primary care delivery in a way that benefits both patients and hospital systems.

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. 

Nonprofit audit committees play a pivotal role in maintaining transparency and accountability. Their responsibilities include financial oversight, compliance, reporting guidelines, risk management, external audits, internal audits, and ethical standards. Have you ever wondered what kinds of questions the audit committee should be asking of management and each other? Consider the following list of sample questions as a starting place.

How often does a new category of lending open up for the banking industry? This could happen if Congress ends federal tax exemptions for interest earned on municipal (“muni”) bonds. While a final decision has not yet been made, Congress is debating this option as they decide how to handle expiring provisions of the 2017 Tax Cuts and Jobs Act.

Employee retention is crucial in construction, where turnover can delay projects, increase training costs, and reduce efficiency. Statistics show that turnover in construction is approximately 21.4%, and with the industry facing an estimated labor shortage of 430,000 workers as of 2023, retaining skilled workers is vital. Here, we’ll look at proven strategies, backed by industry data and case studies, that small to medium-sized construction companies can use to reduce turnover and improve employee satisfaction.

Digital accessibility is more than a legal requirement—it’s about ensuring everyone can access public services, regardless of ability. As government agencies increasingly move services online, compliance with accessibility standards like the ADA’s Web Content Accessibility Guidelines (WCAG), EAA regulations, and Section 508 is essential. 

As new regulations take shape and tariff frameworks continue to change, importers must assess their compliance strategies with heightened scrutiny. One of the most critical components of this evaluation is transfer pricing. 

How does your nursing facility’s financial health stack up against industry peers? Benchmarking can provide you with the clear, relevant comparisons that are essential to measuring and optimizing your facility’s performance.

A financial institution’s core banking system, or core processing system, is an essential software that provides the backbone for day-to-day operations and transaction processing. Accounting for the costs of these systems can be tricky because of the complexities often involved in these contracts.

Last month, in honor of Women's History Month, we had the opportunity to speak with two women making waves in the parks and recreation industry—BerryDunn’s Becky Dunlap and Lakita Frazier. Both have built meaningful careers driven by a passion for community impact and the outdoors, forging paths that inspire others in the field. 

The construction industry presents some unique accounting and financial reporting requirements when it comes to construction work-in-progress (WIP) schedules. To keep a solid pulse on contract financial status and results, it is important that these schedules are accurate and up to date.

The FDIC's Quarterly Banking Profile for Q4 2024 reports positive performance for the 4,046 community banks evaluated.

On March 28, 2025, the FDIC issued a Financial Institution Letter (FIL), which rescinds its prior notification requirement for financial institutions engaging in crypto-related activities, as established in FIL-16-2022. 

In late 2024, the Centers for Medicare and Medicaid Services (CMS) launched a sweeping off-cycle mandate requiring all skilled nursing facilities (SNFs) in the United States to revalidate their Medicare provider enrollment record. Facilities of all types–including for-profit and not-for-profit–are affected.

To address evolving threats and regulatory challenges, OCR has issued proposed modifications to the Security Rule, introducing stricter security controls, mandatory encryption requirements, and a shift away from “addressable” implementation specifications. While these changes aim to improve data security, they also introduce new compliance burdens that could be challenging for many regulated entities. 

For foster teens, the path to adulthood is uniquely challenging. As thousands of young adults age out of the foster care system each year, many child welfare agencies are searching for ways to better support them through this transition. According to Dr. Elizabeth Wynter, child welfare advocate and author of Follow the Love: Permanent Connections Scaffolding, the key is to build strong youth-adult partnerships. In a recent episode of BerryDunn’s Fresh Perspectives in Social Work podcast, Dr. Wynter and I discussed the need for a “connection scaffold” and offered insights on improving outcomes for foster youth. Here are five take-aways from our conversation.

In today's data-driven world, the ability to share information between Medicaid and Public Health Agencies (PHAs) is crucial for efficiently using limited resources to serve both individual patient and population health goals and priorities. Often, states already have the needed technology, but they don’t have the partnerships or workforce infrastructure to leverage existing investments across different agencies.

Public health is at a crossroads. With the lessons learned from COVID-19 and a workforce on the brink of burnout, now is the time for transformative action. By reimagining operations, infrastructure, and health equity, we can shape a system that’s responsive to future challenges.

Most nonprofits rely on federal and state government funds to fulfill their missions. With a federal funding freeze in the headlines, many clients are asking us how they can best prepare for a freeze and protect their organizations if funding is cut. Here are three steps you can take today to stay ahead. 

If your organization is in the process of a large-scale project, such as replacing or implementing an electronic health record (EHR) system in the near future, success will depend on having a sound communication plan in effect before, during, and after the implementation. Fortunately, effective communication is not a difficult task to achieve. Based on our experience helping local governments implement EHR other systems nationwide, our team has developed five simple communication steps for successful implementations. 

The end of 4Q 2024 marks the start of a new year. In the Valuation Group, the end of the calendar year brings us to one of our busiest times of year: “ESOP season.” During the first few months of the year, we perform annual valuations for 30+ ESOP clients.

For manufacturers in New England, the global trade environment has always played a significant role in shaping supply chain strategies and cost structures. With the current tariff landscape marked by rapid changes and adjustments due to ongoing trade negotiations and economic strategies, businesses must be ready to quickly reevaluate their pricing models and material cost standards to maintain profitability. 

As the new year begins, your organization may be starting to plan for your next fundraising event. In addition to raising money for the organization, fundraising events are a wonderful way to build relationships within the community, raise awareness for a cause, and provide a meaningful experience to donors. Beyond the excitement and benefits of these events, there are important Form 990 reporting and compliance requirements that you must consider. Below are the most frequently asked questions we receive from our clients. We hope this helps you avoid some common pitfalls around fundraising events.

Rapid advancements in artificial intelligence (AI), robotics, quantum computing, and augmented reality will redefine how society functions by 2035

The market approach is one of three different ways to estimate the value of a company. In its simplest form, the market approach is fairly straightforward. Below is a very basic model for how a valuation could be applied:

Like many male-dominated industries, construction workplaces are often aligned with traditional masculine values such as self-reliance and stoicism, which can encourage resistance to traditional well-being approaches. 

The Financial Accounting Standards Board (FASB) has recently issued two significant Accounting Standards Updates (ASUs): ASU No. 2023-07 and ASU No. 2024-03. These updates aim to enhance the transparency and usefulness of financial disclosures for public business entities (PBEs) and are only applicable to PBEs.

Is your nonprofit using a break-even bottom line as your ultimate budget goal? If so, you may be missing out on opportunities to strategically further your mission. By looking at your budget using a statement of financial position perspective, rather than just a profit and loss perspective, you can gain a more complete financial picture of your organization.

As organizations navigate the complexities ahead in 2025, economic uncertainty presents both challenges and opportunities. Organizations must strategically address financial stability, donor engagement, federal compliance requirements, and workforce management to sustain their missions. This article dives into five critical finance trends and explores how nonprofits can effectively adapt.

The housing industry is subject to ongoing regulatory changes that are critical to their operations. Recently, we shared changes impacting compliance for multifamily housing, but that's just one example; all facets of the industry are subject to ongoing changes to compliance.

The FDIC's Quarterly Banking Profile for Q3 2024 reports positive performance for the 4,082 community banks evaluated.

Effective January 1, 2025, qualifying businesses in all Maine jurisdictions will be eligible for a generous, refundable credit while simultaneously investing in their business.

What Medicaid agencies and Medicaid-participating managed care organizations need to know about best practices for adhering to federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements.

The Centers for Medicare & Medicaid Services (CMS) issued the final rule for the PPS for SNFs for FY 2025 which was published in the Federal Register on August 6, 2024, the regulations in this rule are effective October 1, 2024.

On November 6, 2024, members of the BerryDunn financial services team joined bankers and board members throughout the state of Maine at the annual Maine Bankers Association FDIC Directors’ College in Augusta, Maine. Here are our key takeaways from the event:

The election created a sense of anxiety and uncertainty among many people for a variety of reasons. One such concern was around how the election would affect business value.

The revenue cycle is an intricate system involving interdependent functions. Like an ecosystem, each component plays an important role. To optimize your revenue cycle, it helps to understand these four components of the ecosystem and the roles they play.

In this guide, we’ll explore the key benefits of the REAP Grant, explain who should consider applying, and highlight the important tax implications to help you make informed decisions about whether this program is right for your business.

This article explores the current trends in banking fraud, highlighting traditional schemes, emerging threats, and effective preventive measures.

These 7 success factors address the essential aspects of an economic development strategy––a roadmap for your community to encourage economic growth, create jobs, and improve the quality of life.

On July 25, 2024, the Public Company Accounting Oversight Board (PCAOB) issued its 2023 Annual Report on the Interim Inspection Program Related to Audits of Brokers and Dealers. The PCAOB can essentially be considered “the auditor of the auditor” and thus performs various inspections of audit firms that conduct broker-dealer audits on an annual basis.

The COVID-19 pandemic taught our public health systems a number of critical lessons about how we should engage, communicate, partner, and share data with other agencies and our communities. It also reinforced the importance of applying an intentional health equity lens to the system to better support vulnerable communities in times of crisis.  

The implementation of Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 606, Revenue from Contracts with Customers, which has been in effect since 2018 for broker-dealers, has had a profound impact on financial reporting across various industries. For broker-dealers, the adoption of this standard has introduced new challenges and considerations in recognizing revenue accurately and in accordance with the principles outlined in ASC 606.  

Your parks and recreation master plan was created with the goals and values of your community at its core. It’s part of what makes your community a great place to live, work, and play. It’s also a living document, designed to meet both current and future community needs—and to evolve as those needs change.

We often see broker-dealers receive 12b-1 fees in the course of ordinary business. With these fees, we often see the broker-dealer acting as a pass-through, retaining these fees on its balance sheet until the ultimate payee requests such funds, typically for payment or reimbursement of expenses that are permissible to be paid from 12b-1 fees, as outlined in the distribution agreement. These fees can often be substantial and result in significant receivables on the broker-dealer’s balance sheet.

Enterprise Resource Planning (ERP) systems provide a shared platform for people in your organization to work together––and the benefits can be game-changing. 

The SECURE Acts made several changes to 401(k) and 403(b) plan requirements. Among those changes is a change to the permissible minimum service requirements.

One of the key strategies to making the patient check-in process a good experience for patients, while also gathering the most important information for billing, is to have clear scripts for your patient access staff. 

The BerryDunn Parks, Recreation, and Libraries team is thrilled to share our highlights from the 2024 NRPA Annual Conference in Atlanta, which showcased the vibrant future of parks and recreation through exciting sessions, meaningful connections, and moments of celebration.

In April 2024, the Governmental Accounting Standards Board (GASB) issued GASB Statement No. 103, Financial Reporting Model Improvements.

A more popular addition to Medicaid Enterprise System Conference (MESC) discussions this year was AI, and attendees expressed both fear and excitement over its potential to tactically support the enterprise.

If it’s been a while since your nonprofit organization last conducted a review of its governing documents and policies, worry not, you’re not alone! This article will highlight a few of the most critical documents applicable to nonprofits to ensure you remain in compliance and good standing.

How should a business owner, management team, or investor estimate the value of its company? There are a variety of methods available in the world of business valuation. Let’s discuss the pros and cons of using a common financial metric in the assessment of a business’s value: Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA).

If there’s one thing that was clear at the recent Medicaid Enterprise Systems Conference (MESC) in Louisville, it is that CMS is focused on meaningful enterprise planning, meaningful outcome definitions, and meaningful data from State Medicaid Agencies (SMAs) to illustrate trends throughout every phase of the IT life cycle and the benefit to Medicaid beneficiaries.

Although summertime is a generally slower time for the valuation team, we’ve seen a notable increase in M&A activity. Transactional activity often follows interest rate trends. We’ve seen activity pick up significantly in the last nine months under the current stable interest rate environment. As rates drop, more deals are sure to follow.

Nursing facilities need to be aware of a wide range of potential data uses for payer-based reporting (PBR) data and have comprehensive internal data review procedures to help ensure the public use file reflects accurate reporting and facility is prepared for an audit.   

For larger educational institutions that can receive hundreds of such disclosable donations in a given year, the Schedule B reporting onus can become downright brutal. However, there is a special rule available for Schedule B reporting that could greatly reduce that requirement. Fundraising and Development departments rejoice!

To help public health state agencies target budget and fiscal management training needs for their workforce, a comprehensive assessment can be utilized to examine four domains of administrative management activities with a focus on financial management.

At first glance, the healthcare patient check-in process seems straightforward. But when examined through the lens of your revenue cycle and patient experience, it’s one of the most important interactions for your team to get right.

Non-profit financial statements include a wealth of important knowledge but can often be overwhelming. When sharing your financial statements with your board of directors or other stakeholders, it can be useful to simplify your statements so the key information stands out and unimportant information doesn’t cause confusion.

Parks and recreation agencies, like any public-serving organization, have an obligation to equally serve all members of their communities. But knowing that something must be done is not the same thing as knowing how to approach it. As heard in a recent episode of the “Let’s Talk Parks with BerryDunn” podcast, host Becky Dunlap spoke with Meredith Tekin, President of the International Board of Credentialing and Continuing Education Standards (IBCCES), and Lane Gram, Manager for Parks and Recreation in Gilbert, Arizona, about how the town is undertaking the endeavor of making their parks and facilities accessible and enjoyable for all.

In February 2024, the American Association of State Highway and Transportation Officials (AASHTO) released a 2024 Edition of the Uniform Audit & Accounting (A&A) Guide, which supersedes the 2016 edition. The guide is a tool for architectural and engineering (A/E) firms calculating and reporting overhead rates to state transportation departments (DOTs), and to guide state DOT auditors and public accounting firms in performing audits of A/E firms’ indirect cost schedules.  

The United States Department of Housing and Urban Development (HUD) signed the Housing Opportunity through Modernization Act (HOTMA) into law on July 29, 2016. For multifamily housing owners, HOTMA went into effect on January 1, 2024, and owners are expected to be fully compliant by January 1, 2025.

To stay competitive in the recruitment and retention of employees, employers need to stay abreast of the current well-being trends—the ones that have the potential to move the needle in creating a thriving, healthy workforce.

The Centers for Medicare and Medicaid Services (CMS) has temporarily paused the Program for Comparative Billing Reports (CBRs) and Evaluating Payment Patterns Electronic Report (PEPPERs). During this pause, which is expected to end in the fall of 2024, CMS will be improving and updating the program.

In November 2023, the US Department of Labor’s Employee Benefits Security Administration (EBSA) issued its fourth assessment of the quality of audit work performed by independent qualified public accountants. Here are our five key takeaways.

Did you receive an Employee Retention Credit (ERC) that you now believe you were ineligible for? Since the ERC was announced, many ineligible claims have been filed, due to a variety of reasons, including companies working with ERC vendors that either did not understand the complexities or were not providing the due diligence necessary to ensure that the applications were complete and accurate.

Early-stage startups must often contemplate the most practical way to raise capital for their business. If traditional debt and equity methods are not available, different avenues to raising capital must be considered. Here are four alternatives to traditional debt and equity transactions:

The Corporate Transparency Act (CTA) was enacted into law by Congress on January 1, 2021, as part of the National Defense Authorization Act. The CTA mandates that every foreign or domestic entity registered to do business in the United States disclose Beneficial Ownership Information (BOI) beginning in 2024.

On December 20, 2023, the National Credit Union Administration (NCUA) issued a technical correction with the calculation of the Current Expected Credit Loss (CECL) transition amount.

A SOC report can be an invaluable tool in helping you gain confidence about your service providers.

With the rapid growth of Medicare Advantage (MA) plans in the last several years, many hospitals are struggling to effectively manage the financial and operational challenges of these plans, including:

  • Increased denials of Medicare Advantage claims
  • Confusion between Medicare, supplemental Medicare plans, and Medicare Advantage (Part C) plans, and what each cover
  • Extra burden of “shadow billing” inpatient claims and leaving potential reimbursement off the table if not done correctly
  • Compliance risk, including the risk of Medicare fraud

Derivatives can be used to hedge against a company’s exposure to a particular risk, whether that be the purchase price of materials or equipment, the selling price of a product a company has already purchased the materials to produce, or a variable rate of interest on debt.   

Staff turnover can present a number of challenges for independent schools. When staff turnover in your business office occurs, there are serious matters related to financial risk that you should consider.  

Owners of rental property who receive assistance from the US Department of Housing and Urban Development (HUD) through debt financing or tenant rent subsidies for affordable housing are subject to specific reporting and compliance requirements. It’s important to know and understand these requirements in order to be ready for audits, maintain compliance, and continue to receive funding. Here are three of the most complex requirements that anyone receiving funding from HUD needs to be aware of and have a process in place to help ensure compliance.  

In the realm of gaming and sports betting, maintaining proper security, privacy, and operational integrity are crucial in providing assurance to all parties involved. In such a heavily regulated industry, it is essential that sportsbook providers have the resources and professional advice needed for obtaining and maintaining compliance.

As we put a bow on another Medicaid Enterprise Systems Conference (MESC), I want to express my thanks to the New England States Consortium Systems Organization (NESCSO), the State of Colorado, and the City of Denver for hosting a fantastic event.

We’ve all heard stories about organizations spending thousands on software projects that take longer than expected to implement and exceed original budgets. One of the reasons this occurs is that organizations often don’t realize that purchasing a large, commercial off-the-shelf (COTS) system is a significant undertaking.

The Centers for Medicare and Medicaid Services (CMS) issued the Final Rule for the PPS for SNFs for FY 2024, which was published in the Federal Register on August 7, 2023. The regulations in this rule are effective October 1, 2023, except certain amendments, which are effective January 1, 2024. 

There’s a good chance that your organization is being forced to do more with less under the strain of budget constraints and competing initiatives. It’s a matter of survival. 

Executive compensation, bonuses, and other cost structure items, such as rent, are often contentious issues in business valuations, as business valuations are often valued by reference to the income they produce. If the business being valued pays its employees an above-market rate, for example, its income will be depressed. Accordingly, if no adjustments are made, the value of the business will also be diminished.

Across all industries, organizations are struggling to attract and retain the employees needed to provide services to their communities. From local governments to retail outlets to…well, just about everyone.

In the latest episode of the Let’s Talk Parks with BerryDunn podcast, we discussed the topic of retaining all-star employees as it relates to Parks and Recreation Departments who are struggling to maintain community services due to staffing levels. The conversation with my colleagues Nikki Ginger and Barbara Heller and our guests Nicole Falceto and Fernando Avellanet from the Loudoun County (Virginia) Parks, Recreation and Community Services Department uncovered tangible and actionable strategies that any type of organization can use to start the process of improving their organizational culture to better retain staff.

Organizational change is hard. And necessary. And manageable.

You know your organization needs to change – to develop a better culture, to enhance efficiencies, or to improve outcomes. But where do you start?

In our most recent episodes of the Fresh Perspectives in Social Work Podcast, I had a conversation about this subject with organizational development experts Megan Clough, Manager with the State Government Practice Group at BerryDunn, and Jennifer Kerr, Director of Organizational Effectiveness at American Public Human Services Association (APHSA).

At BerryDunn, our healthcare consulting teams have worked with hundreds of organizations as they’ve transitioned to new enterprise systems such as Electronic Health Records (EHR) systems and Enterprise Resource Planning (ERP) systems. Based on our experience, there are 10 key areas to focus on in order to have a successful conversion.   

It can be challenging and stressful to plan for technology initiatives, especially those that involve and impact every area of your organization. 

Do you have a CEO succession plan? If not, you need to create one now.

This article is the first in a series to help employee benefit plan fiduciaries better understand their responsibilities and manage the risks of non-compliance with ERISA requirements.

Follow these six steps to help your senior living organization improve cash flow, decrease days in accounts receivable, and reduce write offs. 

As we find ourselves in a fast-moving, strong business growth environment, there is no better time to consider the controls needed to enhance your IT security as you implement new, high-demand technology and software to allow your organization to thrive and grow. Here are five risks you need to take care of if you want to build or maintain strong IT security.

In light of the recent cyberattacks in higher education across the US, more and more institutions are finding themselves no longer immune to these activities. Security by obscurity is no longer an effective approach—all institutions are potential targets. Colleges and universities must take action to ensure processes and documentation are in place to prepare for and respond appropriately to a potential cybersecurity incident.

This is the second blog post in the blog series: “Procuring Agile vs. Non-Agile Service”. Read the first blog. This blog post demonstrates the differences in Stage 1: Plan Project in the five stages of procuring agile vs. non-agile services.

Measuring performance of Medicaid Enterprise Systems (MES) is emerging as the next logical step in modularizing Medicaid programs. As CMS continues to refine and implement outcomes-based modular certification, it is critical that states adapt to this next step in order to continue to meet CMS funding requirements.

On June 18, 2019, the State of Maine enacted Legislative Document 1819, House Paper 1296, An Act to Harmonize State Income Tax Law and the Centralized Partnership Audit Rules of the Federal Internal Revenue Code of 1986

Planning and development service fees are, for many municipalities, often discussed but rarely changed. There are a number of reasons you might need to consider or defend your fee structure―complaints from developers, rising costs of operation, and changes in code or process are just a few.

Patient Driven Payment Model (PDPM) implementation is less than three months away. Is your facility ready for admissions under PDPM? The way you think about admissions and the admission process will change under PDPM.

In my last blog, I defined the what and the why of data governance, and outlined the value of data governance in higher education environments. I also asserted data isn’t the problem―the real culprit is our handling of the data (or rather, our deferral of data responsibility to others).

Proposed House bill brings state income tax standards to the digital age

On June 3, 2019, the US House of Representatives introduced H.R. 3063, also known as the Business Activity Tax Simplification Act of 2019, which seeks to modernize tax laws for the sale of personal property, and clarify physical presence standards for state income tax nexus as it applies to services and intangible goods. But before we can catch up on today, we need to go back in time—great Scott!

As the Project Management Body of Knowledge® (PMBOK®) explains, organizations fall along a structure and reporting spectrum. On one end of this spectrum are functional organizations, in which people report to their functional managers. (For example, Finance staff report to a Finance director.) On the other end of this spectrum are projectized organizations, in which people report to a project manager. Toward the middle of the spectrum lie hybrid—or matrix—organizations, in which reporting lines are fairly complex; e.g., people may report to both functional managers and project managers. 

As your organization works to modernize and improve your Medicaid Enterprise System (MES), are you using independent verification and validation (IV&V) to your advantage? Does your relationship with your IV&V provider help you identify high-risk project areas early, or provide you with an objective view of the progress and quality of your MES modernization initiative? Maybe your experience hasn’t shown you the benefits of IV&V. 

The IRS announced plans to conduct examinations of the universal availability requirements for 403(b) plans (Plans) this summer. Noncompliance with these requirements results in operational errors for Plans―ultimately requiring correction. Plan sponsors should review their Plans for proper inclusion and exclusion of employees. Such review can help you avoid costly penalties if the IRS does conduct an examination and uncovers an issue with the Plan’s implementation of universal availability.

Best practices for financial institution contracts with technology providers

As the financial services sector moves in an increasingly digital direction, you cannot overstate the need for robust and relevant information security programs. Financial institutions place more reliance than ever on third-party technology vendors to support core aspects of their business, and in turn place more reliance on those vendors to meet the industry’s high standards for information security. These include those in the Gramm-Leach-Bliley Act, Sarbanes Oxley 404, and regulations established by the Federal Financial Institutions Examination Council (FFIEC).

What is the difference in how government organizations procure agile vs. non-agile information technology (IT) services?

Focus on the people: How higher ed institutions can successfully make an ERP system change

The enterprise resource planning (ERP) system is the heart of an institution’s business, maintaining all aspects of day-to-day operations, from student registration to staff payroll. Many institutions have used the same ERP systems for decades and face challenges to meet the changing demands of staff and students. As new ERP vendors enter the marketplace with new features and functionality, institutions are considering a change. Some things to consider.

LIBOR is leaving—is your financial institution ready to make the most of it?

In July 2017, the UK’s Financial Conduct Authority announced the phasing out of the London Interbank Offered Rate, commonly known as LIBOR, by the end of 20211. With less than two years to go, US federal regulators are urging financial institutions to start assessing their LIBOR exposure and planning their transition. Here we offer some general impacts of the phasing out, specific actions your institution can take to prepare, and, finally, some background on how we got here (see Background at right).

Who has the time or resources to keep tabs on everything that everyone in an organization does? No one. Therefore, you naturally need to trust (at least on a certain level) the actions and motives of various personnel. At the top of your “trust level” are privileged users—such as system and network administrators and developers—who keep vital systems, applications, and hardware up and running.

Law enforcement, courts, prosecutors, and corrections personnel provide many complex, seemingly limitless services. Seemingly is the key word here, for in reality these personnel provide a set number of incredibly important services.

“The world is one big data problem,” says MIT scientist and visionary Andrew McAfee.

That’s a daunting (though hardly surprising) quote for many in data-rich sectors, including higher education. Yet blaming data is like blaming air for a malfunctioning wind turbine. Data is a valuable asset that can make your institution move.

Best Practices for Educating Your Financial Institution’s Board of Directors on Cybersecurity

According to Cybersecurity Ventures, cybercrime will account for $6 trillion annually by 2021—that’s more than the global trade of all major illegal drugs combined.  Data breaches and other information security events adversely impact organizations through significant losses in revenue, erosion of customer trust, substantial remediation costs, increased insurance premiums, and more.

Not-for-profit board members need to wear many hats for the organization they serve. Every board member begins their term with a different set of skills, often chosen specifically for those unique abilities. As board members, we often assist the organization in raising money and as such, it is important for all members of the board to be fluent in the language of fundraising. Here are some basic definitions you need to know, and the differences between them

Writing a Request for Proposal (RFP) for a new software system can be complex, time-consuming, and—let’s face it—frustrating, especially if you don’t often write RFPs. The process seems dogged by endless questions, such as:

On October 1, 2019, the Medicare Skilled Nursing Facility (SNF) payment system will transition from RUGS-IV to the Patient Driven Payment Model. This payment model is a major change from the way SNFs are currently reimbursed.

Of all the changes that came with the sweeping Tax Cuts and Jobs Act (TCJA) in late 2017, none has prompted as big a response from our clients as the changes TCJA makes to the qualified parking deduction.

In auditing, the concept of professional skepticism is ubiquitous. Just as a Jedi in Star Wars is constantly trying to hone his understanding of the “force”, an auditor is constantly crafting his or her ability to apply professional skepticism. 

As a new year is upon us, many people think about “out with the old and in with the new”. For those of us who think about technology, and in particular, blockchain technology, the new year brings with it the realization that blockchain is here to stay (at least in some form).

A capital campaign is a big undertaking. During the planning stage of a capital campaign you need to not only focus on your donor outreach strategy, but also on outreach materials. 

The existing case mix classification group, Resource Utilization Group IV (RUG- IV) will be replaced with a new case mix model, the Patient Driven Payment Model (PDPM). CMS has indicated factors leading to the change in the payment system include over utilization of therapy and incentives for longer lengths of stay.

Good fundraising and good accounting do not always seamlessly align. While they all feed the same mission, fundraisers work to meet revenue goals while accountants focus on recording transactions in compliance with accounting standards. 

Your government agency just signed the contract to purchase and implement a shiny new commercial off-the-shelf (COTS) software to replace your aging legacy software. The project plan and schedule are set; the vendor is ready to begin configuration and customization tasks; and your team is eager to start the implementation process.

A common pitfall for inbound sellers is applying the same concepts used to adopt “no tax” positions made for federal income tax purposes to determinations concerning sales and use tax compliance. Although similar conceptually, separate analyses are required for each determination.

All teams experience losing streaks, and all franchise dynasties lose some luster. Nevertheless, the game must go on. 

This October, my colleagues and I attended the National Association of Health Data Organizations (NAHDO) annual meeting in Park City, Utah. NAHDO is a national non-profit membership and educational association dedicated to improving healthcare data collection and use.

As 2018 is about to come to a close, organizations with fiscal year ends after December 15, 2018, are poised to start implementing the new not-for-profit reporting standard. Here are three areas to address before the close of the fiscal year to set your organization up for a smooth and successful transition, and keep in compliance:

It’s that time of year. Kids have gone back to school, the leaves are changing color, the air is getting crisp and… year-end tax planning strategies are front of mind! 

Reading through the 133-page exposure draft for the Proposed Statement on Auditing Standards (SAS) Forming an Opinion and Reporting on Financial Statements of Employee Benefit Plans Subject to ERISA, issued back in April 2017, and then comparing it to the final 100+ page standard approved in September 2018, may not sound like a fun way to spend a Sunday morning sipping a coffee (or three), but I disagree.

I leaned out of my expansive corner office (think: cubicle) and asked my coworker Andrew about an interesting topic I had been thinking about. “Hey Andrew, do you know what BATNA stands for?” I asked. 

State governments regularly negotiate contracts with vendors. Unfortunately, these negotiations are often prolonged, which can have major downstream effects on projects, procurements, and implementations—including skewed timelines, delayed milestones, and increased costs. 

With the wind down of the Federal Perkins Loan Program and announcement that the Federal Capital Contribution (FCC) (the federal funds contributed to the loan program over time) will begin to be repaid, higher education institutions must now decide how to handle these outstanding loans.

Reflecting on this year's National Academy for State Health Policy (NASHP) Conference in Jacksonville, Florida, I am amazed by all the recent healthcare innovations, which are resulting in policies with real and positive effects on health outcomes.

Modernization means different things to different people—especially in the context of state government. For some, it is the cause of a messy chain reaction that ends (at best) in frustration and inefficiency. For others, it is the beneficial effect of a thoughtful and well-planned series of steps. 

Truly effective preventive health interventions require starting early, as evidenced by the large body of research and the growing federal focus on the role of Medicaid in addressing Social Determinants of Health (SDoH) and Adverse Childhood Experiences (ACEs).

Do you want to receive top dollar for your business? Do you want to make your business irresistible to a potential buyer? Looking for a stress-free retirement? If you find yourself answering “yes” to these questions, it’s time to take steps to create a transferable business.

Last week, in addition to The Eagles Greatest Hits (1971-1975) album becoming the highest selling album of all time, overtaking Michael Jackson’s Thriller, the IRS issued Notice 2018-67—its first formal guidance on Internal Revenue Code Section 512(a)(6).

Artificial Intelligence, or AI, is no longer the exclusive tool of well-funded government entities and defense contractors, let alone a plot device in science fiction film and literature. Instead, AI is becoming as ubiquitous as the personal computer. 

The world of professional sports is rife with instability and insecurity. Star athletes leave or become injured; coaching staff make bad calls or public statements. The ultimate strength of a sports team is its ability to rebound. The same holds true for other groups and businesses.

As I head home from a fabulous week at the 2018 Medicaid Enterprise Systems Conference (MESC), I am reflecting on my biggest takeaways. Do we have the information we need to effectively move into the next 12 months of work in the Medicaid space? My initial reaction is YES!

Here we go again! With the 2018 Medicaid Enterprise System Conference (MESC) underway, we have another Medicaid Enterprise Certification Toolkit (MECT) Release. On July 31, 2018, the Centers for Medicare and Medicaid Services (CMS) issued the MECT Version 2.3.

Although there is no legal requirement to have a formal shareholder agreement, it’s a good idea for any company with more than one shareholder to have one, as it reduces the potential for conflict between shareholders, helping the company run smoothly and profitably. 

Is your state Medicaid agency considering a Centers for Medicare and Medicaid Services (CMS) Section 1115 Waiver to fight the opioid epidemic in your state? States want the waiver because it provides flexibility to test different approaches to finance and deliver Medicaid services.

All business owners need to consider a business valuation, ideally updated annually. A current business valuation is important for your company’s financial health as it can:

Are you struggling to improve business outcomes through modifications to your software solutions? If so, then you have no doubt tried — or are trying — traditional software implementation approaches. Yet, these methods can overwhelm staff, require strong project management, and consume countless hours (and dollars).

By now, you know all about the new corporate tax rate — a flat rate of 21% vs. the previous top tax rate of 35% — arguably the most publicized change of the recently passed Tax Cuts and Jobs Act (TCJA).

Any sports team can pull off a random great play. Only the best sports teams, though, can pull off great plays consistently — and over time. The secret to this lies in the ability of the coaching staff to manage the team on a day-to-day basis, while also continually selling their vision to the team’s ownership.

For over four years the business community has been discussing the impact Accounting Standards Codification (ASC) 606, Revenue from Contracts with Customers, will have on financial reporting. As you evaluate the impact this standard will have on a manufacturers’ financial reporting practices, there are certain provisions of ASC 606 you should consider.

The late science fiction writer (and college professor) Isaac Asimov once said: “I do not fear computers. I fear the lack of them.” Had Asimov worked in higher ed IT management, he might have added: “but above all else, I fear the lack of computer staff.”

When an organization wants to select and implement a new software solution, the following process typically occurs:

People are naturally resistant to change. Employees facing organizational change that will impact day-to-day operations are no exception, and they can feel threatened or fearful of what that change will bring. Even more challenging are multiyear initiatives where the project’s completion is years away.

Cost increases and labor issues have contributed to the rise of outsourcing as an option for senior living and health care providers.  While outsourcing of all types is a growing trend — from the C-suite to food service, it is a decision that should be considered carefully, as lack of planning could result in significant long-lasting financial, public relations and personnel losses. 

The day-to-day work of providing government services involves collecting, using, and storing large amounts of data. The data that government agencies accumulate is a critical asset — it holds answers about which programs perform best, which interventions are most effective, and how to improve service delivery. 

A professional sports team is an ever-changing entity. To have a general perspective on the team’s fluctuating strengths and weaknesses, a good coach needs to trust and empower their staff to discover the details. Chapter 5 in BerryDunn’s Cybersecurity Playbook for Management looks at how discovery can help managers understand their organization’s ever-changing IT environment. 

While new software applications help you speed up processes and operations, deciding which ones will work best for your organization can quickly evolve into analysis paralysis, as there are so many considerations.

Over the course of its day-to-day operations, every organization acquires, stores, and transmits Protected Health Information (PHI), including names, email addresses, phone numbers, account numbers, and social security numbers.

With the rise of artificial intelligence, most malware programs are starting to think together. Fortinet recently released a report that highlights some terms we need to start paying attention to:

Just as sports teams need to bring in outside resources — a new starting pitcher, for example, or a free agent QB — in order to get better and win more games, most organizations need to bring in outside resources to win the cybersecurity game.

The first time a student walks into a business class, they may expect to learn a lot about numbers. What they might not realize is they are walking into a foreign language class! 

As a leader in a higher education institution, you'll be familiar with this paradox: Every solution can lead to more problems, and every answer can lead to more questions. It’s like navigating an endless maze. When it comes to mobile apps, the same holds true. 

The recent Tax Cuts and Jobs Act includes many sweeping tax law changes, some of which left taxpayers scrambling at the end of 2017 to maximize tax saving opportunities. While the dust settles on tax reform at the federal level, the whirlwind at the state level is just beginning, with many unanswered questions.

Large-scale projects require extensive planning, quick decision-making, thoughtful problem-solving, and above all else, resourcefulness. One way to be resourceful? 

It may be hard to believe some seasons, but every professional sports team currently has the necessary resources — talent, plays, and equipment — to win. The challenge is to identify and leverage them for maximum benefit.

Did you know that there was more than a 40% increase (from $4.3 billion to $6.0 billion) in civil penalties assessed by the IRS regarding employment tax, for the 2016 fiscal year?

Texting has become a simple, convenient, and entrenched component of our everyday lives. We use it with family, friends, coworkers—and clients. My wife and I text to coordinate day care pickup and drop off of our kids every day.

We know, both from our experience as external auditors (all of us) and years of experience working in private sector firms (many of us), that changing audit firms can be a painful process. NOTE: if you’re a current BerryDunn client, feel free to stop reading here.

It’s one thing for coaching staff to see the need for a new quarterback or pitcher. Selecting and onboarding this talent is a whole new ballgame. Various questions have to be answered before moving forward: 

Private-sector pundits love to drone on about drones! Also known as Unmanned Aircraft Systems (UASs), drones are dramatically altering processes and increasing opportunities in the for-profit world. 

Success is slippery and can be evasive, even on the simplest of projects. Grasping it grows harder during lengthier and more complex undertakings, such as enterprise-wide technology projects—and requires incorporating a variety of short- and long-term strategies. 

When it comes to IT security, more than one CEO running a small organization has told me they have really good people taking care of “all that.” These CEOs choose to believe their people perform good practices. 

A penalty letter doesn’t mean the IRS is correct, but it’s important you know what to do to avoid paying an erroneous penalty. 

Most of us have been (or should have been) instructed to avoid using clichés in our writing. These overstated phrases and expressions add little value, and often only increase sentence length. We should also avoid clichés in our thinking, for what we think can often influence how we act.

In a previous blog post, “Six Steps to Gain Speed on Collections”, we discussed the importance of regular reviews of long-term care facility financial performance indicators and benchmarks, and suggestions to speed up collections. 

Is your organization a service provider that hosts or supports sensitive customer data, (e.g., personal health information (PHI), personally identifiable information (PII))? 

The relationship between people, processes, and technology is as elemental as earth—and older than civilization. From the first sharpened rock to the Internet of Things, the three have been crucially intertwined and interdependent. 

For professional baseball players who get paid millions to swing a bat, going through a slump is daunting. The mere thought of a slump conjures up frustration, anxiety and humiliation, and in extreme cases, the possibility of job loss.

After working with state health policy for seven years and Medicaid for 16, I had the opportunity for the first time to attend the 30th Annual National Association of State Health Policy (NASHP) Conference on October 23–25, 2017. Here are my top three takeaways.

The Federal Perkins Loan Program expiration date has passed without extension and now the countdown is on for the program wind-down.

Of course, we’re all suffering from “data breach fatigue.” But some breach announcements carry considerably more risk to the victim than others. For example, if I had received a letter saying a credit card of mine had been compromised, the end result would be simple:

The Merriam-Webster Dictionary defines leadership as having the capacity to lead. Though modest in theory, the concept of leadership permeates all industries and is a building block for every organization’s success. 

As more state and local government workers enter retirement, state and local agencies are becoming more dependent on millennial workers — the largest and most educated generation of workers in American history. But there is a serious gap between supply and demand.

Have you ever had a project derail at the last minute, or discovered that a project’s return on investment did not meet projections? These types of issues happen in the final stages of a project, often as a result of incorrect or incomplete stakeholder identification.

The MESC “B’more for healthcare innovation” is now behind us. This annual Medicaid conference is a great marker of time, and we remember each by location: St. Louis, Des Moines, Denver, Charleston… and now, Baltimore. 

Here’s a challenge for you: Can you identify the number one predictor of project success? According to Prosci, the leading change-management research organization, the answer is the project sponsor.

A year ago, CMS released the Medicaid Enterprise Certification Toolkit (MECT) 2.1: a new Medicaid Management Information Systems (MMIS) Certification approach that aligns milestone reviews with the systems development life cycle (SDLC) to provide feedback at key points throughout design, development, and implementation (DDI).

Today’s senior living providers must ensure that their mission and vision for the future are built on a healthy financial plan and structure. Here are some things you should know to build just that.

While GASB has been talking about split-interest agreements for a long time (the proposal first released in June of 2015, with GASB Statement No. 81, Irrevocable Split-Interest Agreements released in March of 2016), time is quickly running out for a well-planned implementation.

Because we’ve been through this process many times, we’ve learned a few lessons and determined some best practices. Here are some tips to help you promote a positive post go-live experience.

Some days, social media seems nothing more than a blur of easily forgettable memes. Yet certain memes keep reappearing to the point where we have no choice but to remember them. 

Four steps to take if you get an ACA Tax Penalty Notice from the IRS. It’s been almost a year since the IRS filing deadline for 2015 Forms 1094-C and 1095-C. Most expected the IRS to issue employer penalty notices related to the 2015 calendar year in late 2016.

We have talked about the two recent GAAP updates for years now: 1) changes to the lease accounting and 2) changes to revenue recognition standards. 

We all know them. In fact, you might be one of them — people who worry the words “go live” will lead to job loss (theirs). This feeling is not entirely irrational. 

Recently the Governmental Accounting Standards Board (GASB) finished its Governmental Accounting Research System (GARS), a full codification of governmental accounting standards.

We humans have a complex attitude toward change. In one sense, we like finding it. For instance: “Now I can buy something from the vending machine!” In reality, we try to avoid change as much as possible. Why? 

RANSOMWARE UPDATE: It happened again. Another ransomware attack hit very large corporations around the globe. Much like WannaCry, a worm spread through entire networks, and locked out encryption data and systems.

On June 16th the FASB issued the final standard for credit losses. We’ve analyzed the new standard and pulled together some key items you’ll need to know:

As the technology we use for work and at home becomes increasingly intertwined, security issues that affect one also affect the other and we must address security risks at both levels.

In July 2016, we wrote about how the booming microbrewery scene in Maine is shaking up the three-tier system of alcohol distribution, which dates back to the 1930s.

As we begin the second year of Uniform Guidance, here’s what we’ve learned from year one, and some strategies you can use to approach various challenges, all told from a runner's point of view.

During my lunch in sunny Florida while traveling for business, enjoying a nice reprieve from another cold Maine winter, I checked my social media account.

When last we blogged about the Financial Accounting Standards Board’s (FASB) new “current expected credit losses” (CECL) model for estimating an allowance for loan and lease losses (ALLL), we reviewed the process for developing reasonable and supportable forecasts for use in establishing the ALLL. 

Government projects conducted in challenging conditions require trust, collaboration, communication, and project management acumen to succeed. Here are five recommendations for project success.

Recently, federal banking regulators released an interagency financial institution letter on CECL, in the form of a Q&A. Read it here

NEW IRS proposed guidance is welcome news and provides not-for-profit employers with more flexibility than originally expected.

Electronic accessibility in every aspect of modern life has increased ten-fold, but government — and courts in particular — has been slow to follow.

When it comes to offering non-qualified deferred compensation to executives of not-for-profit organizations, there aren’t many options.

People love the idea of being able to conveniently charge their phones without a cable or having to hunt for a plug. Free charging stations are popping up everywhere.

By now, pretty much everyone in the banking industry has heard plenty of talk about CECL – the forthcoming “Current Expected Credit Loss” model of accounting for an institution’s allowance for loan losses (ALL).

Financial fraud by the numbers. In a June 2016 Gallup poll, 72 percent of respondents said they had “very little” or only “some” confidence in banks.

By now you have heard that the Financial Accounting Standards Board’s (FASB) answer to the criticism the incurred-loss model for accounting for the allowance for loan and lease losses faced during the financial crisis has been released in its final form. 

Many of my hospital clients have an increased incidence of providing temporary housing for locums, temps and some employees and, as a result, have questions regarding the proper tax reporting to these individuals.   

With the implementation of GASB 72 now in full force, GASB organizations are hard at work drafting their new fair value disclosures. The addition of a fair value hierarchy table in the footnotes will add a bit more thickness to a likely already hefty financial package. 

There is plenty of media coverage of Maine’s, and specifically Portland’s, burgeoning microbrew scene. It’s good economic development and complements the already established “foodie” scene Portland is renowned for.

Online banking? Check. Online shopping? You bet. Online permit application submittal? What? Actually, yes. As Americans are becoming more and more accustomed to performing everyday functions online, local governments are evolving and keeping up with the times. This online evolution is coming in the form of implementing modern enterprise applications with electronic workflow and a public-facing portal that allows residents to apply for permits, submit documentation, pay for, and collaborate with local government staff to perform a variety of processes.

Why it can happen to you and how to protect yourself. We’ve all seen the headlines. Stories about not-for-profit fraud have been popping up in the news, and the statistics confirm what you might have suspected: fraud in the not-for-profit sector is on the rise.

With the most recent overhaul to the Form 990, Return of Organization Exempt From Income Tax, the IRS has made clear its intention to increase the transparency of a not-for-profit organization’s mission and activities and to promote active governance. To point, the IRS asks whether a copy has been provided to an organization’s board prior to filing and requires organizations to describe the process, if any, its board undertakes to review the 990.

Remember the old adage about pornography? “I know it when I see it,” said the Supreme Court Justice Potter Stewart. 

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.

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Understanding Trump Accounts: A new savings option for families

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.    

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Get key Medicare Advantage insights: MedPAC's June 2025 report

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. 

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Seven essential ways nonprofit boards can lead AI adoption with integrity and impact 

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 

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Healthcare today: Regulatory changes, technology, and the path ahead

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. 

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AI in denials management and prevention: A strategic imperative