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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 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.

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.

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.

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. 

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.

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).

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.

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.

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).

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 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. 

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).

Enterprise Resource Planning (ERP) systems provide a shared platform for people in your organization to work together––and the benefits can be game changing. That said, an effective strategy involves more than simply choosing the right software platform. Integrating your systems will change the way people in your organization work, and change can be challenging! For that reason, change management should be a key component of your ERP implementation project.

Here are eight key success factors to help guide your organization through an ERP implementation.

ERP implementation: The planning phase

ERP implementations rely on collaboration and communication across departments. So, from the start, set up your organization for success.

1. Stakeholder buy-in

Before you plunge in, you need everyone on board. That means helping employees understand the need for change and gaining buy-in from key stakeholders across departments who will help implement and later use the system. It’s critical to have senior management's sponsorship to reinforce decisions made along the way.

2. Strong project management

Establish your project management team right away. Create clearly defined roles and responsibilities, protocols for team collaboration, and project governance structures for decision-making. Senior management’s role is to set the tone and direction of the project and provide visible and active executive sponsorship throughout the process.

ERP implementation: The platform and vendor selection phase

The next milestone is to choose your ERP solution through an RFP process. The RFP should clearly define the functional and technical requirements of the ideal solution and also describe your organization’s business process.

3. Early vendor engagement

Engage vendors through pre-RFP activities such as vendor outreach sessions. This gives your team the opportunity to familiarize themselves with potential partners, explore options, and assess vendor compatibility issues.

4. Partner with the vendor

Plan the ERP implementation with your vendor. Based on the scope of work, set realistic expectations and timelines that take into consideration the staff involved and other responsibilities they may have. As soon as possible, work with the vendor to begin data conversion, interface planning, training, and testing.

ERP implementation: Launch phase

Organizations are often challenged during the ERP implementation process by their staff’s reluctance to accept new roles and responsibilities. An internal change management focus can help maintain staff confidence and keep stakeholders engaged.

5. Prepare your organization for change

Consistent communication is vital. Keep your employees engaged and empowered to do their best by providing regular updates, reaffirming confidence in your staff and empathy for their challenges, and showing active, visible executive support.

6. Test, test, test

In the course of an ERP implementation, you can expect crashes and bugs––even with the most well-designed software. Test at the early stages and continue throughout the implementation to ensure your ERP system functions properly and any issues are identified and fixed before going live.

7. Train, train, train

It’s easy to underestimate the time it takes to train people on new systems and processes. Discuss a plan for customized training with your vendor early on. To make end-user training successful, training should begin before the implementation phase and continue beyond it. Customize your training programs and materials and hold regular cross-functional team meetings.

ERP implementation: Stabilization phase

Stabilization is a process of optimizing your ERP system so that your organization can get the most out of its investment. This includes identifying post-go-live assistance, developing a plan for further training and support, and confirming roles and responsibilities for IT and key users of the system.

8. Reinforce the change

Continue to communicate with your staff about the reasons you began your ERP journey in the first place––the benefits of sticking with the plan. Embed the ERP system within your culture and practices, beware of backsliding, and develop a plan for maintenance and continuous improvement.

BerryDunn’s local government team partners with municipal, county, regional, and quasi-governmental entities to meet the most critical needs of your community. Whether we’re helping clients with strategic planning, economic development, public safety, or organizational excellence, we take pride in tailoring our projects to fit your unique needs, either at the enterprise level or within and across departments. We care about what we do, and we care about the people impacted by our work.  

BerryDunn provides ERP consulting to local and state governments, higher education institutions, and for-profit organizations. Learn more about our ERP consulting services. 

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ERP implementation: 8 key success factors

Read this if you administer a 401(k) or 403(b) plan.

On December 20, 2019, the Setting Every Community Up for Retirement Enhancement (SECURE) Act was signed into law, with SECURE Act. 2.0 signed into law December 23, 2022 (the SECURE Acts). 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.

Many 401(k) retirement plan sponsors have elected to set up minimum service requirements for their plan. Such requirements help eliminate the administrative burden of offering participation to part-time employees who may then participate in the plan for a short period of time and then keep their balance within the plan. Although plan sponsors do have the ability to process force-out distributions for smaller account balances, a minimum service requirement, such as one year of service, can help eliminate this situation altogether.

Although 403(b) plans are required to offer universal eligibility, plans may exclude employees who are expected to work less than 20 hours a week from the plan. Such employees are often excluded for the same administrative burden reason mentioned above.

The SECURE Acts will require “long-term part-time employees” to be offered participation in 401(k) and 403(b) plans (subject to ERISA) if they are over the age of 21. The idea behind the requirement is that 401(k) and 403(b) plans are responsible for an increasingly larger amount of employees’ retirement income. Therefore, it is essential that part-time employees, some of whom may not have a full-time job, have the ability to save for retirement.

Under the SECURE Act, ”long-term part-time” is defined as any employee who works three consecutive years with 500 or more hours worked each year. This new secondary service requirement became effective January 1, 2021. The SECURE Act 2.0 then reduced the three-year period to two years for plan years beginning after December 31, 2024. Previous employment prior to January 1, 2021, will not count toward the three-year requirement. Therefore, the earliest a long-term part-time employee may have become eligible to participate in a plan under the secondary service requirement was January 1, 2024. These employees also earn vesting service for years with 500 hours of service.

The Internal Revenue Service (IRS) issued proposed regulations in 2023 covering the new long-term part-time service requirement and, on October 3, 2024, issued IRS Notice 2024-73, which, among other things, indicates that the final regulation the Treasury Department and IRS intend to issue related to this matter will apply no earlier than to plan years that begin on or after January 1, 2026. The IRS Notice also clarifies that 403(b) plans that exclude students from plan eligibility will not be required to make the plan available to such students if they meet the long-term part-time rules. This is because the student employee exclusion is a statutory exclusion based on a classification rather than on service.

Originally, this provision was only applicable to 401(k) plans; however, SECURE Act 2.0 expanded this provision’s reach to 403(b) plans as well. Furthermore, although long-term part-time employees will be allowed to make elective deferrals into 401(k) and 403(b) plans, management may choose whether to provide non-elective or matching contributions to such participants. These participants also may be excluded from nondiscrimination and top-heavy requirements.

This requirement will create unique tracking challenges as plans will need to track hours worked for recurring part-time employees over multiple years. For instance, seasonal employees who elect to work multiple seasons may inadvertently become eligible. We recommend plans work with their recordkeepers and/or third-party administrators to implement a tracking system to ensure participation is offered to those who meet this new secondary service requirement. If a feasible tracking solution does not exist, or plans do not want to deal with the burden of tracking such information, plans may also consider amending their minimum service requirements by reducing the hours of service requirement from 1,000 hours to 500 hours or less. Or, in the case of 403(b) plans, plans may consider allowing those employees who are expected to work less than 20 hours per week the opportunity to participate in the plan. However, this may allow more employees to participate than under the two-year, 500-hour requirement and may increase the employer contributions each year if there is not a different service requirement for employer contributions.

If you have questions regarding your particular situation, please contact our Employee Benefit Audits team. We’re here to help.

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New Permissible Minimum Service Requirements for 401(k) and 403(b) Plans

Read this if you work for a healthcare organization in a patient access or revenue cycle leadership or optimization role.  

We’ve written before about the importance of the patient access check-in process in your revenue cycle. One of the key strategies to making the 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 to leverage. 

Five steps to creating an effective patient access script 

1. Consider what information you need to collect and when 

The best practice is to proactively collect and/or confirm insurance and patient demographic information at each encounter. If a patient carries more than one insurance, be sure to clarify which insurance should be primary. Doing this correctly up front will save time and prevent denials and associated workload and revenue loss. 

2. Be clear about the information you need and don’t make assumptions 

When you ask a patient if any information has changed since the last time they were in, they likely don’t remember. Instead, it is critical to ask the patient to confirm or provide their information each time.  

Example: When proactively collecting patient information  

Instead of "Have there been any changes to your information since you were last seen here?" 

Say this: "To ensure your account is as accurate as possible, we require all patients to present a minimum amount of information."  

3. Be direct about payments 

Many patient access team members may try to soften the language about making payments in an effort to be polite and create a good experience. Providing scripting around this can help. Scripting should be polite but direct.  

Example: When collecting co-pays  

Instead of "You have a $20 co-pay today. Would you like to pay it?"

Say this: "You have a $20 co-pay today. How would you like to pay it: Cash, credit card, or check?"   

4. Provide context 

The majority of patients don’t completely understand the healthcare system in general, or your systems in particular. If the patient is required to do something, provide context so they understand. Always help patients understand the "why." 

Example: When connecting a self-pay patient to a Financial Counselor  

Instead of: "We can’t schedule you until you speak with someone in finance."

Say this: "Before scheduling your appointment, I will connect you with a financial counselor who can determine if you qualify for assistance and help you understand your financial obligations."

 5. Stay positive 

Changes to the patient check-in process can be frustrating to staff. Change is hard. If you’re implementing new workflows or processes that the staff is still learning, providing scripting can help them explain, in a positive way, to patients why the process is slower than usual. 

Example: When establishing a new patient culture  

Instead of: "I’m sorry, I have to do these new workflows."

Say this: "Our healthcare system has recently implemented improved processes to ensure that you are receiving the highest level of care. "

Communicating clearly, consistently, and positively is important to put patients at ease, and to make sure that you collect the most accurate and up-to-date information from patients. Once you’ve created scripting to support your processes, the next step is to train staff on the scripting provided. Providing ongoing support and feedback to patient access staff will help them feel more confident in their day-to-day communications.  

Get more patient check-in tips to help your revenue cycle.  

BerryDunn's audit, tax, clinical, and consulting professionals, focused on specific healthcare industry areas, understand the biggest challenges facing healthcare leaders, and are committed to helping you meet and exceed regulatory requirements, maximize your revenue, minimize your risk, improve your operations—and most importantly—facilitate positive outcomes. Learn more about our healthcare consulting team

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Five steps to clear patient communication scripts

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.

One of the true highlights of the conference was the chance to connect with professionals across the field. Our booth on the exhibit hall floor was buzzing with energy as we reconnected with past clients, built new relationships, and had insightful conversations with park and recreation professionals from across the country.

We had the honor of leading several sessions during the conference, many with current and past clients, including:

  • “Planting the Seeds of Success: Cultivating a Positive Workplace Culture, Strategically!” with Nikki Ginger
  • “Artificial Intelligence: A Panel Discussion,” with Ryan Hegreness and Lakita Frazier
  • “Squirrel! … Staying Focused With a Coworker Who Has ADHD” with Dannielle Wilson
  • “Unveiling the Wizardry Behind a Career in Consulting” with Barbara Heller, Elsa Fischer, and Nikki Ginger
  • “Parks and Recreation in the Age of Artificial Intelligence,” and “Artificial Intelligence: Productivity and Pitfalls” with Ryan Hegreness
  • “Parks Level of Service – How a Data-Driven Approach Can Help Create a More Equitable Park System” with Jeff Milkes
  • “Excellent Operations: Data, Dashboards, and Smart Decisions” with Becky Dunlap

Beyond our own involvement, we had the pleasure of celebrating the remarkable achievements of several our current clients. A special congratulations to the South Suburban Park and Recreation District (CO), City of New Braunfels Parks and Recreation (TX), and Douglasville Parks and Recreation (GA), all of whom were awarded Grand Plaques in the 2024 NRPA Gold Medal Awards! These honors are a testament to their exceptional work in long-term planning, resource management, and community engagement, and we couldn’t be more proud to partner with them.

We also had the privilege of contributing to NRPA’s strategic vision as a sponsor of the NRPA Business Council. It was incredible to witness how the work we were able to collaborate on to shape NRPA’s new strategic plan came to life in the keynote speeches and discussions throughout the conference.

The 2024 NRPA Annual Conference reminded us why we are so passionate about what we do. Every conversation, every session, and every connection strengthened our belief that parks and recreation is not only thriving but poised for even greater things. Let’s keep moving forward, together!

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NRPA 2024: Meaningful connections and remarkable achievements

The Federal Deposit Insurance Corporation (FDIC) recently issued its second quarter 2024 Quarterly Banking Profile. The report provides financial information based on call reports filed by 4,539 FDIC-insured commercial banks and savings institutions. The report also contains a section specific to community bank performance. In the second quarter of 2024, this section included the financial information of 4,104 FDIC-insured community banks. BerryDunn’s key takeaways from the report are as follows:

Second quarter of 2024 resulted in community banks’ quarterly net income increasing $72.6 million from the previous quarter.

Quarterly net income for community banks increased 1.1% in second quarter 2024, resulting in $6.4 billion in quarterly net income. This increase was the result of higher net interest and noninterest income, which more than exceeded the increase in noninterest expense. Despite the increase in quarterly net income, full year net income declined. Compared to second quarter 2023, net income had decreased $568.9 million, or 8.2%. More than half (61.6%) of all community banks reported an increase in net income compared to first quarter 2024.

Net interest margin (NIM) sees its first quarterly increase to 3.30% since fourth quarter 2022, but continues to remain below the average quarterly NIM of 3.51% over the past 10 years.

Community banks’ NIM increased 7 basis points from the prior quarter. However, NIM was down 9 basis points from the year-ago quarter. The yield on earning assets increased 54 basis points while the cost of funds increased 63 basis points from the year-ago quarter. Community banks’ NIM performance continued to prevail over the overall banking industry’s NIM of 3.16%, which declined 1 basis point in second quarter 2024. Community banks have only shown quarter-over-quarter NIM growth while the overall banking industry showed a decline once over the past five years.

Loan and lease balances continued to grow in second quarter 2024, with 75.7% of community banks reporting quarterly loan growth. 

Loan and lease balances continued to see widespread growth in second quarter 2024. Community banks saw loan growth in all major portfolios. Nonfarm, nonresidential commercial real estate (CRE) loans exhibited the most growth from first quarter ($7.9 billion or 1.4%), followed closely by residential real estate ($7.8 billion, 1.7%). Total loans and leases grew 6.3% from one year ago. This year-over-year growth was also driven by residential real estate and nonfarm, nonresidential CRE loans, which showed growth year-over-year of $30.5 billion (7.0%) and $33.9 billion (6.3%), respectively. The largest loan growth year-over-year, percentage-wise, was with farm loans, which saw a 7.2% increase.

The gap between the quarterly net charge-off rate for community banks and all other banks continues to build. 

Community banks witnessed a 2 basis point increase from the prior quarter and a 5 basis point increase from the prior year. However, the ratio remains 1 basis point lower than the pre-pandemic average of 0.15%. The increase was significantly impacted by the nearly 39% annual increase in net charge-off volume in the moderately sized loan portfolio of commercial and industrial loans (represents 12.8% of total loan balances for community banks). The net charge-off rate for commercial and industrial loans increased 16 basis points from one year earlier to 0.37%. The industry’s net charge-off rate increased 3 basis points to 0.68% from the prior quarter and was 20 basis points higher than one year earlier and the pre-pandemic average. The industry banks’ net charge-off rate for the quarter was the highest reported rate since second quarter 2013.

In September, the Federal Reserve cut interest rates by 50 basis points, the first time the Federal Reserve has cut interest rates since 2020. Although most were speculating that a rate cut was imminent, there was some dissent as to the magnitude of the rate cut and whether it would be 50 basis points or a more modest 25 basis points. Even with the more aggressive 50 basis point cut, the Federal Reserve has signaled that more rate cuts in 2024 are likely. With the reduction in rates, and the expectation this will only bolster bank profitability in the long run, attention has returned to bank merger and acquisition (M&A) activity. As indicated in the second quarter Quarterly Banking Profile, in quarter 2 alone, community banks declined to 4,104, down 27 from the previous quarter. This decline was primarily due to M&A, with 22 out of the 27 community banks having merged out of existence during the quarter. Many believe this is just the beginning. As the need for cutting-edge technology becomes more prevalent to remain competitive, some banks are being squeezed out of the industry as the upfront technology investment needed to remain competitive is too steep.

Another notable trend from quarter 1 to quarter 2 2024 was an increase in the number of institutions on the FDIC’s “Problem Bank List,” which increased from 63 to 66 (this stat is for all banks, not just community banks). This jives with the increases in the net charge-off ratios, as noted above. The consensus we’ve received from those with “boots on the ground” is that regulators are laser-focused on well-defined weaknesses in credits and are being more stringent and unwavering on ratios that are indicative of a needed downgrade. For instance, if debt service coverage ratio is below 1, unless liquidity and/or guarantor strength is a mitigant to downgrade and there is clear support for this mitigant, that relationship should be downgraded to a classified risk rating category. If anything, this is a sign of the regulators’ concerns about credit quality, even with the possibility of a “soft landing” seemingly on the rise. As always, please don’t hesitate to reach out to your BerryDunn’s Financial Services team should you have any questions.

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FDIC Issues its Second Quarter 2024 Quarterly Banking Profile