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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. 

This article is for CFOs, controllers, and directors of finance at companies that are owned by Employee Stock Ownership Plans, particularly recently established plans. 

Employee Stock Ownership Plans (ESOPs) are an attractive employee benefit, giving employees ownership interest in the company through shares of stock and an appealing exit strategy for founders. However, accounting for ESOP transactions can be confusing and cause frustrations for accountants. Understanding the basics of accounting for ESOP transactions is essential to avoiding inaccurate financial statements and ensuring compliance with US Generally Accepted Accounting Principles.  

Financing the ESOP 

ESOPs can be financed with internal or external loans. For an internal loan, the company provides the financing to the ESOP trust, essentially lending money directly to the trust for the purchase of shares. This type of loan is not recognized on the company’s General Ledger (GL), meaning it doesn’t appear as a liability or asset in financial statements. The ESOP trust receives contributions from the company, including the amounts required to repay the internal loan. If the company were to report the internal loan in its GL, it would artificially inflate the total assets on the company’s financial statements. An internal loan provides the company with greater control over provisions of the loan, such as interest rate and repayment terms. 

With external loans, funds are borrowed from either the selling shareholders, a financial institution, or both, and are reported on the company’s balance sheet. External loans are legal obligations of the ESOP trust. However, the company has an obligation to provide the trust with sufficient capital to service the loans and therefore must reflect the liability on the balance sheet.  

Unearned ESOP shares 

Unearned ESOP shares, sometimes referred to as unreleased shares, are shares that have been contributed to the trust but have not yet been allocated to individual employees. On the balance sheet, these shares are reported as a contra-equity account at the original transaction cost of the acquired shares, less the annual amount of shares, which are released for allocation to ESOP participants. Unearned ESOP shares are released at historical cost when repayment of the internal loan occurs.  

Commonly, companies will inappropriately report an ESOP note receivable rather than unearned ESOP shares, resulting in an overstatement of assets.  

ESOP compensation expense 

ESOP compensation expense is recorded annually based on the average fair value of the ESOP shares released for allocation to participants during the year. Shares are deemed to be released ratably throughout the year despite the fact that they are generally allocated at one time. The actual share allocation typically occurs several months after the financial statement date. However, an accrual is generally not required.  

ESOP compensation expense may be presented as a component of the cost of sales or selling, or general and administrative expenses. It is also permissible to present ESOP compensation expense as a component of other income and expense on the statement of income.  

About BerryDunn 

Whether your ESOP is newly established or mature, proper accounting is critical to accurate financial reporting. BerryDunn’s ESOP experts are excited to partner with employee-owners to help address any technical accounting or compliance matters. Learn more about our team and services. 

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Basic accounting for ESOP transactions: How to get it right

In recent years, the public health workforce has faced unprecedented challenges—from responding to the COVID-19 pandemic to addressing the impact of social determinants of health on communities to stark changes in policy at the federal level. These pressures have led to poorer quality of care, reduced access to services, diminished preparedness, and a decline in public trust in the public health system. As political tensions deepen and workplace stress intensifies, public health employees are reporting increased mental health concerns, including burnout and moral injury. 

To address this crisis, government and non-governmental agencies are implementing actionable strategies to support workforce wellness. These include trauma-informed leadership, peer support networks, flexible work policies, and regular wellness check-ins. By creating supportive environments and promoting resilience, organizations can strengthen the public health infrastructure and ensure the workforce is equipped to meet both current and future demands. 

Mental health and stigma 

The Public Health Workforce Interests and Needs Survey (PH WINS) reveals alarming levels of burnout among public health professionals. In 2021, nearly half of respondents reported frequent feelings of burnout—up from 32% in 2017. Similarly, nearly half expressed intentions to seek new employment, compared to 33% in 2017. 

These findings underscore the need for proactive measures such as open dialogue around mental health, access to resources, and flexible work arrangements. 

Read our previous article to explore PH WINS data and the evolving landscape of public health transformation. 

Understanding burnout and moral injury 

Burnout is closely linked to mental health conditions such as anxiety, depression, and trauma. It often manifests as exhaustion, reduced motivation, and cynicism. According to the National Center for PTSD, moral injury was initially identified in military veterans exposed to events that violated their deeply held moral beliefs. In the context of clinical health workers, moral injury is described as “knowing what your patients need and being unable to provide it due to external constraints.” 

These issues are increasingly prevalent across the public health workforce—from community health workers to epidemiologists—and affect both governmental and non-governmental organizations. The de Beaumont Foundation defines burnout as an occupational syndrome caused by chronic workplace stress, leading to emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Key contributors include excessive workloads, moral injury, and insufficient support. 

To mitigate these effects, agencies are encouraged to implement peer support programs, conduct interviews to understand retention drivers, and explore alternative support models such as the Critical Incident Peer Support Model used in emergency response sectors. 

Real-world impact 

The strain on public health workers is evident in crisis situations. For example, in January 2023, over 653,000 people—roughly 20 per 10,000—experienced homelessness in the U.S. As emergency shelters reached capacity, public health workers faced increased workloads with limited staffing and resources. The emotional toll of turning away individuals in need further deepens moral injury and burnout. 

These scenarios highlight the importance of building a dynamic public health emergency response infrastructure and reinforcing core public health functions to better support both the workforce and the communities they serve. 

Trauma-informed public health practice 

To support recovery and resilience, agencies are increasingly adopting trauma-informed approaches. These frameworks recognize the impact of trauma on both the workforce and the communities served. Trauma-responsive leadership can empower public health professionals to perform effectively while fostering healing. 

A trauma-informed organizational change model is built on four core assumptions—known as the “Four Rs”: 

  1. Realization of the widespread impact of trauma 
  2. Recognition of trauma symptoms 
  3. Response through integrated policies and practices 
  4. Resisting re-traumatization 

These are supported by six guiding principles that promote safety, trust, collaboration, empowerment, and cultural sensitivity. Agencies can use these principles to create trauma-informed environments that support healing and resilience. 

Key recommendations for agencies 

To champion mental wellness and build a resilient public health workforce, agencies can: 

  • Create supportive environments: Encourage open dialogue around mental health, provide access to supportive resources, and implement flexible work policies. 
  • Promote work-life balance: Support boundary-setting and offer flexible schedules to reduce overload. 
  • Establish peer support networks: Create safe spaces for sharing experiences and mutual encouragement. 
  • Conduct regular wellness checks: Use surveys and check-ins to detect early signs of burnout. 
  • Build leadership pathways: Review promotion practices and policies to help assure accessible career ladders within the public health agency 
  • Strengthen emergency response infrastructure: Develop dynamic systems to handle public health crises. 
  • Reinforce core public health functions: Invest in foundational capabilities. 
  • Foster trauma-responsive environments: Ensure organizational practices support healing and resilience. 

BerryDunn's public health team is comprised of former state and local health agency leaders and public health professionals with assessment and planning, accreditation readiness, technology solution planning and procurement, policy and program development, project management, health information exchange, and data modernization expertise. Learn more about our team and services. 

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Supporting mental wellness in the public health workforce

Most healthcare organizations conduct internal or external Evaluation and Management (E/M) audits on a monthly, quarterly, or annual basis to stay ahead of compliance risks and optimize reimbursement. While these audits can be stressful, given their association with risk, penalties, and payer scrutiny, when executed effectively, they can uncover significant opportunities within a practice. A well-structured E/M audit, combined with a strategic audit plan and targeted education, can shift the focus from apprehension to opportunity. Instead of asking, "Did we do something wrong?" the conversation transforms to, "What can we improve, clarify, or claim with greater confidence?" 

Audits frequently reveal consistent issues such as under-coding, vague documentation, or inconsistent use of templates. Addressing these concerns can lead to more accurate coding and enhanced revenue integrity. Implementing a strategic audit plan allows practices to proactively identify and correct such issues. By doing so, practices can not only avoid potential penalties but also optimize their revenue streams. Keep these things in mind during your next E/M audit:  

Involve certified coders for the most accurate and compliant E/M audit 

Certified coders help ensure that coding is precise and compliant with current regulations. Trained in CPT®, ICD-10-CM, and payer-specific E/M guidelines, coders apply their expertise to help ensure proper audits. They examine documentation and coding for issues. Coders also provide educational feedback to providers by looking at audit insights and then illustrating a finding for providers with examples from the provider’s notes. The improved documentation and corrected coding errors that result from the certified coder’s work help providers boost revenue through accurate reimbursements and reducing denials. 

Tie your E/M audit to physician education

The true advantage of audits emerges when findings are tied to education—specifically, sessions tailored to the provider’s specialty and utilizing examples from their own documentation. When providers comprehend the rationale behind the feedback, their engagement, confidence, and ability to improve increase significantly.  Comprehensive physician education remains critical, equipping providers with insights into intricate coding requirements and the necessity of detailed documentation. E/M audits extend beyond mere compliance checks. They are essential tools for continuous quality improvement, operational efficiency, and financial sustainability.  

Think strategically 

A strategic E/M audit plan is designed to continuously improve accuracy, compliance, and revenue integrity. By integrating certified coders and focused physician education into the audit process, practices can enhance their revenue integrity and ensure long-term success. A strategic audit plan, therefore, creates opportunities for improvement, turning potential apprehensions into avenues for advancement. 

BerryDunn’s healthcare compliance team incorporates deep, hands-on knowledge with industry best practices to help your organization manage compliance and revenue integrity risks. Learn more about BerryDunn’s team and services. 

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Keys to strategic and effective E/M audits

This content was originally published on the website of Washington State Association of Counties.

Artificial Intelligence (AI) is no longer a futuristic concept reserved for research labs or tech giants in Silicon Valley. Today, AI is becoming a practical and powerful tool for local governments across the country—helping to boost efficiency, reduce costs, and elevate the quality of public services. 

When people think of technology in local government, they often picture modest upgrades: digital kiosks at city hall, online form submissions, or automated customer service portals. While these improvements are helpful, they only scratch the surface of what’s possible. They’re incremental steps in a world that increasingly demands bold, transformative change. 

Traditionally, local government hasn’t been seen as a pioneer of innovation—and that’s okay. But the landscape is shifting. Rising service demands, workforce shortages and their expectations of the workplace, and tight budgets require new and innovative ways of doing business. While it’s natural to feel uncertain about AI, avoiding it will put your organization at a disadvantage. 

The real question isn’t if local governments should engage with AI—it’s how to do it thoughtfully and strategically. Embracing AI doesn’t mean replacing people; it means empowering them. In fact, as technology becomes more integrated into our daily work, human creativity, critical thinking, and leadership are more important than ever.

How does AI translate to the public sector? 

AI can support local governments in tackling complex, everyday challenges. For example: 

  • Revenue forecasting: AI-powered tools can help municipalities navigate economic uncertainty by identifying trends and improving budget accuracy. 
  • Workforce planning: AI systems can optimize staffing levels to match service demands, helping reduce unnecessary costs while maintaining service quality. 
  • Infrastructure maintenance: Public Works departments can use AI to analyze road usage and wear patterns, enabling proactive maintenance and smarter resource allocation. 

AI excels at analyzing data and surfacing insights—but it can’t set a vision or lead change. That’s the role of human leadership. Now more than ever, local governments need to think creatively and act strategically. Delaying key initiatives—like modernizing outdated systems or developing a long-term strategic plan—due to short-term budget concerns can hold communities back. Failing to plan is increasingly becoming more costly than taking action. Holding off on AI until you feel completely comfortable with it is not a viable strategy; forward-thinking municipalities are already realizing its benefits. 

By embracing innovation and focusing on the future, local governments can turn today’s challenges into tomorrow’s opportunities. The needs of your constituents are evolving, and so too must the capabilities of the governments that serve them. AI is not a replacement for real people doing real work—it’s a tool to help them do that work even better.  

How BerryDunn can help

The human aspect of projects can often be forgotten in the maze of regulatory changes and legal requirements with which organizations and government entities must comply. Whether we work with you from project inception or come in to refocus an initiative already underway, our team has the background to understand your needs, and the depth of project experience and technical expertise necessary to provide the guidance and support you need.

BerryDunn is not affiliated with any specific software vendor, allowing us to be truly objective. We stay abreast of the best solutions in the market, as well as industry best practices, emerging trends, and updates in the software vendor community. Our independence allows us to provide objective system consulting services and offer recommendations that serve your organization’s best interests. Learn more about our team and services. 

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Empowering communities: How AI can enhance local government services

"The National Recreation and Parks Association’s (NRPA) Conference is just around the corner, and the annual conference can really be overwhelming, especially for first-year attendees," shares Rich Neumann, manager with BerryDunn's Parks, Recreation, and Libraries team. "Here you have direct access to the brightest minds in our industry exploring the hottest trends in parks and recreation." With the conference approaching (September 16-19 in Orlando), our team of consultants and former practitioners shares their proven strategies for navigating this landmark event. 

Plan smart, stay flexible 

"I'm a big fan of going in with a plan," explains Ryan Hegreness. "Usually, I review the education sessions a week before and use the NRPA app or my Outlook calendar to schedule sessions. I pick a primary and backup session for each time slot—but don't overschedule yourself. The best conference experiences often come from those spontaneous hallway conversations." 

Include the exhibit hall in your pre-planning, advises Jason Genck. “The exhibit hall can be overwhelming. If there are particular areas you want to visit to gain information and learn more, make a game plan ahead of time to be sure you stay focused. 

Maximize learning opportunities 

"Go to every session and take advantage of every opportunity," advises Jeff Milkes, who's attended since 1984. "Get there early—some sessions may be standing room only. Sit in the front. You'll get the most out of each session when you're not busy thinking about emails or deadlines back at the office. Use the NRPA app by selecting everything that appears interesting to you. Do this a few days in advance and ignore the schedule conflicts. Then whittle down your list and make the hard choices." 

Focus on practical solutions 

"If you're anything like me," Rich Neumann suggests, "you might want to consider prioritizing presentations that are heavy on storytelling through case studies. While theory is great, nothing compares to seeing new ideas put into practical use." 

When exploring technology solutions, Erin Provazek advises: "Come to the conference with an idea of the major pain points you have with your current system. But it's equally important to have an idea of the functionality that works really well for you." 

Network naturally 

"Don't underestimate the value of the coffee line," Nikki Ginger emphasizes, drawing from 15 years of conference experience. "I have met some incredible people and some lifelong friends... these casual conversations really can lead to some incredible knowledge sharing and problem solving." 

For introverts, Ryan Hegreness offers a practical tip: "Having a role at a conference or event helps me connect with people more easily. This can be serving as a volunteer, getting involved in planning, being a room host, or leading an education session." 

Practice self-care 

"It's important to take care of staying hydrated, eating well, and making sure you're getting some rest," Dannie Wilson advises, "so that you can really fully participate and enjoy all the conference opportunities." 

Nikki adds, "Don't try to do it all. Take a break when you can... practice self-care," whether that's exploring Lake Eola Park or finding a quiet moment with coffee. 

Listen to these and more tips on the "Let's talk parks with BerryDunn" podcast! 

Sessions presented by our team members 

We love to talk parks! Please join us at these sessions presented by our team and clients.  

Design Together, Build Together, Play Together 

Date: Monday, September 15, 2025 
Time: 8:00 – 11:00 a.m. 
Speaker(s): Lisa Paradis, Stacey Dicke 

From Data Chaos to Clarity: Streamline Operations with Dashboards 

Date: Tuesday, September 16, 2025 
Time: 2:45 – 3:45 p.m. EST 
Speaker: Becky Dunlap 

Lights, Camera, Action? Social Media for the Social Beginner 

Date: Tuesday, September 16, 2025 
Time: 2:45 – 3:45 p.m. EST 
Speaker(s): Johnathan Skinner, Nikki Ginger 

Thriving as an Introvert in an Extroverted Industry 

Date: Wednesday, September 17, 2025 
Time: 4:15 – 5:15 p.m. EST 
Speaker: Ryan Hegreness 

Should I Stay or Should I Go? 

Date: Thursday, September 18, 2025 
Time: 9:00 – 10:00 a.m. EST 
Speaker: Lisa Paradis 

“Squirrel!” …staying focused with a coworker who has ADHD 

Date: Thursday, September 18, 2025 
Time: 9:00 – 10:00 a.m. EST 
Speaker: Dannielle Wilson 

Tackle Them If You Have To: Rethinking Traditional Approaches to Community Engagement 

Date: Thursday, September 18, 2025 
Time: 2:30 – 3:30 p.m. EST 
Speaker(s): Ryan Hegreness, Rich Neumann 

And be sure to visit us at Booth 932! As Rich jokes, forget the typical conference swag—stop by for "really terrible hand-drawn portraits... the one souvenir everyone will be talking about and maybe even crying over." 

See you in Orlando! 

Innovative strategies for parks, recreation, and libraries 

BerryDunn's consultants work with you to improve operations, drive innovation, identify improvements to services based on community need, and elevate your brand and image―all from the perspective of our team’s combined 100 years of hands-on experience. We provide practical park solutions, recreation expertise, and library consulting. Learn more about our team and services.  

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Making the most of NRPA: Tips, stories, and sessions from the BerryDunn team