Skip to Main Content

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

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 Public Company Accounting Oversight Board (PCAOB) has released its 2024 Annual Report on the Interim Inspection Program for audits of broker-dealers. This 10th annual report outlines persistent deficiencies in broker-dealer audits and attestation engagements. For management and audit committees, the report offers crucial insights into audit risks, regulatory expectations, and areas where stronger oversight is needed.

Persistent deficiencies raise oversight red flags

In 2024, the PCAOB inspected 60 accounting firms and reviewed 102 audits of broker-dealer financial statements. The PCAOB also examined 93 related attestation engagements—either examinations of compliance reports or reviews of exemption reports. The results were:

  • 66% of broker-dealer audits had at least one deficiency related to audit evidence.
  • 59% of compliance examinations and 42% of exemption reviews were found deficient.
  • Deficiencies were most prevalent among smaller firms that audit fewer broker-dealers or issuers.

These statistics reflect a growing concern about audit quality in the broker-dealer space—and highlight where management and audit committees should be particularly vigilant.

Key areas of concern identified
 

1. Revenue recognition and accuracy

Deficiencies in auditing revenue were the most common and serious. This is nothing new, as revenue had been the area cited with the most deficiencies in the 2023 and 2022 reports as well. Of the 102 audits reviewed, 97 included revenue testing—nearly half (48%) had deficiencies.

Common problems included failure to:

  • Verify the accuracy of commissions, advisory fees, 12b-1 fees, and merger/acquisition fees.
  • Confirm that performance obligations were distinct and satisfied prior to revenue recognition (as required by ASC 606).
  • Disaggregate revenue sources appropriately to reflect their nature and timing.
  • Assess the classification and disclosure of revenue, including required qualitative information.
  • Test the accuracy and completeness of third-party reports (e.g., clearing broker data) used in audit procedures.

For example, some firms did not test whether securities trade amounts and commission rates were accurate, nor did they evaluate whether revenue from variable annuity trails or 12b-1 fees should have been disaggregated. Others did not ensure advisory fee calculations were tied to accurate Assets Under Management (AUM) data or fee schedules.

Takeaway for management and audit committees:

Audit committees should confirm that revenue processes—including fee calculation, classification, and third-party data use—are well-documented and transparent. Management should ensure contracts and performance obligations are clearly delineated and that disclosures meet ASC 606 requirements. An ASC 606 practice aid, which walks management through the five-step revenue recognition process, can be useful to take inventory of the broker-dealer’s various contracts and how revenue from those contracts should be recognized in the financial statements. Such a practice aid can also prove useful in crafting ASC 606 disclosures.

2. Journal entry testing and fraud risk

Deficiencies in journal entry testing—critical for identifying and responding to fraud risk—were found in 18% of audits.

Common issues included:

  • Failing to test the completeness of journal entry populations
  • Selecting entries without considering fraud risk characteristics
  • Reviewing listings but not examining supporting documentation
  • Excluding flagged entries from testing without documented rationale
  • Testing too few entries to provide sufficient audit assurance

The PCAOB specifically noted that many auditors failed to respond appropriately to the risk of management override of controls—a key component of fraud risk under PCAOB standards.

Takeaway for management and audit committees:

Ensure your auditors are applying rigorous, risk-based journal entry testing and that internal finance and compliance teams are involved in identifying and monitoring manual entries, especially at period end. Make sure that supporting documentation is retained for all posted journal entries. Also, ensure the journal entry posting process is clearly documented, including the types of journal entries that can be posted, by whom, and who the designated reviewer is. Having such a process clearly documented will make it easier for auditors to understand your broker-dealer’s journal entry process, which is a critical first step in effective journal entry testing.

3. Related party relationships and transactions

Deficiencies in this area were particularly concerning given the potential for misstatement or hidden liabilities. The PCAOB found that some auditors:

  • Did not test allocations of revenues and expenses between broker-dealers and affiliates
  • Failed to assess the financial capability of affiliates to cover material receivables
  • Missed required disclosures of related party transactions under ASC 850

In one case, auditors accepted related-party expense allocations without verifying whether they were accurate, complete, or consistent with underlying agreements.

Takeaway for management and audit committees:

Ensure formal agreements with affiliates are in place and that intercompany transactions are reviewed regularly. If changes to related party transactions are made, these changes should be formally documented in the form of agreement amendments. If an allocation methodology, such as headcount or time studies, is used, broker-dealers must ensure this allocation methodology is thoroughly documented and followed. Disclosures about related parties must be clear and complete. Committees should confirm that auditors are probing related party risks—not just accepting management’s assertions.

Key areas of concern identified – examination engagements (compliance reports)

Of the 29 examination engagements reviewed, 59% had at least one deficiency. Common issues included:

  • Incomplete testing of controls over compliance with SEC financial responsibility rules (e.g., the Net Capital Rule, Customer Protection Rule)
  • Failure to evaluate the design and operation of controls with a review component (e.g., how management reviews reserve computations or account statements)
  • Insufficient testing of IT general controls upon which other control procedures depended
  • Lack of compliance testing over reserve account balances and the existence of securities held for customers
  • Improper or missing representation letters from broker-dealer management
  • Failure to issue modified opinions when material weaknesses in internal control over compliance (ICOC) existed

Takeaway for management and audit committees:

Engage in proactive conversations with your auditor about the internal controls they expect to see in place over the financial responsibility rules. Gain an understanding of your auditor’s testing approach, ensuring it aligns with the expectations of the PCAOB. Throughout the year, make sure sufficient documentation is retained so your auditor can easily test ICOC. Again, what is deemed sufficient should be determined through proactive conversations with your auditor.

Key areas of concern identified – review engagements (exemption reports)

Among the 64 review engagements evaluated, 42% had deficiencies. Key failures included:

  • Inadequate understanding of the broker-dealer's exemption under Rule 15c3-3
  • Insufficient inquiry into controls or monitoring practices related to exemption compliance
  • Failure to test or inquire about the handling of customer checks to ensure prompt transmittal
  • Errors or omissions in review reports—such as referencing assertions not made or failing to include required language

Takeaway for management and audit committees:

If your broker-dealer claims an exemption, ensure operational practices support that status. Review internal monitoring processes and make sure what is happening in practice aligns with your written supervisory procedures. If exceptions to your exemption status are identified, ensure they are promptly corrected and that your auditor is notified of the exception.

What you can do now

To help improve the quality of oversight:

  • Engage in proactive dialogue with your auditor about the PCAOB’s findings and how they apply to your engagement.
  • Assess your auditor’s broker-dealer experience—particularly if your firm is served by a smaller firm.
  • Re-examine and test your internal controls over customer protection, capital computations, revenue recognition, and related-party arrangements.
  • Strengthen audit committee oversight by requesting clear audit strategies, better documentation, and enhanced reporting on high-risk areas like revenue and related parties.
  • Confirm that required auditor communications are received and appropriately documented.

Final thought

The PCAOB’s report is a call to action—not just for auditors, but for management and those charged with governance. As regulatory expectations continue to rise, management and audit committees must ensure that internal processes, control environments, and auditor relationships are all aligned to support accurate, transparent, and compliant financial reporting.

About BerryDunn

BerryDunn's financial services team understands the complex regulatory environment that broker-dealers operate in and provides practical solutions to help you stay ahead of requirements. From broker-dealer financial statement audits to tax preparation and compliance to consulting services, we tailor our services to meet your unique needs. Learn more about our team and services.

Article
PCAOB 2024 inspection report: Takeaways for broker-dealers and audit committees

The Centers for Medicare & Medicaid Services (CMS) issued the final rule for the PPS for SNFs for FY 2026 which was published in the Federal Register on August 4, 2025; the regulations in this rule are effective October 1, 2025.  

The rule: 

  • Updates the PPS payment rates for SNFs for FY 2026 using the market basket update and budget neutrality factors effective October 1, 2025. 

  • Updates the International Classification of Diseases, 10th Revision, Clinical Modification (ICF-10) code mappings used under PDPM. 

  • Updates the SNF Quality Reporting Program (SNF QRP).

  • Updates the SNF Value-Based Purchasing (SNF VBP) Program. 

2026 PPS rate calculations 

The final rule provides a productivity-adjusted market basket increase for SNFs of 3.2% beginning October 1, 2025, which reflects: 

  • A market basket increase of 3.3% based on IHS Global Inc.’s (IGI’s) second quarter 2025 forecast with historical data through the first quarter of 2025.  

  • An upward forecast error adjustment of 0.6% due to the difference between the estimated and actual percentage increase in the market basket exceeding the 0.5 percentage point threshold.  

  • A downward 0.7 percentage point multifactor productivity adjustment (based on the 10-year period ending September 30, 2026).  

The unadjusted federal rates for FY 2026, prior to adjustment for case-mix, are as follows: 

FY 2026 Unadjusted Federal Rate Per Diem – Urban 

Rate Component PT  OT  SLP  Nursing NTA Non-Case-Mix
Per Diem Amount $75.73   $70.49   $28.28   $132.00   $99.59  $118.21






FY 2026 Unadjusted Federal Rate Per Diem – Rural 

Rate Component PT  OT  SLP  Nursing NTA Non-Case-Mix
Per Diem Amount $86.33  $79.29  $35.63  $126.12 $95.15 $120.40





The rates shown in the tables above are subsequently case-mix adjusted, and a facility-specific wage index—determined by the Core-Based Statistical Area (CBSA) in which each facility is located—is also applied. To assist you with the calculation of your facility-specific PPS rates for FY 2026, our experts at BerryDunn have updated our interactive rate calculator, which is part of the BerryDunn Senior Living Portal.  

Please note: The rates per our calculator are prior to any FY 2026 VBP adjustment. When CMS releases the final VBP incentive payment multipliers for FY 2026, BerryDunn will update the interactive rate calculator as necessary. 

CMS estimates that the aggregate impact of the payment policies in this final rule would result in a net increase of 3.2%, or approximately $1.16 billion, in Medicare Part A payments to SNFs in FY 2026. This estimate does not reflect a projected $208.36 million decrease as a result of the SNF VBP program reductions. 

The projected overall impact to providers in urban and rural areas is an average increase of 3.1% and 3.7%, respectively, with a low of 2.0% for urban Pacific providers and a high of 6.6% for rural Mountain providers—actual impact will vary. 

Changes in PDPM ICD-10 code mappings 

CMS has changed the clinical category assignment for 34 new ICD-10 code mappings that were effective October 1, 2024. These updated code mappings can be found on the PDPM website

SNF QRP Update 

Updates to the SNF QRP Program include: 

  • CMS finalized removing four items that were previously adopted as standardized patient assessment data elements in the Social Determinants Of Health (SDOH) category, starting with the FY 2027 SNF QRP. These are: 

    • One item related to Living Situation,

    • Two items concerning Food

    • One item regarding Utilities   

  • Finalized and codified changes to the reconsideration policy and process. Now, SNFs will be permitted to request an extension to file a reconsideration request. Additionally, CMS is updating the criteria that will be used to evaluate and potentially grant these reconsideration requests. 

SNF VBP Program update 

Updates to the SNF VBP Program include: 

  • The Health Equity Adjustment (HEA) will be removed beginning in the FY 2027 program year, to streamline the scoring methodology and offer clearer incentives for SNFs.  

  • Final performance standards for the FY 2028 and FY 2029 program years were provided to meet the SNF VBP Program's statutory notice deadline.  

  • The previously established scoring methodology will be applied to the SNF Within-Stay Potentially Preventive Readmission (SNF WS PPR) measure, starting with the FY 2028 program year, to align the scoring methodology for this measure with the scoring methodology previously finalized and applied to all other measures in the measure set.  

  • Adoption of a new reconsideration process, allowing SNFs to seek reconsideration on Review and Correction requests. 

The following table lists the measures that have been adopted for the SNF VBP Program, along with their status in the program for the FY 2026 program year through the FY 2029 program year. 

 Measure FY 2026 Program Year FY 2027 Program Year  FY 2028 Program Year  FY 2029 Program Year 
SNF 30-Day All-Cause Readmission Measure (SNFRM)  Included  Included 
SNF Healthcare-Associated Infections Requiring Hospitalization (SNF HAI) measure  Included  Included  Included  Included 
Total Nurse Staffing Hours per Resident Day (Total Nurse Staffing) measure  Included  Included  Included  Included 
Total Nurse Staff Turnover (Nursing Staff Turnover) measure  Included  Included  Included  Included 
Discharge to Community – Post-Acute Care Measure for SNFs (DTA PAC SNF)  Included  Included  Included 
Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay) (Falls with Major Injury (Long-Stay)) measure  Included  Included  Included 
Discharge Function Score for SNFs (DC Function) measure  Included  Included  Included 
Number of Hospitalizations per 1,000 Long Stay Resident Days (Long Stay Hospitalization) measure  Included  Included  Included 
SNF Within-Stay Potentially Preventable Readmissions (SNF WS PPR) measure  Included  Included 

































If you have any specific questions about the final rule or how it might impact your facility, please contact Ashley Tkowski or Melissa Baez

Article
Fiscal Year (FY) 2026 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule

As financial institutions continue to navigate evolving regulatory landscapes, the recently enacted OBBBA legislation introduces a noteworthy incentive aimed at supporting rural and agricultural development. Effective July 4, 2025, the bill provides a 25% federal income tax exemption on interest income earned from qualifying rural or agricultural real estate loans.  

This represents a strategic opportunity for lenders to reassess their portfolios and tax planning strategies. With further guidance expected, institutions should begin preparing to identify eligible loans and evaluate the broader implications of this new provision. 

Key information for financial institutions 

  • Effective date: Applies to qualifying loans originated on or after July 4, 2025. 
  • Exemption: 25% of the interest income earned on these loans will be tax-exempt. 
  • Ineligible loans: Refinanced loans do not qualify. 
  • Qualified loans: Loans must be secured by rural or agricultural real estate, defined as property substantially used for: 
  • Producing agricultural products (not defined) 
  • Fishing or seafood processing 
  • Aquaculture (hatcheries, rearing ponds, pens, etc.) 
  • Leasehold mortgages on such real estate also qualify, provided they have lien status 

Please also note that, similar to municipal bond investments, these loans are subject to IRC Section 265, which may limit deductibility of interest expense allocable to the tax-exempt income. 

Considerations for financial institutions

Loan identification and tracking: Determine whether any existing lending activity aligns with these definitions and develop a method for flagging and tracking qualifying loans after the effective date. 

Strategic expansion: Assess whether this creates an incentive to expand your presence in agricultural or rural real estate lending. 

Loan pricing models: Revisit pricing for these types of loans to account for the blended tax benefit and any associated disallowed interest expense. 

Tax planning: Analyze how this partial exemption could affect your effective tax rate and broader tax strategies going forward, particularly as it creates a permanent tax difference. 

About BerryDunn

BerryDunn's dedicated audit, tax, and consulting professionals understand the financial services industry and its challenges and are committed to helping you meet and exceed regulatory requirements. We partner with you to bring tailored approaches to fit your needs and operations and provide guidance on best practices and recommendations that make sense for you. Learn more about our services and team.  

Article
New tax exemption boosts incentives for rural and agricultural lending

Executive Order (EO) 14221 released on February 25, 2025, directed the Secretaries of Labor, Health and Human Services (HHS), and the Treasury to implement changes to improve implementation and increase enforcement of the hospital price transparency (HPT) rule. On May 22, 2025, the agencies announced progress in implementing the EO, including issuance of a request for information (RFI), as well as providing updated guidance regarding requirements for machine readable files. 

HPT enforcement 

An HHS Office of Inspector General (OIG) audit report released in November 2024 estimated only 46% of hospitals were in compliance with HPT rule requirements. While the HHS OIG noted a variety of issues with shoppable services requirements, the most common areas of non-compliance observed related to the machine readable file (MRF), including: 

  • Failing to update the file annually 

  • Lack of appropriate naming conventions 

  • Providing negotiated charges by payer/plan

Civil monetary penalties (CMP) for HPT non-compliance range from $300 to $5,500 per day, depending on hospital bed count. From 2021 – 2024, CMS issued CMP notices totaling approximately $5 million.  

Based on reports from our clients and anecdotes shared by compliance and finance colleagues and from presenters at recent conferences, HPT-related complaints from patients have remained minimal, whereas the pace of CMS non-compliance warning letters has increased. 

Practical tips for HPT compliance 

The risks related to non-compliance with HPT rules can be mitigated through a multidisciplinary team approach, establishing accountability, and engaging external resources to fill gaps in expertise. 

  • Making certain to include the functions with an HPT role, such as finance, revenue cycle, revenue integrity, compliance, IT, and payer contracting 

  • Considering the vendor as part of the team if any aspect of HPT rule compliance is outsourced 

  • Designating an internal resource to monitor and advise your team on HPT-related announcements from regulators and CMS enforcement activity 

  • Linking chargemaster/CDM and fee schedule updates to MRF and shoppable services maintenance activities supports compliance with multiple HPT requirements 

  • Adding HPT-related audit items to the compliance work plan to demonstrate internal oversight 

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. 

Article
Hospital price transparency compliance: It's a team sport

Read this if you are a CFO or on the fundraising team at a nonprofit organization. 

Capital campaigns can be game changers for nonprofits, enabling bold investments in infrastructure, programs, and long-term growth. Whether you're building a new facility, expanding services, or upgrading technology, a capital campaign aligns fundraising with your strategic vision. 

When to consider a capital campaign 

A capital campaign may be right if your organization lacks the funds for a major initiative or your annual budget is unable to support a strategic opportunity. Capital campaigns are also ideal for: 

  • Infrastructure improvements  

  • Major construction or renovations  

  • New or expanded programs 

Capital campaigns often inspire larger gifts and deeper donor engagement than annual appeals, especially when the purpose is clearly communicated.   

Key success factors 

A successful campaign requires more than passion; it demands planning, clarity, and commitment from leadership and the board. Consider these best practices: 

  • Clear messaging: Campaign materials should define the fundraising goal, project purpose, and how funds will be used. Avoid overly restrictive language if flexibility is needed. 

  • Community engagement: Events, media outreach, and visibility efforts help build momentum and attract new supporters. 

  • Board involvement: Active leadership from your board and executive team is essential to credibility and success. 

If you're including an endowment component, remember: Endowed gifts are donor-restricted in perpetuity. Only investment returns, not the original gift, can be used for the restricted purpose. The availability of investment returns is typically determined by a board-approved spending policy that follows the Uniform Prudent Management of Institutional Funds Act (UPMIFA)

Accounting for capital campaigns under GAAP 

Proper classification and reporting are critical. Follow FASB ASC 958-205 to ensure compliance: 

  • Purpose-restricted gifts: Recognized as donor-restricted until the specified use or time condition is met. 

  • Endowment gifts: Always classified as donor-restricted in perpetuity; only earnings may be used per the donor’s intent and your spending policy. 

Final thoughts 

In uncertain economic times, a well-executed capital campaign can provide the resources and energy your nonprofit needs to thrive. With the right strategy, your campaign can strengthen donor relationships, elevate your mission, and leave a lasting impact. 

BerryDunn’s team of professionals serves a range of not-for-profit organizations, including but not limited to educational institutions, foundations, behavioral health organizations, community action programs, conservation organizations, and social services agencies. We provide the vital strategic, financial, and operational support necessary to help nonprofits fulfill their missions. Learn more about our team and services.  

Article
Is a capital campaign right for your nonprofit?