Samuel Accounting Services PLLC

09/22/2026

🌱 Healthcare CFO Brief | Ambient AI and Clinical Documentation

Why Healthcare Owners Should Pay Attention to Ambient Scribe AI

Clinical documentation is an integral part of healthcare service delivery. It is not simply about regulatory compliance. It demonstrates what care was provided, supports continuity of care, and ultimately helps determine whether healthcare organizations get paid for the services they deliver.

As someone cleverly stated: “If it’s not documented, it wasn’t delivered.”

Clinical documentation is now experiencing a major technological advancement through Artificial Intelligence, generally known as Ambient Scribe AI. In simple terms, Ambient Scribe AI can work in the background during a patient or client visit , capture relevant information from the conversation, and help generate a structured clinical note for the caregiver to review and approve.

This is not just a technology for hospitals and physician offices.

WellSky, for example, has introduced an Ambient Documentation solution that streamlines assessment completion, care plan evaluation, and client onboarding for personal care agencies.

Andy AI is another an ambient AI scribe for home health. It listens during the visit while the clinician focuses on the patient and helps document the encounter directly in the record.

So the question is no longer simply: “Will Ambient AI eventually come to home health?” Ambient AI is already being introduced into home health.

The benefits from this technology is enormous. Suppose a home health agency completes 10,000 visits per year and Ambient AI saves just 15 minutes per visit.

10,000 visits × 15 minutes = 2,500 clinician hours per year.

But this is important: The agency has not automatically saved 2,500 hours of payroll. The financial benefit depends on what happens to that recovered capacity.

Nevertheless, at minimum, it makes sure visits are documented, team member show up at the client house, denials due to incomplete documentation is possibly eliminated and ultimately some financial returns from your return on investment.

The technology may reduce the burden of creating documentation, but it does not eliminate the organization’s responsibility for the accuracy and integrity of the medical record.

🧩 Healthcare CFO Insight

Before implementing Ambient AI, establish a baseline for your return on investment and balanced outcomes assessment.

🎯 Executive Takeaway

Ambient AI has already begun moving into home health. The opportunity is bigger than simply allowing AI to write clinical notes.

The technology may be clinical, but the business case is financial.

💬 Boardroom Question

If Ambient AI could give every caregiver in your organization 15 minutes back on every visit, what would those recovered hours be worth to your organization?

09/11/2026

Healthcare CFO Brief | Additional Medicaid Changes

The Medicaid Change Home Care Owners May Not Be Talking About Yet

Earlier this week, we discussed several major Medicaid changes under the One Big Beautiful Bill, including changes to eligibility, work and community-engagement requirements, more frequent eligibility reviews, and reduced retroactive coverage.

I intentionally left out another major change because it deserves its own discussion: restrictions on Medicaid provider taxes and state-directed payments.

Hospitals and other large healthcare organizations are paying close attention to this issue, but it is receiving far less attention in the home care and group home community. Perhaps this perceived lack of interest is due to the fact that most of these providers don’t directly pay provider taxes.

Why Provider Taxes Matter

Medicaid is jointly funded by the federal government and the states. For the Medicaid expansion population, the federal government pays 90% of the cost, but states still have to finance their share.

States finance the non-federal share of Medicaid spending through various sources, including general fund revenue and provider taxes imposed on hospitals, nursing facilities, managed care organizations, ambulance providers and other entities specifically designed to help finance the program.

States can use this revenue to help finance their Medicaid share and draw federal matching dollars. Provider taxes have also helped support supplemental and state-directed Medicaid payments without requiring an equivalent increase in state general-fund spending.

This financing mechanism is widespread: every state except Alaska had at least one Medicaid provider tax in 2025, according to HHS.

So What Is Changing?

The One Big Beautiful Bill does not eliminate the 90% federal match for Medicaid expansion.

Instead, it restricts some of the mechanisms states have used to finance Medicaid. The law limits new or increased provider taxes, progressively lowers permissible provider-tax levels for many provider classes in Medicaid expansion states, and places new limits on state-directed payments.

The scale is significant. HHS reports that state-directed payments grew from approximately $43 billion in 2021 to $144 billion in 2025 and, without the new legislation, were projected to exceed $300 billion by 2034.

The rules are complicated, but the financial question is simple:

If states have less flexibility to generate Medicaid financing through these mechanisms, where will the replacement money come from?

Why Should Home Care and Group Home Owners Care?

Your agency may never pay a provider tax, but your reimbursement still depends on the broader Medicaid financing system.

States could replace constrained financing with additional general-fund dollars or restructure their Medicaid programs. But where sufficient replacement funding isn’t available, policymakers could face difficult decisions involving provider reimbursement, future rate increases, benefits, utilization controls, supplemental payments, or other Medicaid spending.

That does not mean every state will cut home care or group home rates. The impact will depend heavily on each state’s financing structure and policy response.

🧩 Healthcare CFO Insight

Your reimbursement rate sits on top of a larger system of state funding, federal matching dollars, provider taxes, managed care arrangements, and supplemental payments.

Changes to that system can eventually reach your income statement.

🎯 Executive Takeaway

Financial constraints on the state Medicaid funding budget could have ripple effects on future rate increases, tighter eligibility requirements and reductions on services coverage

💬 Boardroom Question

If your state faced increasing Medicaid funding pressure over the next three years, and decide to hold rate constant, how much of your agency’s revenue would be exposed?

09/08/2026

🌱 Healthcare CFO Brief | Medicaid Changes

Your Medicaid Clients’ Eligibility Is Changing. Is Your Agency Ready?

On July 4, 2025, President Donald Trump signed the One Big Beautiful Bill into law. The legislation included major changes to Medicaid eligibility, and enrollment. In today’s post, I want us to focus on several changes taking effect October 1, 2026, and January 1, 2027 that could affect home care agencies, group homes, home health agencies, and other Medicaid providers across the country.

The financial impact will vary depending on each provider’s Medicaid population, payer mix, and how the changes are implemented in their state. But if Medicaid represents a meaningful part of your business, these are changes you cannot afford to ignore. They can affect patient coverage, authorization, and ultimately cash flow.

October 1, 2026 — Eligibility Changes for Certain Noncitizen Adults

Beginning October 1, 2026, only the following immigration statuses will qualify for Medicaid: U.S. citizen, U.S. national, Lawful Permanent Resident, Cuban-Haitian Entrant, or Compact of Free Association migrant.

This means that if you have a client with some immigrants granted official humanitarian protections, including refugees, asylees, and trafficking survivors will no longer be eligible for Medicaid starting October 1, 2026 and you therefore need to verify their eligibility.

For providers, the practical question is much simpler:

Do you know whether any of the Medicaid clients you currently serve could be affected beginning October 1?

January 1, 2027 — New Work Requirements

Beginning January 1, 2027, certain adults covered through Medicaid Expansion will be subject to new federal work and community-engagement requirements unless they qualify for an exclusion or exemption.

The federal framework generally requires affected individuals to complete 80 hours per month of qualifying activities such as employment, education, work training, or community service. The requirement can also be satisfied through certain other pathways, including qualifying income or educational enrollment. Many exclusions and exemptions apply such as :

* Caretakers for children 13 and under
* Caretakers for individuals with disabilities
* Pregnant individuals
* People with disabilities

For providers, the important takeaway isn't memorizing every eligibility rule. It is recognizing that some clients may face new conditions for maintaining Medicaid coverage that did not previously apply to them.

January 1, 2027 — More Frequent Eligibility Reviews

Another important change is the move to six-month eligibility renewals for Medicaid Expansion members instead of every 12 months.

Operationally, that means more points during the year when a member's eligibility could change. A missed notice, incomplete renewal, change in circumstances, or failure to satisfy an applicable requirement could potentially interrupt coverage.

For a home care agency providing recurring services every week, that creates a very real revenue-cycle concern.

One More Change Providers Should Watch: Retroactive Coverage

Beginning January 1, 2027, the One Big Beautiful Bill also shortens Medicaid retroactive-coverage periods. The law has cut retroactive coverage from 90 days to just 30 for Medicaid Expansion or 60 other Medicaid eligibility groups.

This matters most because providers may have less opportunity to resolve some eligibility problems after services have already been delivered. Discovering an eligibility issue weeks or months later could therefore create greater financial exposure.

Taken together, these changes reinforce one important lesson:

Eligibility needs to be actively monitored, not checked once and assumed to remain unchanged.

🧩 Healthcare CFO Insight

This is the time to understand your Medicaid patient population and identify clients who could potentially be affected by the new eligibility requirements.

Special attention should be placed on eligibility verification and building systems that routinely confirm coverage before services are delivered. The goal isn't simply to comply with Medicaid rules. It is to reduce the possibility that your agency delivers care, pays caregivers, and later discovers that reimbursement is unavailable.

👥 Leadership Challenge

Before October 1, review your Medicaid eligibility process and ask: Who verifies eligibility? How frequently is it checked? What happens when coverage changes? How quickly are scheduling and billing notified? And how many visits could your agency provide before discovering that a client's eligibility has changed?

If your organization operates in multiple states, review guidance from each state Medicaid program. The changes originate in federal law, but implementation and operational details can vary by state.

🎯 Executive Takeaway

There are two dates Medicaid providers should have on their radar:

October 1, 2026: Federal eligibility changes affecting certain noncitizen adults begin.

January 1, 2027: New work and community-engagement requirements, six-month eligibility renewals for Medicaid Expansion members, and reduced retroactive coverage begin taking effect.

💬 Boardroom Question

If one of your Medicaid clients became ineligible next month, how many visits would your agency provide before your team discovered it?

09/04/2026

🌱 Healthcare CFO Snapshot™

Why Your Revenue Is Up But Your Margin Isn’t

Recently, I was analyzing two patients who received almost identical services from my healthcare organization. Both went to the same ambulatory surgery center, received a similar outpatient back procedure, were treated by the same surgeon, and were discharged home after a similar amount of time. From a clinical and operational standpoint, the cases looked almost identical. Financially, however, they were very different.

For one patient, the organization received approximately $18,000. For the other, reimbursement was approximately $90,000. The major difference was not the procedure, surgeon, or location. It was the insurance coverage. That experience was a strong reminder that in healthcare, providing the same service does not necessarily mean receiving the same reimbursement.

The same principle applies to home care agencies. The differences between Medicaid, Medicare, managed care plans, private insurance, and private-pay patients may not always be as dramatic, but they can still have a meaningful impact on financial performance. Two agencies can serve the same number of patients, provide a similar number of service hours, and still generate very different margins because their payer mix is different.

This is where growth can sometimes be misleading. Patient volume may be increasing, caregiver hours may be increasing, and total revenue may even be increasing, yet profitability can still weaken if more of that growth is coming from lower-reimbursing payers, slower-paying payers, or contracts that require more administrative work to authorize, document, bill, and collect. A payer that brings significant volume is not automatically a payer that strengthens the business.

🧩 Healthcare CFO Insight

Volume alone does not determine financial performance. Who pays for the care can be just as important as how much care you provide. A growing agency can still become less profitable if its payer mix shifts toward contracts with lower reimbursement, higher administrative cost, or slower collections.

👥 Leadership Challenge

Review your last 12 months of revenue by payer. Compare reimbursement per patient or service hour, payment speed, administrative burden, direct cost of delivering care, and estimated margin. Then ask yourself: Which payers are driving volume, which are driving revenue, and which are actually driving profit?

🎯 Executive Takeaway

Do not manage your agency only by patient count or total revenue. Understand the mix behind the revenue and how that mix is affecting margin, cash flow, and long-term growth.

💬 Boardroom Question

If your largest payer increased from 25% to 50% of your business next year, would that strengthen your agency financially—or create greater risk?

08/31/2026

08/26/2026

📊 Healthcare CFO Snapshot™

Your Financial Statements Are Telling a Story. Are You Reading It?

On Monday, I shared a conversation with a business owner whose first question after receiving a detailed financial package was, “So, how much do I owe in taxes?” It was a reminder that many small-business owners still view accounting primarily through the lens of tax compliance. But once we move beyond the tax question and start looking at what the financial reports are actually telling us, the conversation becomes much more interesting.

Consider a home care agency whose revenue increased significantly over the past year. At first glance, that sounds like good news. More clients, more billable hours, and more revenue should mean the business is moving in the right direction. But when we look deeper, we discover that operating margin declined, accounts receivable increased, and despite the higher revenue, cash decreased.

Suddenly, the important question isn't “How much do I owe in taxes?” It becomes: “If revenue is growing, why doesn't the business appear financially stronger?”

To answer that question, we need more than one financial report.

Three Reports. One Financial Story.

The Income Statement, Balance Sheet, and Cash Flow Statement each answer a different management question. Looking at only one can give an owner part of the picture while leaving out something important.

1. Income Statement — Are We Actually Making Money?

Revenue tells us how much business the agency generated. The Income Statement helps us understand whether that activity translated into operating profit. If revenue increased but operating margin declined, something underneath the growth changed. Caregiver payroll, overtime, administrative expenses, insurance, or other operating costs may be consuming more of every revenue dollar.

This is why revenue growth by itself can be misleading. Revenue tells us the agency grew. Operating margin helps us understand whether that growth translated into stronger operating profitability. When revenue is growing while operating margin is shrinking, expenses are outpacing revenue somewhere, and management needs to understand what's driving it.

2. Balance Sheet — Are We Becoming Financially Stronger?

The Balance Sheet answers a different question. It shows the agency's financial position—what the business owns, what it owes, and what is left for the owners. For a home care agency, some of the important areas to watch include cash, accounts receivable, accounts payable, loans, and owner's equity.

Suppose revenue is increasing, but accounts receivable and debt are also climbing while cash remains tight. That's information the Income Statement alone can't fully explain. Leadership now needs to understand whether claims are taking longer to collect, whether growth is requiring additional borrowing, and whether the agency's overall financial position is actually improving.

3. Cash Flow Statement — Where Did the Cash Go?

This is where many owners become frustrated. The Income Statement says the business made a profit, but the bank account doesn't seem to reflect it. The Cash Flow Statement helps explain why cash increased or decreased during the period. More money may be tied up in receivables, debt may have been repaid, equipment may have been purchased, or cash may have been used for another purpose.

Profit and cash are related, but they aren't the same thing. That's why looking only at the bottom line—or only at the bank balance—can leave an owner with an incomplete understanding of what's happening financially.

The Numbers Should Lead to Better Questions

Now the financial picture begins to make more sense. Revenue increased, but operating margin declined, receivables increased, and cash decreased. Instead of simply celebrating growth, leadership can start asking better questions: Are labor costs increasing faster than reimbursement? Are we using too much overtime? Are claims taking longer to collect? Are receivables aging? Are administrative expenses growing too quickly? Are we growing faster than our cash can support?

The financial statements don't make those decisions for management. They tell management where to look. And that brings us back to the three questions from Monday: What changed? Why did it change? What should we do about it?

That's when accounting begins moving from simply reporting history to helping leadership manage what happens next.

💡 Healthcare CFO Insight™

No single financial statement tells the entire story. The Income Statement shows operating performance. The Balance Sheet shows financial position. The Cash Flow Statement explains the movement of cash. Together, they give leadership a much more complete picture of what's happening inside the business.

🛠️ Leadership Challenge™

Pull your most recent Income Statement, Balance Sheet, and Cash Flow Statement and review them together. Don't try to analyze every number at once. Find one significant change and ask: What changed? Why did it change? What should we do about it?

The goal isn't simply to understand the reports. The goal is to use them to manage the business.

🎯 Executive Takeaway™

Revenue growth can tell you that your agency is getting bigger. Your financial statements help you determine whether it's actually getting financially stronger. Don't just read the numbers. Understand the story they're telling and use that story to make better decisions.

💬 Boardroom Question™

If your agency's revenue increased significantly this year, but cash and operating margin both declined, would you still call that a good year?

08/24/2026

📊 Healthcare CFO Brief™

# The Question That Caught Me Off Guard

Recently, I spent hours preparing for a meeting with a business owner. I reviewed the financial statements, analyzed operating results and trends, and prepared summaries to explain how the business had performed and where there might be opportunities for improvement. Walking into the meeting, I expected questions about profitability, expenses, cash flow, and margins.

But before we really got into the reports, the owner asked:

“So, how much do I owe in taxes?”

I smiled, not because taxes aren't important. They absolutely are. But I had spent hours preparing information that could help us understand the financial performance of the business, and the owner's first concern was simply how much she would have to pay in taxes. The more I thought about that conversation afterward, the more I realized that this owner isn't unusual.

# # When Accounting Becomes a Tax Exercise

For many small-business owners, accounting is closely associated with tax compliance. Transactions get recorded, bank accounts get reconciled, financial information goes to the accountant, the tax return gets prepared, and the owner finds out how much is owed. Once that's done, attention quickly returns to finding clients, hiring employees, managing schedules, marketing, and increasing revenue.

That's understandable. Those activities feel directly connected to business growth. But focusing almost entirely on them can cause us to overlook an important question:

Is all this growth actually making the business financially stronger?

Without understanding profitability, cash flow, margins, and financial trends, an owner may know the business is getting bigger without really knowing whether it is getting stronger.

# # The Reports Were Telling a Bigger Story

The reports sitting in front of us weren't simply there to calculate taxable income. They could tell us whether revenue growth was translating into better profitability, whether expenses were growing faster than revenue, whether the business was generating enough cash, whether margins were improving or declining, and where management needed to pay closer attention.

Those aren't simply accounting questions. Those are leadership questions.

Accurate accounting tells us what happened. Financial management turns that information into questions, decisions, and action.

# # From Tax Compliance to Financial Leadership

Think about how larger healthcare organizations operate. Their leaders don't wait until tax season to find out how the organization performed. Financial results are reviewed throughout the year, performance is compared against expectations, trends are monitored, significant changes are investigated, and that information is used to make operational and strategic decisions.

A home care agency doesn't need the finance department or reporting infrastructure of a large healthcare organization. But the principle is the same.

Your accounting system shouldn't only answer:

“How much do I owe in taxes?”

It should also help you understand:

“How is my business performing?”

“Why are the numbers changing?”

And ultimately:

“What should I do next?”

That's the shift from tax compliance to financial leadership.

# # 💡 Healthcare CFO Insight™

Tax compliance tells you what you owe. Financial management helps you decide what to do next.

Accounting shouldn't start and stop at tax season. Its greater value is helping business owners understand financial performance and make better decisions throughout the year.

# # 🛠️ Leadership Challenge™

The next time you receive your financial statements, don't simply review the bottom line and file them away. Ask three questions:

What changed? Why did it change? What should we do about it?

Those three questions can begin turning your financial reports from compliance documents into management tools.

# # 🎯 Executive Takeaway™

Accurate books help keep your business compliant. Understanding those books helps you manage it.

The real value of accounting isn't simply producing financial reports. It's using those reports to make better business decisions.

# # 💬 Boardroom Question™

If your accountant stopped filing your taxes tomorrow but continued sending you accurate monthly financial reports, would those reports still be valuable to you?

08/21/2026

📊 Healthcare CFO Brief™

# Could Your Agency Survive 90 Days Without You?

Imagine waking up tomorrow and learning that, because of an unexpected illness or emergency, you cannot work for the next 90 days.

Your home care agency doesn't stop.

Friday still comes.

Caregivers expect their paychecks. Clients expect care. Claims need to go out. Receivables need to come in. Payroll taxes, insurance, rent, and other bills still become due.

But you aren't there.

Could your agency continue operating without you?

Earlier this week, we discussed something I hear from many small-business owners:

"My business is my retirement plan."

If that's true, understanding your financial condition is important—but so is protecting what you're building.

# # When the Owner Is Also the System

In many small businesses, the owner doesn't simply own the company. The owner approves payroll, controls banking relationships, monitors collections, maintains key relationships, and makes the hard calls when something goes wrong. Often the critical processes aren't even documented, because the owner already knows how everything works.

In other words: the owner is also the system. That works fine while you're there every day. But that also means a single missed login, a single relationship only you maintain, or a single decision only you're authorized to make can quietly stop the business cold.

If too many critical functions depend on one person, an unexpected absence becomes both an operational and a financial risk—fast.

# # Cash Reserves Aren't Enough

Personal financial planning teaches us to maintain emergency savings because life doesn't always go according to plan. A business needs reserves for the same reason: if reimbursements slowed or an unexpected expense hit, how long could your agency meet payroll and other obligations without immediately borrowing?

Most home care agencies I work with can answer "how much cash do we have" but not "how many days will that actually last us." That single number—your days of cash on hand—is worth calculating this week, not someday.

But cash alone doesn't solve owner dependency. A resilient agency also needs documented processes, delegated responsibilities, cross-trained team members, secure access to critical information, and clear decision-making authority. Cash protects the agency's ability to meet its obligations. Systems protect its ability to keep operating. You need both.

# # From 90 Days to Retirement

Now take the scenario one step further. If you build systems that let your agency operate during a 90-day absence, you're also reducing how heavily the business depends on your daily presence. That matters if the business is truly part of your retirement plan.

One day, you may want to work fewer hours. You may want a management team running daily operations, a family member continuing the business, or a buyer to sell it to. There's a real difference between owning a business that depends heavily on you and building one that can continue without you.

The goal isn't to create a job for yourself. It's to build a business that can operate beyond the owner—and over time, to build financial security beyond the business itself.

# # 💡 Healthcare CFO Insight™

The owner shouldn't be the agency's emergency plan. Cash reserves protect the business financially. Systems, documented processes, delegated authority, and capable people protect its ability to operate.

# # 🛠️ Leadership Challenge™

Give your agency the 90-Day Owner Absence Test. If you couldn't work for the next 90 days, could your agency:

- Continue serving clients?
- Schedule and pay caregivers accurately?
- Submit claims and collect receivables?
- Pay taxes, vendors, and other obligations?
- Access critical banking and financial information?
- Make important decisions without you?
- Continue operating without emergency borrowing?

Every "No" identifies something worth strengthening—not because you're expecting an emergency, but because a resilient business shouldn't depend entirely on your daily presence to keep operating.

# # 🎯 Executive Takeaway™

If your business is your retirement plan, don't just build revenue. Build reserves, systems, and people—so the business is worth more precisely because it doesn't depend entirely on you.

# # 💬 Boardroom Question™

If you couldn't work for the next 90 days, would you still own a functioning business—or would you have a financial emergency?

Reply yes if your agency is prepared

08/19/2026