Joe Gamis, CFE, MBA

Joe has been with Myers and Stauffer for 12 years, leveraging his expertise in healthcare reimbursement and Medicaid financing strategies. He plays a key role in guiding state Medicaid agencies through the development, implementation, and ongoing management of various hospital prospective payment systems (PPS), including diagnosis-related groups (DRG), ambulatory payment classifications (APC), and enhanced ambulatory patient groups (EAPGs). His specialized knowledge extends to long-term care hospital reimbursement methodologies, cost per diem rates, and physician payment systems utilizing the resource-based relative value scale (RBRVS).

Joe’s work encompasses the analysis of Medicaid claims and expenditure trends, the development and manipulation of complex datasets, and the preparation of policy recommendations. He also designs and models claims-based payment systems, conducts fiscal analyses, and delivers detailed reports and presentations on complex reimbursement structures to state officials and industry stakeholders.

In addition to his core responsibilities, Joe manages daily operations for several Medicare upper payment limit (UPL) contracts, ensuring strict compliance with federal guidelines. He has partnered with numerous Medicaid agencies to design and implement innovative fee-for-service supplemental payment programs, managed care directed payment initiatives and preprint submissions, and Medicaid financing strategies, including provider taxes, intergovernmental transfers (IGTs), and certified public expenditures (CPEs).

Joe serves on the Rate Setting and Federal Compliance engagement team and works out of the Kansas City office. He is a Certified Fraud Examiner and member of the Association of Certified Fraud Examiners.