Accountable + Impactful + Quality
“Our work with delivery system reform incentive programs allows states to try new ways of service delivery and payments to get at the underlying issues that can affect people’s health. We’ve helped states tackle issues such as lack of housing and transportation, food insecurity, opioid addiction, and coordination of physical and mental health services. There’s a lot of talk about providing quality health care, but we also need to focus on a person’s quality of life. These projects have opened my eyes to all of the factors that can have a direct impact on a person’s health and their access to health care.
Doing a cost report audit helps hold providers accountable to the state and the money they receive from the government. There’s a great sense of pride when a review you worked on helps the state recover misspent funds and helps individuals get the services they need.
I take a lot of personal pride in assisting our state clients establish a rate methodology that is calculated specific to how services are currently provided and gives states information they can leverage with their legislatures to request additional funding. The cost reports we create help states capture data needed to develop new methodologies that are transparent and provide a tool to model policy decisions going forward. This is especially important for states that need to address current workforce shortages and wage issues so they can continue to provide quality Medicaid services.
Home and community-based services (HCBS) have received some press recently with their inclusion in the Build Back Better bill. I don’t think the general population understands what HCBS is and how much it impacts thousands of individuals in their daily lives. I’ve been able to use my experience with HCBS and Medicaid to help people understand that Medicaid isn’t just for people with low incomes.
Medicaid provides not only health care, but also employment services, therapies, and living supports (among many other services) for people living with disabilities, brain injury, and autism to help them live independently and increase their quality of life. Many services provided under HCBS waivers are not covered under regular health insurance, so Medicaid is a life line for many individuals and their families.” – Lesley Beerends, MBA, CPA
Get to Know Lesley
Lesley has more than 22 years of experience in health care reimbursement. As a member of the firm’s Consulting engagement and the Rate Setting/Federal Compliance engagement teams, she assists state officials with designing reimbursement methodology and cost reporting procedures for new Medicaid programs, including market research and relevant rate and fiscal impact analysis. This includes ongoing policy and procedure analysis for current Medicaid services and updating the state plan amendment and drafting administrative rules. She also has extensive knowledge of Medicaid cost reports and rate setting for HCBS, targeted case management, habilitation, community mental health centers, hospitals, federally qualified health centers, and rural health centers. Lesley provides technical assistance and cost report training for Medicaid providers.
For the past 14 years, she has led the diagnosis related group and ambulatory patient care recalibration and rebasing project for state clients. This includes determination of hospital rates and CMI factors, calculation of DRG relative weights and outlier thresholds, cost-to-charge-ratios, fiscal impact studies, management of databases, statistical analyses, calculation of disproportionate share and graduate medical education payments for qualifying hospitals, and upper payment limit calculations. She provides analysis of Medicaid claims data for financial and policy support and to assist providers with claims billing and payment issues.
Myers and Stauffer is proud to help our clients serve those who are most vulnerable. Our staff feel empowered to know that their hard work and dedication each day makes a difference. We believe it and so do the millions of individuals helped by the clients we serve. We will release new stories each month highlighting associates and their stories. Follow along with our LinkedIn, Twitter, and Instagram for more information.