In the world of accounting and auditing, there is a concept called materiality. The term materiality essentially means an amount that, if erroneously omitted or included, impacts the financials of a company to the point where they don’t tell the truth. One very basic example would be if a $1 million revenue small business made a mistake recording their accounts payable, and as a result, the business has $100,000 of expenses missing from their results. This would be material. If the same exact mistake happened in a multi-billion multinational company, it would not.

When it comes to materiality in accounting, there are many nuances that need to be considered when evaluating and determining what’s material and what’s not. One way to look at materiality from an accountant’s perspective is to determine how much a particular transaction (such as a purchase) or event (such as a lawsuit) will have on a company’s financial performance. Whether it’s an omission or a mistake in calculating and reporting such an event, the way an accountant evaluates and decides how to proceed with reporting the information (or not) can make a big difference in whether or not such information is material or immaterial.

Another way to look at whether information is material or immaterial is to determine if omitting (or through an accounting mistake) such information would mislead or change a person’s actions regarding the company (investing in, providing a loan to the company, etc.). If omitting the information would influence an outside party’s decision, it would be material. If including the mistake would not change an outside party’s decision regarding the company, it would be immaterial.

One consideration is the benchmark a company uses to determine if a transaction or event would trigger a materiality classification. For example, net profit, operating income, total assets/shareholder’s equity, gross profit, or gross revenue are commonly used. However, it’s important to keep in mind that operating income might not be the best metric if the business loses money, breaks even, or is modestly profitable.

When it comes to looking at net income and a loss, what matters is how big of a percentage the loss represents against the net income. If there’s a $10,000 loss of inventory (for example, due to a termite infestation of a special type of wood) at a furniture manufacturer that has annual sales of $100 million, it would be immaterial and not necessary to report it on the income statement. However, if this occurred at a start-up furniture factory with a net income of $50,000, it would be a 20 percent loss and would certainly make a material impact to investors, lenders, etc.

Documenting Decisions

The next step is for accountants to document their judgments and the reasons why they made each type of documentation. It’s a way for the internal financial managers or the auditor to determine what was done and why. One example looks at whether or not to depreciate or expense an item – for which the materiality depends on the item’s cost.

If an office desk costs $125, depreciating the office desk seems impractical and would likely be classified as a business expense during a company’s tax year. However, depending on the size of a business’ net income, a start-up may consider it material, but an established, publicly traded consumer staple corporation buying the same item would likely consider it immaterial.

Determining (im)materiality is often a judgment call by the financial experts within a company and the auditors who evaluate companies’ financial statements. With a consistent approach, businesses can make measured decisions for their internal and external audiences.

According to the Centers for Medicare & Medicaid Services’ report “Advancing Rural Health Equity,” the 2022 Consolidated Appropriations Act (CAA) maintained telehealth options due to the COVID-19 Public Health Emergency (PHE) order for 151 more days beyond the original expiration of the Covid-19 PHE. Medicare recipients will benefit from the extension of telehealth services. This legislation will also permit Medicare to pay for telehealth services provided by Federally Qualified Health Centers and Rural Health Clinics.

The 2023 Consolidated Appropriations Act extends, through 12/31/2024, the following telehealth flexibilities authorized during the COVID-19 public health emergency. Healthcare providers are permitted to bill Medicare for telehealth services regardless of Medicare patients’ residence. Examples of providers include audiologists, speech-language pathologists, physical therapists, and occupational therapists. Telehealth coverage will also remain available for mental health services through 2024.

During March 2020, the U.S. Centers for Medicare & Medicaid Services (CMS) lengthened the Covid-19 Accelerated and Advance Payments (CAAP) Program to more medical suppliers under Part A and Part B. Such accelerated and advanced payments are remittances to both Part A and Part B providers in the case of interruptions to submissions and processing of claims. This can happen during man-made or natural disasters as a means to speed up cash flow to healthcare suppliers and providers. The CARES Act (P.L. 116-136) offers greater flexibility via increased time lines and payment sums through the expanded CAAP program for providers.

Based on the Continuing Appropriations Act, 2021, and Other Extensions Act, while the CMS no longer accepts accelerated or advance payments, permitted providers will have repayment begin 12 months after each provider or supplier’s accelerated or advance payment is issued.

One important consideration when it comes to accounting for these types of transactions is party consideration. Primarily, these transactions involve more than simply the purchaser and merchant. When it comes to medical services, and especially Medicare and Medicaid, there’s the patient, the direct service provider (doctor, nurse, admin staff, etc.), the facility (in or out of network consideration), and the private or government-based administered entity. The point here is that when it comes to revenue recognition, there needs to be explicit delineation for which party delivers services to the patient (and when) and how each party recognizes revenue based on their arrangement(s) with the patient.  

As for recognizing revenue, the relationships between the patient and the different providers are important due to when the entities are able to recognize revenue — generally when the material/service/product is delivered/satisfied. This is where records are important to keep and analyze on the accounting end so there can be proper reconciliation as to when the product/service has been fulfilled and when it’s recognized by the appropriate entity for revenue recognition procedures.

While there’s no cut-and-dried method to account for the evolving way payments are made, it’s important to keep up with state and federal legislation. Always check with your accountant to stay current with the latest updates to these laws.