States' Any Willing Provider Laws

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Jeffrey S. Baird, chairman of the Health Care Group at Brown & Fortunato, PC, recently shared his insight on the managed care system in the DME industry. Over the last 12 years, the DME industry justifiably focused on competitive bidding, responding to audits, lower reimbursement, and stringent documentation requirements. Managed care was fairly low on the list of the industry’s priorities. 

While we were focused on other priorities, managed care quietly became a large part of the lives of DME suppliers. There are 78 million Baby Boomers (those born between 1946 and 1964) in the United States. They are retiring at the rate of 10,000 per day. This is putting a tremendous strain on the Medicare and Medicaid systems. 

The Medicare/Medicaid programs are looking at ways to take care of the health care needs of Baby Boomers—while trying to contain costs. One way for Medicare/Medicaid to accomplish this is to enter into managed care contracts with insurance companies. For Medicare beneficiaries, these are called Medicare Advantage (“MA”) Plans. For Medicaid beneficiaries, these are known as Medicaid Managed Care (“MMC”) Plans. 

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