Operational components of medical loss ratios

The Patient Protection and Affordable Care Act (PPACA) requires health insurance carriers to meet medical loss ratio (MLR) requirements on a state-by-state basis starting in 2011 (we have blogged about this before). This leaves insurers with a fairly short time frame in which to learn the intricacies of MLR calculations. Because specifications and interpretations are also likely to evolve over time, health plans will need to keep abreast of any regulatory changes and should consider performing annual operational audits that document their compliance efforts.

Read more in a recent healthcare reform briefing paper by John Phelan and Patty Jones.

One thought on “Operational components of medical loss ratios

  1. Thank You for very informative insights.

    I appreciated reading the briefing paper. I believe this is another example of healthcare reform getting much more complicated before the situation gets any better. With the creation of additional regulations and operational audits to insure compliance, the great challenge will be to satisfy the very different needs of healthcare providers,employers, and customers.

    Thanks again…

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