The Centers for Medicare and Medicaid Services has published a final rule, with a comment period, establishing health insurers' "medical loss ratios," including provisions to account for ICD-10 conversion costs.
Implementation of medical loss ratios is mandated under the Affordable Care Act. To reduce excessive costs, the reform law requires insurers spend a minimum amount of revenue from premiums on payment for clinical care. This is the "medical loss ratio" and the minimum level is set at 85 percent for the large group market and 80 percent for the small group market.
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