MLR Reporting Requirements, Compliance and Enforcement – The Risks Beyond Rebates


Are you ready for the audit? This webinar presents an overview of the risk factors surrounding compliance with MLR reporting requirements established in HHS' interim final rule and pragmatic approaches to address those risks. While most have focused on the impact of rebates if MLR thresholds are not met, HHS' regulation contains numerous reporting requirements and enforcement guidelines that will have fundamental implications for health plans and their delegated vendors. Presenters will address best practices that health plans should implement now to mitigate risk and prepare for the wide-ranging implications of minimum MLR.

Specific topics will include:

  • The critical importance of accurate and complete documentation and conscientious retention
  • Vendor reporting requirements (e.g., PBM, behavioral health, radiology management, etc.)
  • Key audit requirements and the impact on health plan operations
  • HHS enforcement and civil penalties
  • Potential implications for premium review and rate setting
  • Coordination and role of counsel, compliance and finance to address the requirements and risks
In this complimentary webinar, presenters will discuss how to address these new risk areas and will provide information you can use to be prepared for these new requirements.