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Three steps to avoid accepting partial payments from plans

Patient Financial Services Weekly Advisor, December 10, 2004

Some health plans stamp the words "payment in full" on reimbursement checks that are made out for less than the full amount of providers' claims-and that's cause for concern. If a provider deposits such a check, it is legally giving up its right to the full amount of the claim, even if it didn't realize the check was only a partial payment.

There are ways to avoid getting burned, says Michael Williams, Esq., an attorney at Daniel W. Dreyfuss, Co. in Cleveland. Try these three steps:

1. Alert the CFO's office. Inform your CFO and his or her staff of the possibility that plans could use this tactic and ask him or her to carefully inspect any check that plans send directly to the CFO's office. (If you're the CFO, alert your staff.)

2. Create and distribute check-depositing procedures. Make sure you have-or if you don't have them implement-check-depositing procedures at your facility, office, or provider organization that safeguard against accord and satisfaction-an agreement to accept less than is legally due just to wrap up the matter.

For instance, require that all checks are routed through the claims department so payments can be identified and processed as part of day-to-day operations and the amount compared to what the claims department expected for that claim, suggests Williams.

3. Tell the plan to whom it should send partial payments. To stop a plan from using accord and satisfaction against you, notify the plan by certified mail that any communication about payment disputes, including checks with the full payment language on them, must be sent to a designated representative.

The accord and satisfaction laws in most states allow providers to set such a requirement.

If the plan later sends a partial payment check to a person other than your designee, the accord and satisfaction doctrine won't apply.

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