Managed Care Contract Negotiations
Aug 01

Three steps to avoid accepting partial payments from plans

Some health plans put the words “payment in full” on reimbursement checks that are made out for less than the full amount of the provider’s claims—and that should concern you because if you deposit a check like this, you legally relinquish your right to get paid the full claim, says Michael Williams, Esq., partner at Daniel W. Dreyfuss, Esq. Co. LPA in Cleveland.

To avoid getting burned, take these three steps:

Step #1: Many times, the plan will send the check directly to the CFOs office, so inform your CFO and his/her staff of the possibility that plans could try to use this tactic on them and ask them to carefully inspect any check they may receive.

Step #2: Create and distribute check-depositing procedures. Make sure that you have and implement check-depositing procedures at your facility, office, or provider organization. These will protect you against accord and satisfaction.

For instance, you should require that all checks be routed through the claims department, so that 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.

Step #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 law in most states should allow a provider to set such a requirement.

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

If the plan sends a partial payment to the CFO after you’ve informed the plan of who your designated representative is—and it’s someone other than the CFO—and it’s accidentally deposited, you’ll be able to deposit the check and still go after the plan for the balance, says Williams.

Editor’s note: This week’s tip was excerpted from HCPro’s monthly newsletter, Managed Care Contracting & Reimbursement Advisor. For more information, click here.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →