Community Connect is a good deal for a lot of independent practices. For a fraction of what an Epic license would cost on your own, you get the same chart your local hospital uses, a referral network that already knows how to send you patients, and MyChart for your own patients. What you do not get, in most agreements, is the hospital’s billing office. The chart is shared. The revenue cycle is still yours.
That distinction gets lost in the sales conversation and found about four months after go-live, when a practice manager opens Resolute for the first time and sees a claim-edit workqueue nobody has touched since the Tuesday the practice went live.
The shared chart and the separate revenue cycle
Under a typical Community Connect arrangement the host health system owns and maintains the Epic instance. Your providers document in it, your front desk schedules in it, and your claims are generated by it. But professional billing in Epic is organized around workqueues: claim edits, charge review, follow-up, denials, credits. Somebody has to own each of them. In a health-system-owned practice that somebody is the central business office. In a Community Connect practice it is, by default, you.
Some host systems offer billing services to their affiliates as an add-on. Many do not. Even where they do, the affiliate practice is rarely the business office’s first priority, and the service is often limited to the parts that touch the host’s own contracts.
Six things to find out before the first claim drops
1. Who works the claim-edit workqueues?
Claims that fail Epic’s internal edits never leave the building. If nobody is assigned to the edit workqueues, those claims sit. A claim that sits for 60 days is on its way to a timely-filing denial that no appeal will fix. Ask the host for the list of edit workqueues created for your department and confirm, in writing, which ones you own.
2. Who posts your remittances?
Electronic remittances (835s) route by payer enrollment and by the TIN they are enrolled under. If your practice bills under its own TIN, your ERAs need their own enrollment, and somebody has to review the remits that post with errors or land in an unapplied bucket. Paper EOBs still arrive for a share of payers. Posting is unglamorous, and it is the step most often left unowned.
3. Which payer contracts are yours and which are the host’s?
This is the one that surprises practices the most. Being on the hospital’s Epic does not make you part of the hospital’s payer contracts. Your providers are credentialed under your group and your contracts unless an agreement says otherwise. If a new provider is added to the instance before payer enrollment is complete, Epic will happily generate claims that the payer will happily deny. Our new-provider credentialing guide walks through what has to be true before any application goes out.
4. What reports will you actually get?
Epic’s standard revenue-cycle reporting is strong, but access to it depends on the security class and reporting templates the host assigns you. Before go-live, ask to see the exact A/R aging, denial and charge-lag reports you will have on day one. If the answer is a monthly PDF from the host, you do not have reporting; you have a newsletter.
5. How do security classes and templates get requested?
Every biller who touches your account needs a named user, a security class that matches the work, and the right workqueue assignments. Learn the host’s request process and its turnaround time now, because you will use it every time staff changes, and billing staff change more often than anyone would like.
6. What happens to your A/R if the arrangement ends?
Agreements end. Practices get acquired, hosts change strategy, groups move to a different system. Know what the agreement says about data export, read-only access to historical accounts, and who works the open A/R during a transition. Our guide on switching billing companies covers the same two-ended approach (can you send a clean claim, can you receive and post the payment), which applies here too.
What good looks like
A well-run Community Connect practice looks like any well-run practice: claims drop within a day or two of the visit, edit queues are empty by Friday, remits are posted the week they arrive, denials are worked by payer and dollar rather than in date order, and the practice manager can state days in A/R, the share of A/R over 90 days and the top denial reasons without opening a spreadsheet. None of that requires leaving Epic. All of it requires someone owning the workqueues.
If you are not sure where you stand, the Billing Company Performance Scorecard is a 100-point assessment you can run on your own team or on whoever is doing the work for you. It takes about an hour, and the sections you score lowest are your agenda for the next conversation with the host, or with us.
AMS Solutions works inside clients’ own Epic instances, under the access the practice grants. If you would like a second set of eyes on your Resolute A/R, request a free review here or call 866-973-2221.
Epic, Resolute, MyChart and Community Connect are trademarks of Epic Systems Corporation. AMS Solutions is an independent medical billing company and is not affiliated with or endorsed by Epic.
