Physician groups leave health systems for all kinds of reasons: a divestiture, an expired professional services agreement, a decision to go independent again, a system that is winding down its employed-physician strategy. Whatever the reason, the group almost always wants to keep the chart. The patients are in it, the templates are tuned, and nobody wants to re-train forty people on a new EHR in the middle of a corporate separation.
Keeping Epic is often possible, through a continued access agreement, a Community Connect arrangement with the former parent, or a move to another system’s instance. What does not come along is the business office. The group is about to discover how much of its revenue cycle was being done by people it never met.
What transfers, and what quietly does not
The chart transfers. Scheduling, documentation and MyChart relationships carry on much as before. The things that do not transfer are the plumbing underneath the claims:
- Payer enrollments. If providers were billing under the health system’s TIN and group NPI, every payer relationship has to be re-established under the group’s own TIN. Until that happens, claims under the new TIN are denied as provider-not-enrolled or processed as out-of-network.
- EDI and ERA enrollments. Electronic claim and remittance routing is set up per payer, per submitter, per TIN. New TIN, new enrollments, and some payers take weeks.
- EFT. Payments go to the bank account on file with each payer. Change the TIN and the account, and every payer has to be told, with the paperwork each one prefers.
- Workqueue ownership. The central business office staffed the edit, follow-up and denial queues. On separation day those queues still exist and still fill up; they just belong to nobody.
- Reporting access. Security classes and reporting templates were built for the system’s business office. The group may find it can see its patients but not its aging.
The orphaned-A/R problem
There are two piles of money during a separation, and they are easy to confuse. The first is new claims under the group’s own TIN. The second is everything billed before the separation date, which belongs to the health system’s TIN and will be paid to the health system. Who works that old A/R, who gets the cash, and how long the business office will keep chasing it are commercial questions that belong in the separation agreement. Groups that leave them vague end up with months of receivables that nobody is following up on because nobody is sure whose they are.
Ask for three things in writing: a date-of-service cutoff, a reconciliation schedule for payments that land on the wrong side of it, and read-only access to the historical accounts, or a complete export, for the applicable record-retention period.
A 90-day checklist, in order
Start the clock as early as the separation agreement allows. Most commercial payers take longer than 90 days to credential a new group, so day 1 should fall well before the separation date, not on it.
- Days 1–15: foundation. Confirm the group’s legal name, TIN, group NPI, addresses and bank account are consistent everywhere they will be used. Pull the provider roster with individual NPIs, CAQH status and current payer participation. Our new-practice credentialing timeline covers this phase in detail; a spin-off is a new practice as far as payers are concerned.
- Days 1–30: payer strategy and applications. Rank payers by the group’s actual volume and submit Medicare, Medicaid and the top commercial applications first. Do not apply to every plan the health system participated in; apply to the ones your patients have.
- Days 15–45: Epic access. Agree in writing which Resolute workqueues the group (or its billing partner) will own. Request named users, security classes and reporting templates. Test that a claim can be generated, scrubbed and transmitted under the new TIN before the first real visit.
- Days 30–60: plumbing. Clearinghouse submitter IDs, payer EDI enrollments, ERA routing and EFT, one payer at a time, tracked on a single sheet with the status of each.
- Days 45–90: run the bookends. Can we send a clean claim? Can we receive and post the payment? Then work down the edit queues, set the denial cadence, and decide what to do about claims for payers whose enrollment is still pending (hold them knowingly, with a filing deadline next to each).
Where a billing partner fits
A group leaving a business office has two choices: hire and train a billing team in the middle of a separation, or bring in a partner that already works in Resolute and can own the workqueues from go-live while the group’s own staff focus on the clinical move. Either way, the group should hold whoever does the work to a measurable standard. The switching guide has the transition checklists, and the scorecard is how you check the result.
AMS Solutions works inside clients’ own Epic instances; nothing is migrated and no data leaves your instance for a system of ours. If a separation is on your horizon, request a free review of your Resolute A/R 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.
