How Five Star Physicians Weathered the Change Healthcare Hack With PUREDI
Five Star Physicians Group is a clinical practice serving post-acute and long-term care communities in Virginia, Maryland, and Delaware. The group combines innovative medical management with next-gen technology to deliver quality clinical care through clinical specialists, attending physicians, medical directorships, and nurse practitioners.
Five Star turned to PUREDI when its software suddenly became outdated and has stayed with the platform for many reasons, including the customer service and custom reports feature. When the Change Healthcare hack threatened their business, these features became even more essential and were critical to a rapid recovery.
About Five Star Physicians
Founded in 2007 and led by Chief Medical Officer Dr. Teizu Wolokolie, Five Star Physicians delivers clinical care and efficient practice management to post-acute and long-term care facilities. The professional team manages community and facility partnerships, delivers training and education programs, and provides EHR systems and advanced practice technology to ensure quality outcomes and compliance.
The goal is to build meaningful relationships between facilities and professionals so clinicians can serve patients without distraction.
The Move to Modern, Flexible RCM Software
Five Star once had a billing system that linked to its EHR software. It was limited in function, but it processed reports with the data the group needed. However, when Five Star became certified in the 2015 edition of the Health IT certification program, the billing software was no longer compatible with their system. The tech company phased out the software, providing a mere 30 days' notice to find a new program.
Five Star Physicians suddenly needed new billing software — one that met specific reporting requirements — on an extremely tight timeline. They used data to manage clinicians in the field and keep the CFO and CMO up to date. Five Star needed software that could process claims and that also had reporting tools for deep insights.
Their EHR didn't have those capabilities, so they turned to new software. However, after trial and error, the company failed to deliver.
"We actually went with another group," says Lee Maynard (VP of Operations). "We signed the agreement with them, and as soon as I started, they turned it over to me for implementation, and I realized they hadn't built any of what they said they had."
Five Star turned to PUREDI. Within a few days of implementation, Five Star was up and running with new RCM software, pulling essential data to drive operations.
"We had a couple sessions, learning what to do with PUREDI. As far as I remember, it went smoothly, and they learned a lot. We were amazed, that as a smaller company, PUREDI was able to support us quickly in our transition and continues to assist in that capacity."
PUREDI Transforms With Custom Reports
The move to PUREDI streamlined reporting for Five Star. Their previous software was better than most for reporting, but still subpar for their needs and required manual report generation. PUREDI, on the other hand, features custom reports that gave Five Star real-time insight into KPIs, such as the number of encounters, amount of collections, and number and amount of charges.
Five Star could create and save custom reports and import those into an external cloud-based CRM software for a detailed business snapshot in seconds. They could then automate those reports and receive critical data on a set timeline, increasing efficiency and productivity. With these tools working together, Five Star now has enough data to make decisions without having to search through the EHR.
"PUREDI and our current EHR system work together to make our billing processes flow smoothly, " says Maynard. "But I don't even go to my electronic health record anymore. All of my reporting and my data comes out of PUREDI."
The Change Healthcare Hack Lands
Like hundreds of clinical practices around the U.S., Five Star Physicians was suddenly rocked by the Change Healthcare cyberattack in February 2024. The event led to one of the largest medical data breaches in the U.S. and affected Change Healthcare's sister companies, including the clearinghouse known as Optum.
PUREDI used Optum for clearinghouse services, among many other houses, as did all major payors. However, Five Star's primary clearinghouse was Optum, which meant they couldn't submit any claims, leading to six weeks of no revenue.
The situation was dire, impacting the viability of the practice. Optum made an offer to provide financial support if Five Star promised not to leave them. Maynard says it wasn't an option.
"I don't know what this is going to look like, but we've got to find other avenues to save our business," Maynard recounts. "We can't survive without revenue."
PUREDI worked closely with Five Star, brainstorming solutions and presenting the risks and steps of each. The main solution was to find a new clearinghouse and quickly initiate approval with CMS.
PUREDI Offers Caring Support
The migration itself was straightforward. The PUREDI team found other viable clearinghouses and kept Five Star updated with the negotiation status of each deal in progress, the potential risks, and what they needed to do to prepare.
Conversations occurred four to five times every week, with constant updates and details on the next steps. Finally, with the help of a dedicated PUREDI support team, Five Star quickly migrated data to a new clearinghouse.
The biggest challenge, however, was getting revenue flowing again. The process was lengthy and peppered with hurdles. Every other practice in the region was also migrating houses and trying to get approval from CMS and the regional Medicare Administrator, effectively overwhelming the office.
A series of administrative errors led to an initial denial from CMS that wasn't open for appeal. However, Five Star spoke to the state senator, who advocated on behalf of the organization requesting immediate help.
At the same time, a clerical error caused mass rejections, forcing PUREDI and the Five Star team to find and correct data errors. Eventually, Five Star was approved for the new clearinghouse and received accelerated payments for temporary financial relief.
Maynard attributes that success to the support team: "All of this happened, not because I knew what was going on, but because Cara was helping me understand what the process was.
"She kept me apprised on exactly what she was trying to do, what the risks were, and what we needed to get done. I was able to go back to my executive team and keep them briefed.
"We knew what we were doing. We knew what to expect and we knew what the timeline was going to be."
PUREDI Reports Save the Day
Reports were part of the solution to Five Star Physicians' approval and migration hiccups. During the migration of Medicaid claims, one number was mistakenly transposed during the data entry process, leading to a rejection of every claim.
PUREDI was instrumental in finding the issue and getting it resolved quickly. Five Star worked closely with PUREDI, having frequent conversations with the support representative to dive into the data and identify the delay.
"So we had long conversations with me and Cara trying to figure out where the holdup [was]," says Maynard. "Is it on their side? Is it on our side? Are we doing something wrong? She worked with me to solve all of those major problems.
"I had to learn. I had to build those reports. I had the ones that I used for productivity and management for my staff, but I also needed ones to help us understand what the billing team was doing and whether we were being effective in our billing efforts."
That deep data analysis also allowed Five Star to identify neglected accounts and clear up bad habits. Maynard says while the experience was difficult, reporting and data mining helped them understand their operations: "I've had an opportunity to get really deep into it and start clearing out a lot of the stuff that we shouldn't have been doing in the past.
"We were able to see exactly what was going on in the operations and course-correct as needed . . . So we got there. Really, I've felt Cara was in my office with me most of the time."
PUREDI Support Strengthens Operations and Visibility
Today, the leaders at Five Star Physicians say they're pleased with their revenue cycle management process, especially with the increased visibility and professional support. That support has been vital through challenging times.
Close working relationships with the PUREDI team helped Five Star Physicians rapidly re-establish a working system in a time crunch and migrate clearinghouses after a major cyber attack. With PUREDI's collaboration and custom features, Five Star gained a deeper understanding of its operations, enhancing financial recovery and stability.
"The most important thing that we have in PUREDI is our relationship with Cara," (President, Cara Greer) says. "The customer support is the reason we are with PUREDI."
That individual, white-glove service is PUREDI's promise to its clients. Expert professionals take the time to understand business needs and provide complementary specialized insights and services. As with Five Star Physicians, business consultations and deep analytics help troubleshoot errors and issues, increase revenue, and enhance financial performance.