Ask physicians in an independent practice to identify their biggest frustrations, and they will inevitably include "insurance compliance and paperwork" on the list. Checking patient eligibility, submitting clean claims and then waiting for payment all take valuable time and cost big dollars. Dr. Sol Lizerbram, a family practice physician in the San Diego area for years, knows all about that aggravation. "I could take an ATM card and go anywhere in the world and, in a few seconds, get cash. In other words, they could check my eligibility to see if I had money in the bank," he said. "But if I was a doctor and wanted to check a patient's eligibility with an insurance company, I had to call and spend 17 minutes over the phone — and all I wanted was the same information." Thus, Lizerbram founded HealthFusion in 1998 with the purpose of connecting healthcare provider offices with insurance companies "through this new thing called the Internet," he said. While there are many players in the claims clearinghouse space, HealthFusion offers physician offices the ability to connect in real time with a growing number of insurance companies — and do it for free. "We wanted to provide this service to the doctor for free," he explained. "We felt there was an economic savings to the insurance company for them not to receive a phone call." The idea caught on. Today, about a dozen major insurers such as Aetna and Cigna "sponsor" HealthFusion, and more than 50,000 physicians are using the service. "That number is growing every day," Lizerbram added. "There's a clear economic savings to the insurance company, and a huge savings to the doctor's office," he said. "If a busy primary-care doctor is seeing 25 patients a day and the average time that it would take to call an insurance company to get information on a patient is 17 minutes per inquiry, you have a full-time person just calling insurance companies all day long." Using HealthFusion, a practice manager can check patient eligibility, copays and deductibles; submit a claim; check claim status; and send or receive referrals. "So this improves quality of care," Lizerbram said. "Instead of waiting several days for approval of a referral, the patient has it in five seconds and off they go to their specialist." Using HealthFusion frees personnel from learning the ins and outs of all the insurance payers of the practice. "It's much easier learning one set of screens. Literally, our doctors offices come in in the morning, open up their front door and they log onto HealthFusion and they stay there all day. They don't have to log in and log out, log in and log out," Lizerbram said. While many major payers are HealthFusion sponsors, some aren't. However, many of the nonsponsors have agreed to make their data available. In those circumstances, physicians can pay a monthly fee of less than $10 to access that information. Lizerbram said HealthFusion "broke the two barriers" that prevented electronic improvement in physician office operations. The first was cost. "Physicians didn't really want to spend $50,000 to get up-to-speed and able to perform certain transactions," he said. The second barrier was a lack of incentive. "Personnel in the office weren't necessarily under any pressure to change," he said. But saving money and improving efficiency prompted interest, especially as people became more and more comfortable with Internet transactions. To register with HealthFusion, physician offices with Internet access only need to make a phone call to set up an account. "We take the user on what we call a test drive, which takes about 15 minutes. We get them set up with a user name and password and give them a demo," he explained. "It's easy to use. If you want to check a patient's eligibility, you click on 'eligibility' and fill in the patient's data required by the insurance company and click 'submit.' Want to make a referral? Click on 'referral.' "The platform also stores patient data for the doctor's office, so when patients return, it's not necessary to fill in all the patient information again. Using a pull-down menu or the search option, "we populate all the patient data for them," Lizerbram said. He stressed that physician offices are accessing the payers' legacy systems and thus receiving up-to-the-minute information and filing claims in real time. Physicians may also opt to be paid electronically, using HealthFusion's Electronic EOB® — a trademarked phrase of the company. "They could literally submit a claim on Monday, and their money would be in the bank by Friday," Lizerbram said. In September, HealthFusion received full certification for two years from the Electronic Healthcare Network Accreditation Commission, which is referred to as the "gold standard" of HIPAA compliance "Not all clearinghouses are EHNAC certified," Lizerbram said. "HIPAA is an issue, and doctors should only deal with companies that are EHNAC certified." While HealthFusion was founded with physician offices in mind, larger groups, medical centers and hospitals are using the platform, too. They may upload a patient schedule for an entire week, and HealthFusion sends a report back on the insurance eligibility of each patient. "So they know a week in advance where their patients stand regarding their financial obligations," Lizerbram said. November 2006