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Every once in a while, we come across something where I’m just in awe at how bad it is for so long. Once upon a time, fifteen years ago, the first billing system we used in the billing company that I co-founded was Kareo.

What are the built-in features?

There were some great features about Kareo. One of them was the fact that it had a built-in fax server. We gave telephone numbers to all of our clients, who could fax face sheets, op reports, and things like that directly into our system. They would route to the individual clients. This was great because we had a lot of hospital-based providers, surgeons, anesthesiologists, and more. So there were some nice things about it circa 2007.

However, one of the things that were terrible about it was their reporting. What’s impressive, though, is that not much has changed in fifteen years. The system is the same system that was fifteen years ago. It’s a thin client that you download, and it’s built off the same technology as it was fifteen years ago. Nothing has changed.

Bad reporting

The biggest disappointment is that their reporting is so janky. When you download a report, whether it’s in CSV or Excel format, the first part is that the formatting is odd. There are all kinds of extra columns, rows, and things like that where they don’t put the data in a series of columns. Most data. There’s like a square, where you have row after row after row and column after column after column. In Kareo, it doesn’t do that. It’s like column, blank column, column, blank column. In addition, there are all kinds of weird forms. Further, that’s not even the worst thing.

The biggest thing is, it’s not data. It’s text. So if you try to sum a column, it doesn’t add up to anything. It just counts the fields that have something in them. So that means you can’t calculate the charges in a column. In the report that you download, it has stored a sum as text at the bottom. But if you want to do any calculations, if you’re going to do anything with the data, if you’re going to add a subset of them, or you want to calculate using multiple columns, you can’t do that because it’s not data. It’s not stored as numbers. It’s stored as text.

Why is it like that? Well, it was fifteen years ago the same way. There’s no reason for it to be that way still.

What’s new?

I had recently seen Kareo’s browser-based billing analytics. I thought, “Okay, great! Maybe, they’ve got some new stuff. This is cool.” I logged in recently. I’m actually in their billing analytics right now, looking at what they have included. The top section is called “Top of Mind.” It just counts the number of visits gross charges in dollars. It has net collections, basically collections. So it has visits, charges in dollars, collections in dollars, and AR. Then, there’s a little bit of information about whether those have gone up or down compared to six months ago. That’s not much information.

Review each section

Below that, it has more detail on each of those. It has a section called “How Much Did I Bill,” which is just the charges trend. So you have the dollar amount up above. Let’s say it’s 2 million or something like that. Then below, you have the $2 million, and then you have 1, 2, 3, 4, 5, 6 months where it shows what that trend is in dollars. Then, it’s got a little table next to it that shows the top procedures, CPT codes, top five, and the dollars for each one.

If you want additional details, you can click on “More details,” and it shows you a drop-down menu where you can have encounters by date, encounters by the provider, meetings by location, gross charges by date, gross charges by the provider. You can see a couple of different reports where it breaks down, slices and dices similar things.

Net collections

The following section is “Net Collections.” Not net collections. That sometimes can be misinterpreted to be a net collection ratio. It is just your collections, the dollars collected. And then shows a trend of the charges and the collections over six months. If you expand the “Hide details” to “Show more details,” you can see it by date by the provider. In the case of single provider practice, it shows a single bar going across and all the dollars associated with them. If you click by location (and they have a couple of locations), it shows the breakdown by location. Nothing particularly fancy.

Then, there’s an “Outstanding AR” section. It shows the trend of the outstanding AR: whether AR is going up or down over time. It has a little bit of value, which is more than some of these other charts. So you can see if your AR is increasing over time.

The only problem is, since it doesn’t show you whether or not your charges increased overtime in that same report, you have to flip back and forth between charges up above to see, “Hey, did the charges go up?” to then go down below to see, “The AR went up in corresponding lockstep (or not) with the charges.” So some value. Not a tremendous amount of value, but there’s something there.

Spike in AR

Maybe, a significant spike in AR might indicate that there’s a problem. In the case of this particular practice, we’re looking that over the course of two months, the AR doubled from 46 days to 104 days. That suggests something isn’t going well. But again, it doesn’t tell you a lot. It only means, “Hey, AR, for some reason, has gotten a lot bigger. We don’t know why.”

That’s it. You’ve got a little bit on the breakdown of AR by type in terms of insurance versus patients. You can see AR by the provider. Again, if only a couple of providers, that doesn’t help you much. There’s nothing about AR by the payer. You’ve got a few days to the bill. I’m not exactly sure what the definition of that is. That might be how many days it took the claim to get out the door on average. Since this shows 56 days, 42 days, 126 days, I sure hope that’s not the number of days it took to submit claims. 

Billing analytics

So I’m not sure what that is, but that might be cycle time in terms of how long it took to get charges submitted. That would be an extraordinary catastrophe if it took a month or four months to get charges out the door.

That’s it. Also, that’s all of the billing analytics. In addition, there isn’t anything else. You can put a couple of filters on: By date range, by location. That’s about it.

First of all, that’s not analytics. Second of all, pretty limited reporting, but now in a browser. Of course, you can’t download any of it. I did try. There is an “Export Data” button. If you click “Export Data,” then hopefully sometime within the next couple of days, you will get an email or a message in their system saying that it’s been downloaded. But you cannot access that information immediately.

The short version of Kareo’s reporting is, it’s garbage. It isn’t good. Also, it’s spectacularly wrong. Yet, I’m impressed. It’s hard to be this bad. We will do some more podcasts and tell you more about some of the other aspects of the reporting because it’s imposing.