How AI Search Is Recommending Medical Billing Services: Monthly Trends

Executive Summary

The September 2026 measurement shows a broad decline in recommendation coverage: five of the ten tracked brands posted significant declines in valid recommendation coverage since July, while no brand posted a significant baseline-to-current rise. R1 RCM posted the month's only significant single-month rise, from August to September.

athenahealth remains the category leader with 44.2% valid recommendation coverage in September, though the benchmark shows a significant 6.1-point decline from July's 50.3%. The lead over second-place Tebra (Kareo), at 34.0%, now stands at 10.2 points, up from July's 9.0-point gap. Both leaders are declining, but athenahealth's pace of decline has been slower, which is the category-level story this month: the top is holding its relative position, and its lead over the second-place brand is widening even as both brands lose ground.

The strongest single-month mover is R1 RCM, whose coverage rose 3.9 points from 8.7% in August to 12.6% in September. Against July's 11.2%, the baseline-to-current change of 1.4 points was within normal variation, meaning September's result is a recovery from August's dip rather than a new high for the brand. The sharpest baseline-to-current decliner is AdvancedMD, down 9.7 points from 40.3% in July to 30.6% in September, with a two-month downward streak.

Across the three-month series, four brands carry a two-month downward streak. DrChrono is also a significant baseline-to-current decliner, but its sharpest drop occurred between July and August; the August-to-September move held within normal variation, indicating stabilization rather than a continuing streak. The remaining five brands are classified as stable. As AdvancedMD's coverage fell, its lead over several lower-ranked, stable brands narrowed every month: the gap over R1 RCM compressed from 29.1 points in July to 18.0 points in September, over CareCloud from 25.6 to 14.6 points, and over eClinicalWorks from 18.1 to 7.4 points. At the same time, the gap at the top widened, with the distance between athenahealth and third-place AdvancedMD growing from 10.0 points in July to 13.6 points in September.

Each monthly run begins with 800 prompt-surface observations (419 unique questions in July, 480 in August, 486 in September) across the benchmark's defined AI/search surface universe. Of those, 800 mentioned a tracked brand or competitor in each month; 747 were relevant and 53 were irrelevant in July, versus 764 relevant and 36 irrelevant in August, and 753 relevant and 47 irrelevant in September. The public metrics use the 571 qualified observations in July, 588 in August, and 595 in September that survive both qualification stages.

Key Findings

Benchmark Context

The report separates the raw collection universe from the qualified analysis set. Brand-level recommendation percentages are calculated within the qualified benchmark set.

With the collection and qualification stages established, the benchmark's headline metrics for the category are summarized below.

Benchmark-Level Metrics

Recommendation-shaped answers fell from 227 in July to 179 in September, as the qualified observation count rose. The response-type mix shifted materially: factual answers rose from 228 to 271, while recommendation shortlists fell from 213 to 159. The August intermediate month shows this was a gradual shift, with comparison analysis answers peaking at 68 in August before settling at 44 in September. The benchmark cannot establish why AI systems produced fewer shortlist-style answers over the three-month series.

AI Recommendation Trend

The category's leadership is stable in name but declining in magnitude, with five significant decliners reshaping the middle of the table. athenahealth retains first place, but the sustained declines from AdvancedMD, Tebra (Kareo), CureMD, and DrChrono mean fewer brands are earning placement within valid shortlists in September relative to July.

Valid Recommendation Coverage by Brand

Five brands moved beyond normal month-to-month variation across the series, and all moved downward. The remaining five stayed within their expected bands. Even as the leading brands decline together, the distance between them is growing rather than closing: the gap between the leader and the third-place brand widened from 10.0 points in July to 13.6 points in September, and athenahealth's lead over second-place Tebra (Kareo) widened from 9.0 points to 10.2 points over the same period.

What Changed This Month

AdvancedMD: Sustained Significant Decline

AdvancedMD's valid recommendation coverage fell 9.7 points from 40.3% in July to 30.6% in September, a significant decline carrying a two-month downward streak. The prior-to-current move was 2.4 points from August's 33.0%, within normal variation, meaning the sharper drop happened earlier in the series and September confirms the new level rather than extending it sharply.

Raw mention presence held steady or rose slightly, from 53.2% in July to 57.3% in September. Top-three recommendation rate fell from 23.3% to 17.1%, while rank-one rate rose modestly from 2.3% to 3.7%. The valid recommendation count fell from 230 in July to 182 in September.

The distinction to notice: AdvancedMD's presence is stable or rising while its shortlist placement has fallen, separating the brand's visibility in AI answers from its recommendation outcomes. Highest-priority diagnostic: In which prompt contexts did AdvancedMD appear without earning shortlist placement across these months, and which competitor is capturing those slots?

Tebra (Kareo): Significant Decline With Rank-One Erosion

Tebra (Kareo)'s coverage fell 7.3 points from 41.3% in July to 34.0% in September, a significant decline on a two-month streak. The brand retains second place but now sits 10.2 points behind athenahealth.

Raw mention presence held essentially flat at 58.1% in September versus 58.5% in July. Rank-one rate fell from 12.3% to 8.7%, and the valid recommendation count dropped from 236 to 202. The prior-to-current move of 2.4 points was within normal variation.

The distinction to notice: Tebra (Kareo) held its breadth of presence while losing both top placements and overall shortlist inclusion, with the rank-one erosion the sharpest signal. Highest-priority diagnostic: Which surface families and prompt types drove the decline in top recommendation placements, and which evidence sources anchor competing brands at rank one?

athenahealth: Leader Declining Within a Stable Frame

athenahealth's coverage fell 6.1 points from 50.3% in July to 44.2% in September, a significant baseline-to-current decline, though the brand remains the category leader by 10.2 points. The prior-to-current move of 3.4 points was within normal variation.

Raw mention presence rose from 89.3% to 91.6%, meaning the brand appears across nearly the entire qualified set. Top-three rate declined from 36.4% to 31.4%, and rank-one rate declined from 15.2% to 13.1%. The valid recommendation count fell from 287 in July to 263 in September.

The distinction to notice: athenahealth's presence is near-saturated and stable, so its coverage decline is a function of shortlist placement rather than visibility. Highest-priority diagnostic: In which prompts did athenahealth appear without earning a shortlist placement, and which brands captured the rank-one slot in those answers?

CureMD: Significant Decline on Significant Prior Move

CureMD's coverage fell 8.4 points from 21.0% in July to 12.6% in September, a significant decline. The prior-to-current move of 4.7 points was itself significant, making CureMD one of the few brands with a material single-month drop in September.

Raw mention presence also fell, from 25.7% to 20.0%. Top-three rate was essentially flat, at 4.4% in July versus 4.5% in September, while rank-one rate held near flat at 1.4% versus 1.3%. The valid recommendation count fell from 120 in July to 75 in September.

The distinction to notice: CureMD's decline spans both presence and coverage, distinguishing this from brands whose coverage fell while presence held. Highest-priority diagnostic: Which prompts reduced CureMD's mentions entirely, and which evidence sources are no longer surfacing the brand?

DrChrono: Significant Decline Followed by Stabilization

DrChrono's coverage fell 7.0 points from 28.9% in July to 21.9% in September, a significant decline. The prior-to-current move of 1.0 point from August's 20.9% was within normal variation, indicating stabilization after the sharper July-to-August drop.

Raw mention presence rose from 39.9% to 42.7%. Top-three rate was steady at 7.1% versus 6.8%, while rank-one slipped from 0.7% to 0.3%. The valid recommendation count fell from 165 in July to 130 in September.

The distinction to notice: DrChrono's coverage stabilized in September while its presence rose modestly, a pattern consistent with a brand holding visibility without regaining shortlist placement. Highest-priority diagnostic: Which competitor captured the DrChrono shortlist slots lost in the July-to-August move, and is that pattern persisting in September's stable month?

R1 RCM: Significant Prior-to-Current Rise

R1 RCM's coverage rose 3.9 points from 8.7% in August to 12.6% in September, a significant prior-to-current movement. Against July's 11.2%, the baseline-to-current change of 1.4 points was within normal variation, meaning the brand's September result is not distinguishable from July's level but represents a material recovery from August's dip.

The rise was accompanied by baseline-to-current gains in top-three rate, from 4.5% to 7.6%, and rank-one rate, from 1.6% to 4.4%. Raw mention presence rose modestly from 14.4% to 17.3%. The valid recommendation count rose from 51 in August to 75 in September.

The distinction to notice: R1 RCM is the only tracked brand with a significant rise on the prior-to-current measure, and its gains are concentrated in higher-ranked placements rather than breadth alone. Highest-priority diagnostic: Which prompts produced the additional rank-one and top-three placements, and which evidence sources anchor those recommendations?

eClinicalWorks and Greenway Health: Presence Growth Without Coverage

eClinicalWorks' coverage was stable at 23.2% in September versus 22.2% in July, while raw mention presence rose from 49.9% to 60.7%. Rank-one rate rose from 0.0% to 0.7%, a shift from a small base. The valid recommendation count rose from 127 in July to 138 in September.

Greenway Health's coverage was flat at 1.8%, while raw mention presence rose from 3.3% to 7.6%. The valid recommendation count is small, rising from 10 to 11.

The distinction to notice for both brands: presence is growing faster than coverage, meaning increased mentions are not yet converting into proportionally more shortlist placements. Small counts for Greenway Health warrant caution. Highest-priority diagnostic for eClinicalWorks: Can the presence gain be converted into shortlist placements, and where is that conversion weakest? Highest-priority diagnostic for Greenway Health: What drives the increase in mentions, and in which contexts is the brand named without being recommended?

Medusind: Small-Count Uptick

Medusind's coverage rose from 0.2% in July to 0.5% in September, on valid recommendation counts of 1 in July, 2 in August, and 3 in September. Raw mention presence rose from 0.7% to 0.8%, with presence counts of 4 in July and 5 in September.

The distinction to notice: these are very small absolute counts, and movement here is directional only. Highest-priority diagnostic: Which prompts produced the three valid recommendations, and what evidence sources are surfacing the brand at all?

CareCloud: Stable With Modest Rise

CareCloud's coverage rose from 14.7% in July to 16.0% in September, a 1.3-point change within normal variation. The prior-to-current move of 3.4 points from August's 12.6% was the brand's sharpest single-month move but remained within its expected band.

Raw mention presence rose from 19.3% to 22.0%, and top-three rate rose from 3.7% to 5.9%. The valid recommendation count rose from 74 in August to 95 in September. Highest-priority diagnostic: Which prompts drove the September rise in shortlist placements, and can that pattern be sustained?

Buyer-Intent Interpretation

In each month of this series, all qualified observations in this vertical fell into the brand recommendation cluster. The benchmark found no qualified observations in the pricing and value or multi-brand comparison clusters in July, August, or September. The public benchmark can measure which brands AI systems recommend, but it cannot yet answer commercial questions about price positioning, value perception, or direct head-to-head comparisons.

The response-type distribution shows pricing analysis answers did appear in the raw collection, rising from 12 in July to 16 in September, and comparison analysis answers peaked at 68 in August before settling at 44 in September. These responses exist but did not qualify as valid recommendation observations. The commercial questions of price and comparison are visible in AI answer behavior but not yet measurable at the benchmark level.

Brand Opportunity Summary

The benchmark identifies where attention is warranted; a company-level analysis is needed to explain why.

Evidence Behind the Benchmark

The aggregate metrics are built from prompt-level observations (query, surface, recommendation outcome, rank, sentiment, and citations where exposed). Company-level analysis can go deeper into prompt, competitor, surface, and evidence patterns. Source presence is not automatically treated as proof of causation.

About This Benchmark

This report is part of the LLM Authority Index AI Market Discovery research program.

• AI Industry Market Discovery Methodology
• AI Industry Market Discovery Metrics
• AI Industry Market Discovery Standards

Report-Specific Interpretation Notes

• Movement between months identifies changes worth investigating; it does not by itself establish the cause of those changes.
• Small-count brands (Greenway Health, Medusind) carry higher uncertainty; their movements are directional signals, not conclusive trends.
• The qualified benchmark set (571 in July, 595 in September) is smaller than the raw collection (800); percentages are calculated within the qualified set.
• Changes in recommendation-shaped answer share and response-type mix may make coverage comparisons more complex, independent of any single brand's performance.

Next Step

The Public Benchmark Shows Where a Brand Is Winning or Losing. A Company-Level Audit Shows Why.

Beneath the aggregate percentages lie the questions that matter for competitive position: which high-intent prompts are won, which competitor takes the recommendation when a brand loses, what attributes AI systems associate with each option, and which external sources shape those answers. The benchmark shows a category with five significant decliners and one significant riser, but it does not explain what is driving the AI systems' shortlist decisions.

A company-specific AI visibility audit maps those prompt, surface, competitor, ranking, sentiment, and evidence-source patterns into a prioritized visibility strategy. Where the benchmark tells you what changed, a company-level audit tells you why, and what to do about it.

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