No. 03 · The observatory
Medical billing and revenue cycle
UC Davis’s billing conversion worsened denials. One programme booked fake appointments.
- Status
- Open
- Rank
- 33 of 35 in the atlas
- Scored
- 2026-10-05
- Report
- Back to the study
- Rank
- 33 of 35, published score 42.5
- Scoring date
- 2026-10-05, reported 2026-10-09
- Buyable
- $4.8B buyable midpoint, $2.6B to $8.8B recorded legacy spend
- Factors
- size 3, pain 3.7, AI fit 4, lock-in 4.5, crowding 4.7
- Coverage
- none recorded; AI-native challenger recorded
Medical billing and revenue cycle
Ranked 33 of 35 at 42.5 out of 100.
Billing and revenue-cycle systems for hospitals and health systems.
What the evidence says
The checked evidence corroborates bounded billing pain. A buyer-side audit documents UC Davis’s 2014 Epic Resolute conversion. Denial rates and receivable aging initially worsened. One programme resorted to dummy appointments to trigger billing.
Providers
The card checked three incumbents: Epic, MEDITECH and TruBridge. Epic reports 325 million-plus patients across its software environments. MEDITECH reports about 2,200 active sites at fiscal 2019 year-end. TruBridge reports 1,500-plus healthcare organisations company-wide. The units are incompatible. No ranking is supported.
Candid is the recorded challenger. Its adoption evidence is an investor funding announcement, not a named client. The AI-native label rests on that interested source.
Sources:
- Sixth Street
- Financial | open.epic.com
- University of California
- About | Epic
- Medical Information Technology, Inc. Form 10-K for the fiscal year ended December 31, 2019
- TruBridge, Inc. Form 10-K for the fiscal year ended December 31, 2025
- IKS Health Completes Acquisition of TruBridge
The pain
Post-conversion, most units skipped reconciliations to the new system. Work queues sat with former employees. Control gaps spanned the cycle.
The Lifeline programme needed per-client accounts Epic could not provide. Staff booked monthly non-real appointments so billing could occur.
Sources:
Events
UC Davis switched to Epic Resolute in July 2014. An October 2015 audit documented the disruption and later improvement. Corrective actions ran into 2016-2017.
Sources:
Limits
All pain evidence is one internal audit of one health system. The audit also documents improvement by June 2015. The Lifeline closure is management-stated, not proven to have occurred.
Sources:
- Financial | open.epic.com
- University of California
- About | Epic
- Medical Information Technology, Inc. Form 10-K for the fiscal year ended December 31, 2019
- TruBridge, Inc. Form 10-K for the fiscal year ended December 31, 2025
- IKS Health Completes Acquisition of TruBridge
- Sixth Street
In their words
inadvertently be overlooked and thus unaddressed.
Source: UC Davis Audit and Management Advisory Services, 2015-10
began establishing “dummy” appointments each month so billing could occur.
Source: UC Davis Audit and Management Advisory Services, 2015-10
Relevant workflows
6 recorded openings. A missing mapped round is a coverage gap, not an empty field.
| Workflow | Index | Labour | AI use | Core | Mapped |
|---|---|---|---|---|---|
| Patient statements, payment plans and self-pay collections medical-billing-rcm:rcm-patient-billing | 313 | $13.7B | 14% | non-core | 0 |
| Patient access: registration, eligibility and prior authorization medical-billing-rcm:rcm-patient-access | 207 | $15.4B | 33% | non-core | 4 |
| Medical coding and clinical documentation review medical-billing-rcm:rcm-coding | 147 | $6.1B | 39% | non-core | 7 |
| Claim follow-up, denials and appeals medical-billing-rcm:rcm-denials-ar | 111 | $14.9B | 12% | non-core | 5 |
| Remittance posting and cash reconciliation medical-billing-rcm:rcm-payment-posting | -260 | $29.3B | 12% | touches core | 0 |
| Charge capture, claim build and submission medical-billing-rcm:rcm-charge-claims | -409 | $19.5B | 21% | touches core | 3 |
Recorded providers
Provider claims carry their recorded kind and citations. Undisclosed figures stay undisclosed.
| Provider | Products | Parent | Claims |
|---|---|---|---|
| Epic Systems | Epic Resolute Hospital Billing, Epic Professional Billing, Epic Enterprise Billing, Epic Home Health (Dorothy) Billing | unknown | cl-rcm-m-epic-325m (observation) source |
| Medical Information Technology, Inc. (MEDITECH) | MEDITECH integrated hospital billing / accounts receivable software | unknown | cl-rcm-mtc-inc (inference) source cl-rcm-m-mtc-2200 (observation) source |
| TruBridge | TruBridge revenue cycle management (RCM) offerings, TruBridge EHR | 2026-07-09 | cl-rcm-tb-own (reported) source cl-rcm-m-tb-1500 (observation) source |
Recorded inputs
Raw scored inputs exactly as frozen. Values and units keep their recorded definitions.
| Factor | Input | Value | Count | Score |
|---|---|---|---|---|
| pain | keep_alive_share | unavailable | 1 | unavailable |
| pain | backend_failure_share | unavailable | 36 | unavailable |
| pain | app_rating_inverted | 3.412524666666667 | 10 | 4 |
| pain | failed_rate | 0.2222222222222222 | 9 | 2 |
| pain | s3_grade | strong | 1 | 5 |
| pain | mean | 3.6666666666666665 | unavailable | 3.7 |
| lockin | award_duration_months | unavailable | 2 | unavailable |
| lockin | noncompetitive_share | unavailable | 0 | unavailable |
| lockin | replacement_duration_months | 60 | 6 | 4 |
| lockin | regulator_approval | true | 1 | 5 |
| lockin | mean | 4.5 | unavailable | 4.5 |
| crowding | ai_native_traction | 5 | 5 | 5 |
| crowding | funding_per_billion | 83226986.0459557 | 18 | 4 |
| crowding | yc_2024_plus | 31 | 31 | 5 |
| crowding | mean | 4.666666666666667 | unavailable | 4.7 |
| size | users_midpoint | 3002 | unavailable | unavailable |
| size | buyers_mid | 299653.5 | unavailable | unavailable |
| size | midpoint | 4783304297.24056 | unavailable | unavailable |
| ai_fit | mean | 3.887407407407408 | 12 | 4 |
| ai_fit | unanswered | unavailable | 0 | unavailable |
Recorded sources
29 recorded citations. Each link lands on the sources catalogue.
Back to the 35-category table or the explorer.