RCM Service Providers Help Healthcare Providers Overcome Challenges in Revenue Cycle Management

June, 2022

Healthcare providers need effective revenue management, which in turn is driving the adoption of emerging technologies among revenue cycle management (RCM) service providers. RCM service providers use artificial intelligence (AI) for denial analytics and medical coding, cloud infrastructure for building and deploying scalable healthcare solutions, optical character recognition (OCR) capabilities for document processing, and robotic process automation (RPA) for automating account receivables workflows. Additionally, strategic partnerships between RCM service providers and technology partners ensure continued digital transformation of healthcare providers’ revenue operations.

These emerging trends are covered in Avasant’s new RCM Business Process Transformation 2022 RadarView™. The report is a comprehensive study of RCM service providers, including top trends, analysis, and recommendations. It takes a close look at the leaders, innovators, disruptors, and challengers in this market.

Avasant evaluated over 40 service providers across three dimensions: practice maturity, domain ecosystem, and investments and innovation. Of these, we recognized 20 that brought the most value to the market during the past 12 months.

The report recognizes service providers in four categories:

    • Leaders: Access Healthcare, Conifer Health, GeBBS, Omega Healthcare, Optum, and R1 RCM
    • Innovators: Cognizant, Genpact, HGS Heathcare, Wipro, and nThrive
    • Disruptors: AGS Health, Atos, Ciox, Firstsource, and Sutherland
    • Challengers: Corrohealth, Ensemble Health, Exela Technologies, and IKS Health

Figure 1 from the full report illustrates these categories:

Moneyshot RCM Business Process Transformation 2022 1030x687 - RCM Service Providers Help Healthcare Providers Overcome Challenges in Revenue Cycle Management

“At a time when attrition and labor costs are rising for hospitals, outsourcing, process reengineering, and automation can help control costs and improve patient experience,” said Avinash Baliga, partner at Avasant. “RCM outsourcing providers need to offer innovative solutions that help hospitals effectively navigate the pandemic world.”

The full report provides a number of findings and recommendations, including the following:

    • The healthcare services industry is seeing increased vertical integration as RCM service providers make use of mergers and acquisitions to strengthen their offerings in healthcare analytics, revenue intelligence, medical coding, patient experience, and clinical documentation integrity.
    • Midcycle and backend RCM processes each account for around 46% of total RCM outsourcing, while frontend processes account for the remaining 8%.
    • RCM service providers use AI for denial analytics and medical coding, analytics for claims tracking, and cloud capabilities for building and deploying scalable healthcare solutions.
    • Emerging technologies such as OCR and RPA are used by RCM service providers to extract information and automate A/R workflows, respectively. This helps prevent revenue leakage and improves the efficiency of medical staff.

“RCM service providers are increasingly building strategic partnerships to strengthen domain-specific knowledge and expertise,” said Avasant’s Research Leader Shwetank Saini. “Service providers that have end-to-end RCM transformation capabilities are likely to become the preferred choice of healthcare providers.”

The full report also features detailed RadarView profiles of 20 service providers, along with their solutions, offerings, and experience in assisting enterprises in digital RCM transformation.

This Research Byte is a brief overview of the RCM Business Process Transformation 2022 RadarView™ report (click for pricing).