Revenue cycle management (RCM) is the key to a thriving healthcare practice because you cannot operate smoothly without a steady cash flow. Thus, many healthcare facilities turn to RCM companies to outsource their practice’s financial aspects for increased reimbursements.
While choosing from a large pool of revenue cycle management vendors, which one should you choose for your healthcare practice? How can you differentiate between an unreliable RCM company and a reputable one? Don’t worry, we’ve got you! This guide lists the top 10 revenue cycle management companies and shares some factors you must look for while partnering.
So, without further ado, let’s get right into it!
Top 10 Healthcare RCM Companies in 2024
You can improve your medical practice’s financial performance by hiring a qualified RCM vendor to manage your revenue cycle. The right RCM company can reduce administrative burdens, increase profitability, and minimize the impact of industry changes.
However, we have curated a list of the top 10 healthcare RCM companies to help you choose the best fit for your practice:
1. MediBill MD
MediBill MD is a reliable yet affordable RCM company, securing first place in our list of top 10 revenue cycle management companies. Its diversity in catering to healthcare facilities of all sizes and specialties makes it unique among the other candidates. You can check their website for all 46 specialties the firm empowers with its tailored healthcare RCM services.
Each specialty has its specific needs and coding and billing guidelines to follow, and having a team of certified professional coders (CPCs) and billing specialists is remarkable. Besides, it claims to boost revenue by 15-30%, reduce A/R by 30%, secure 96% collection ratios, and achieve a 95% claim first-pass rate on its website.
Its notable offerings include claim creation, scrubbing, submission, denial management, claim follow-ups, and old AR recovery services. Furthermore, MediBill MD is one of the most affordable revenue cycle management companies, charging a flat 1% of your monthly collections for the first month of service.
2. PwC
PwC is a healthcare RCM company that excels in providing comprehensive revenue cycle management solutions, including account receivable and denial management, charge capture and claim posting, physician/clinician advisory services, revenue cycle automation, and analytics support.
The firm supports healthcare facilities, such as medical groups, hospitals, and payers, with its tailored solutions that can operate in full-function or partial outsource capacity. Besides, what makes it stand out as one of the best revenue cycle management companies is the way it harnesses the power of artificial intelligence (AI), machine learning (ML), and automation to streamline repetitive administrative tasks.
On their website, they claim to provide access to care through digital enablement and automation, leveraging virtual workforce capabilities and pushing healthcare facilities’ revenue cycle towards efficiency.
3. R1 RCM
As a tech-enabled healthcare revenue cycle management company, R1 RCM claims to serve more than 1,000 clients throughout the US. The firm’s notable clients include charitable organizations, non-profit healthcare facilities, virtual healthcare practitioners, telemedicine providers, etc.
They offer a modular solution involving physician advisory, revenue integrity, practice management, patient experience enhancement, and business office support solutions. Their primary services include financial counseling and clearance, coding and charge capture, billing, claim follow-up, payment collection, and denial management.
Additionally, they claim to reduce costs by up to 15%, revenue improvement by up to 1-3%, and enhance the patient experience to an average 46 net promoter score. Like many other RCM companies, they do not mention pricing on the website and require you to schedule a call with its representatives.
4. Change Healthcare
Change Healthcare, previously known as Emdeon, is one of the leading revenue cycle management companies in the US market. This healthcare RCM company connects providers, patients, and insurance payers.
It operated one of the biggest administrative and financial information exchanges in the USA. The vendor mainly specializes in the mental health sector, including counseling centers, psychiatric clinics, mental health providers, rehabilitation centers, etc. It provides comprehensive solutions, including coverage insight, patient eligibility, clearance authorization, enrollment services, charge capture compliance, insight coding, coding quality, and RCM audit.
One reason to include Change Healthcare in our top 10 RCM companies list is its success stories that instantly grab attention and build trust. However, the pricing details are not available on their website. But you can connect with their representatives for more details.
5. Athenahealth
Athenahealth primarily caters to workplace clinics, occupational healthcare practitioners, industrial healthcare companies, employee wellness programs, workforce health centers, etc. It is one of the top-rated revenue cycle management companies, focused on improving the healthcare experience nationwide with its integrated technology and broad customer base.
Its solutions include co-pay collection, registration verification, insurance eligibility verification, charge entry and coding, authorization management, claim scrubbing, payment posting, denial management, patient collections, and performance insights and reporting.
They claim to be a leader with integrated clearinghouses and take pride in successfully reducing the cost to collect for SCP Healthcare, limiting claim rejections to less than 1% for Banner Imaging and reducing claim denials by 17% for Virginia Mason (as showcased on their website). If you are interested in partnering with Athenahealth, you may need to connect with its representative to schedule a demo.
6. NextGen
NextGen Healthcare is next on our list of top 10 healthcare revenue cycle management companies. They are committed to empowering ambulatory practices along with virtual healthcare practitioners, telemedicine providers, online health platforms, remote medical consultations, etc.
They are poised to foster collaborative and integrated care for healthcare facilities by helping them achieve financial success. Their solutions include patient insurance eligibility verification, A/R recovery, payment posting, coding, credentialing, patient statements, analytics, and consultative services.
Besides, they have a team of over 2,800 experts ready to analyze your practice’s financial aspects if you schedule a demo. The case studies on its website are a great way to do your ground research and decide if it is the right fit for your healthcare organization’s unique needs.
7. eClinicalWorks
eClinicalWorks has a team of 6,000 employees working collaboratively to ensure healthcare providers’ financial success. Its relentless pursuit of innovation and cutting-edge solutions made it a strong candidate, securing a place in the top 10 healthcare revenue cycle management companies.
Its end-to-end solution includes features, like visibility dashboards to monitor practice performance, real-time patient insurance eligibility, claim creation, submission, review, scrubbing, follow-up, denials and A/R management, insurance and patient payments, daily, monthly, and annual statements and reports, etc.
Its notable clients are walk-in clinics, retail health clinics, urgent care centers, general outpatient care, occupational health services, etc.
Unlike other RCM firms, its website features a pricing page with different packages. If you need revenue cycle assistance, you will be charged around 2.9% of your practice’s monthly collections.
8. CareCloud
CareCloud is another leading healthcare revenue cycle management company earning a spot in our list of top-rated RCM companies. It takes pride in having a global workforce of over 4,000 and offering comprehensive RCM solutions to empower healthcare providers nationwide.
Its notable clients include group medical practices, corporate healthcare practitioners, primary care facilities, family medicine clinics, outpatient services, etc.
It leverages automation, such as robotic process automation (RPA), to automate repetitive tasks and reduce manual errors. The key features of its solution are payment posting, claim submission, payer follow-up, denial, A/R management, and charge entry.
You can find different case studies on its website highlighting its successful collaboration with healthcare facilities over the years. However, you may need to schedule a demo for pricing details.
9. Waystar
Waystar came into existence after the merger of ZirMed and Navicure. It claims to serve over 3,000 healthcare providers. The RCM company assists healthcare organizations in streamlining payments throughout the entire revenue cycle, much like other leading RCM companies.
Its RCM system helps automate manual tasks, reducing errors, and offering comprehensive reporting to enable practices to make data-driven decisions for improved financial health. Besides, the firm offers patients a summary of medical expenses, leading to payment transparency and improving patient satisfaction.
Its key RCM features include revenue capture, financial clearance, claim management, denial prevention and recovery, payment posting, analytics, and reporting.
On its website, it claims to have a provider net promoter score of over 74. For pricing, you may need to connect with its representative.
10. Experian Health
Experian Health claims to have over 900 payer connections, more than 1,800 core HIS integrations, processed 216 million claims annually, and completed 2.9 billion eligibility transactions in 2019.
Its notable clients include physical therapy practices, wellness facilities, chiropractic clinics, occupational therapy clinics, rehabilitation centers, etc. It made its way to our top 10 healthcare RCM companies list because of its custom solutions like identity management, patient engagement, revenue cycle management, and data analytics.
Healthcare facilities can eliminate manual claim processing, secure better patient access, stay compliant, and increase collections by leveraging its comprehensive RCM suite. It houses a team of around 1,000 billing and coding specialists. Additionally, it has expanded its services from hospitals and medical groups to pharmacies and diagnostics. However, for pricing details, you may need to connect with its representative.
Things to Consider When Choosing a Healthcare RCM Company
Not sure which RCM provider to choose from the list we shared? You can conduct your research by considering the following factors:
Industry Expertise
When choosing a healthcare RCM company, industry experience is crucial. A firm that has previously worked with a facility like yours will be familiar with the rules and challenges that are particular to your specialty. Besides, the more experienced the firm will be, the less likely the errors will become, optimizing revenue capture and assuring compliance.
What’s more? An expert RCM provider can offer customized solutions, adjust to industry changes, and provide insights to make informed decisions.
Technological Considerations
The second factor to consider while partnering with a healthcare RCM company is its technological and software capabilities. Effective revenue cycle management requires advanced software tools, safe data processing, and integration with your current systems.
Thus, we recommend you look for an RCM provider with user-friendly and reliable platforms, automated procedures for coding and billing, financial performance insights, and rigorous data security measures to safeguard patient information.
Compliance and Data Security
Healthcare facilities deal with sensitive patient data and must comply with stringent regulations, including HIPAA. Thus, when outsourcing your revenue cycle operations to a third-party RCM provider, we recommend you choose the one with strong data security protocols. It will help you steer clear of financial penalties, legal issues, and reputational damage.
You must also make sure that the healthcare RCM company exhibits a thorough comprehension of compliance guidelines and a dedication to being current with evolving healthcare legislation. Look for certifications, reflecting its commitment to upholding strict compliance and data security requirements.
Pricing and Contract Terms
Pricing is another factor when partnering with a healthcare RCM company. Try looking for a vendor with transparent service charges, as hidden or additional costs can leave you frustrated and your practice struggling.
Besides, we recommend you pay attention to the terms of service levels, termination clauses, and performance guarantees when you go over the contract. Also, it is beneficial for contract terms to be flexible and allow for options like scaling the services up or down as needed.
Training and Support
Uninterrupted and prompt customer assistance is mandatory for the seamless provision of RCM solutions and for handling issues and inquiries. Thus, it is advisable to choose an RCM company with committed support staff, fast response times, and several contact options, including live chat, phone, and mail.
Besides, training programs are equally integral as they guarantee a smooth transition and optimize the overall RCM performance. We recommend you examine the training materials’ accessibility, quality, and availability and whether they provide updates and continuing assistance.
Reputation and Client References
Another best practice in the RCM company selection process is assessing the vendor’s reputation and client references. In the healthcare sector, a solid reputation is a sign of dependability, credibility, and a track record of accomplishment. Thus, look for case studies, testimonials, and vendor evaluations to determine the performance and customer satisfaction of an RCM company.
You can correspond with the vendor’s previous or present clients and request references. It will help you identify if the RCM company can fulfill its half of the bargain and adjust to evolving requirements.
Bottom Line
These top 10 healthcare RCM companies in the USA have notable clientele and offer key features like revenue capture, financial clearance, claim management, accounts receivables, charge entry, analytics/ reporting, and more.
Their experienced workforce is equipped with the needed skills and technology to provide tailor-made solutions across healthcare specialties. Based on their pricing, contract terms, industry experience, compliance & data security checks, reputation, and client references, you can select a healthcare revenue cycle management company that best fits your practices’ unique needs.
