Revenue can be complicated in the healthcare industry. As profitable as the sector can be, registration, billing and collections are typically long, heavily regulated processes. Without the help of top healthcare revenue cycle management (RCM) partners, administrative workflows can quickly encounter bottlenecks, backlogs and financial pressure.
What to Look for in Healthcare Revenue Cycle Management
Revenue cycle management partners handle claims processing, payment collection and similar tasks to reduce healthcare organizations’ administrative burden. A worrying 63% of medical providers face revenue department staffing shortages. As a result, 61% plan on relying on third parties to help with their RCM. It’s a sound strategy, but finding the best partner can be challenging.
Healthcare companies looking to outsource their RCM must keep a few key factors in mind. Trust and transparency are crucial, as any agreement in this field means handing over highly sensitive data. A reliable RCM partner should also offer extensive communication and customer service to streamline collaboration and ensure a smoother patient experience.
A diversity of services and coverage types is also beneficial, as many specific healthcare practices can require unique regulatory or insurance requirements. Reports, data visualization and any other ease-of-use tools are also good to have. Other functions and features to look for include:
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- Artificial intelligence (AI) analytics
- Platform-agnostic functionality
- Integrations with existing software
- A commitment to compliance and security
What Are the Top Healthcare Revenue Cycle Management Partners?
With these factors in mind, here’s a look at the eight top healthcare revenue cycle management partners.
1. Millenia
One of the best RCM partners for any organization is Millenia, which offers patient-centric, technology-driven solutions. Millenia provides patients with various easy payment methods to streamline the billing process. In-depth analytics and AI-optimized communication strategies offer deep insights into financial performance and patient care.
Millennia is best for mid-to-large practices, though it serves organizations of many sizes, specialties and niches. Most importantly, it’s helped providers recover two to four times the national average in payments while maintaining a 98% patient satisfaction rate.
2. Oracle
As one of the largest players in the RCM space, Oracle is another leading company to note. Its revenue cycle management platform focuses on streamlining workflows to ease the patient experience while boosting financial efficiency. Extensive automation features and cloud-native electronic health record (EHR) solutions help it do so.
Oracle’s sheer size and experience mean it’s a good fit for many kinds of practices of all sizes. It also deploys advanced cybersecurity solutions and emphasizes data privacy. That’s important when breaches exposed more than 133 million records in 2023 alone.
3. CureMD
CureMD is another one of the top healthcare revenue cycle management partners today. Versatility is the key advantage here, with CureMD’s services supporting integrations from dozens of billing platforms and covering over 32 medical specialties.
The solution includes many analytical and automation features, including prior authorizations, AI reporting, automatic insurance verification and business intelligence (BI) tools. A strong emphasis on transparency and HIPAA compliance adds needed trust to the suite of tools, especially for companies looking to scale up in the future.
4. eClinicalWorks
Larger hospitals with a wider range of billing considerations may find eClinicalWorks particularly valuable. The tech-centric, AI-heavy solution specializes in flexibility and scalability, giving providers a range of tools to customize their services to their specific needs. An integrated EHR system and accompanying mobile apps enable fast deployment.
eClinicalWorks also offers telehealth solutions, which not all RCM partners cover. Considering that 22% of U.S. adults used telemedicine over a four-week period, such support can be crucial. Users can also choose between a self-service package or end-to-end managed RCM, giving them added flexibility according to their needs and preferences.
5. TriZetto Provider Solutions
TriZetto Provider Solutions is another popular option. It puts patients front and center, aiming to promote timely payments and prevent delays by creating a better patient experience. The team monitors every transaction for potential issues, streamlines the claims process, and actively engages consumers to shorten cycles and avoid loss.
TriZetto may offer less cutting-edge technology than some other partners, but it still manages the revenue process end to end. Some providers may prefer this human touch over unbridled automation, so it depends on a practice’s specific preferences and needs.
6. athenahealth
A more tech-centric solution comes from athenahealth. The company’s athenaOne platform combines RCM, EHR and patient engagement into a single cloud-based solution to align revenue-affecting processes and remove bottlenecks. Such efficiency improvements are especially important for high-volume hospitals.
One of athenaOne’s biggest strengths is its use of predictive analytics to predict and prevent denials. Claim denial costs the industry $262 billion annually, so this capability can be a huge asset. However, smaller practices with fewer patients may not benefit as much from it.
7. R1 RCM
Another one of the top healthcare revenue cycle management partners for tech-driven businesses is R1 RCM. R1 relies on AI from start to finish, starting with generative tools to engage patients and extending through machine learning contract analysis. The automation enables high efficiency, streamlined compliance and in-depth analytics providers may be unable to access otherwise.
As helpful as R1’s cutting-edge tools can be, they’re not a perfect fit for every medical business. The solution largely targets enterprise-level institutions, so newer or more specialized operations may not see a significant return.
8. Optum
Optum, which merged with Change Healthcare in 2021, is one of the largest RCM providers operating today. Like athenahealth, Optum deploys predictive analytics to prevent denials. It also emphasizes scalability and flexibility through a suite of automated tools and analytics-reporting functions, making it easier to understand a practice’s revenue trends.
The Optum platform offers some of the most advanced features on the market, but some hospitals may not trust it after its 2024 data breach. Despite handling nearly 40% of all medical claims in the U.S., Change Healthcare was not using industry-standard multifactor authentication, leading to the attack. Such oversight may turn some organizations away from the partner.
Choosing an RCM Partner
These eight services are not the only RCM partners available today but are some of the most significant. However, choosing between them can still be difficult for some facilities. Healthcare companies can make the right choice by starting with an outline of their needs.
Providers should list their largest inefficiencies, revenue goals, tech experience, budgets and any existing IT infrastructure they’ll need compatibility with. From there, it will be easier to narrow down a solution that suits their specific situation. When multiple could fill the role, leadership should compare their user reviews, pricing and scalability should the business grow in the future.
Find the Optimal Revenue Cycle Management Partner Today
Working with a top RCM partner makes a massive difference in a provider’s agility and profitability. Even small operations can benefit from the efficiency and loss prevention such services provide. Acting today to optimize this cycle will ensure continued success down the road.
