According to latest report, the U.S. revenue cycle management market size was USD 172.94 billion in 2024, calculated at USD 190.58 billion in 2025 and is expected to reach around USD 456.78 billion by 2034, expanding at a CAGR of 10.2% from 2025 to 2034. the U.S. revenue cycle management market is driven by the increasing adoption of value-based care models.
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U.S. Revenue Cycle Management Market Key Takeaways
- The services segment dominated the market in 2024 with a market share of over 69.11% and is anticipated to grow at the fastest rate during the forecast period.
- The software segment is anticipated to grow significantly during the forecast period.
- The integrated segment dominated the market in 2024 with a market share of over 73.14% and is anticipated to grow at the fastest rate during the forecast period.
- The web-based segment dominated the market in 2024 with a market share of over 57.16%.
- The cardiology segment held a significant share of 7.65% in 2024 and is expected to grow at the fastest rate during the forecast period.
- The in-house segment dominated the market in 2024 and accounted for a revenue share of over 71.22%.
- The outsourced RCM services segment is expected to grow at the fastest rate during the forecast period.
- Based on end use, the physician back-office segment held the market with the largest revenue share in 2024.
- The hospitals segment is expected to grow at the fastest rate during the forecast period.
- The claims management segment dominated the market in 2024 with a market share of over 53.11%.
- The care management segment is anticipated to grow at the fastest rate during the forecast period.
A crucial fundamental purpose of any medical application is Revenue Cycle Management (RCM). It is a firm's brain and bloodstream. Without RCM, the revenue doesn't flow through the clinic and the application is deprived of the much-required cash flow for the clinic to thrive and grow. The RCM function is vital to the survival of any healthcare organization.
RCM integrates administrative data into the patient's care. It assists practices to save time and money by overcasting the number of denied claims and making it attainable for patients to make payments online.
Moreover, market players are strengthening revenue cycle platforms by integrating artificial intelligence (AI), electronic health records systems, and data analytics, which contributes to reducing administrative burdens, streamlining workflows, & improving revenue capture. For instance, in October 2023, Omega Healthcare announced the launch of its Omega Digital Platform (ODP). This platform is specifically designed to assist healthcare organizations in streamlining their administrative processes while simultaneously enhancing their financial performance. The ODP aims to address common challenges faced by healthcare providers, such as high administrative costs and inefficiencies in operations. The growing adoption of telemedicine and homecare offering value-based care is expected to support market growth.
“With rising costs and ongoing staffing shortages, healthcare organizations need technology-enabled solutions that empower them to focus on delivering care and improving the patient experience. We are excited to bring cutting edge technology advancements through the Omega Digital Platform and will continue to innovate to help our customers solve their most pressing challenges.”
Role of Artificial Intelligence in the Revenue Cycle Management
AI software can enhance accuracy throughout the revenue cycle management process. AI greatly raises the accuracy of all patients and claims information. It also increases the accuracy of bills. This lessens the demand for staff time to deal with follow-up questions and delays from the payer. Moreover, AI software can improve accuracy throughout the revenue cycle management process. AI greatly increases the accuracy of all patients and claims information. It also raises the accuracy of bills. This decreases the demand for staff time to deal with follow-up questions and delays from the payer.
Major Trends in the U.S. Revenue Cycle Management Market
• Growing emphasis on value-based reimbursement models: Government initiatives such as the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated the adoption of VBR models.
• These programs tie reimbursement rates to quality metrics, efficiency, and patient satisfaction, necessitating advanced RCM solutions that track performance-based payments.
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U.S. Revenue Cycle Management Market Report Scope
|
Report Attribute |
Details |
|
Market size value in 2025 |
USD 190.58 billion |
|
Revenue forecast in 2034 |
USD 456.78 billion |
|
Growth rate |
CAGR of 10.2% from 2025 to 2034 |
|
Actual data |
2018 - 2024 |
|
Forecast data |
2025 - 2034 |
|
Quantitative units |
Revenue in USD million/billion and CAGR from 2025 to 2034 |
|
Report coverage |
Revenue forecast, company ranking, competitive landscape, growth factors, and trends |
|
Segments covered |
Product, component, delivery mode, specialty, sourcing, function, end-use |
|
Country scope |
U.S. |
|
Key companies profiled |
athenahealth, Inc.; Cerner Corporation; eClinicalWorks; Epic Systems Corporation; McKesson Corporation; NXGN Management, LLC; Oncospark, Inc.; R1 RCM, Inc.; The SSI Group, Inc.; Veradigm LLC (Allscripts Healthcare LLC) |
Market
Concentration & Characteristics The chart below
illustrates the relationship between industry concentration, industry
characteristics, and industry participants. The X-axis represents the level of
market concentration, ranging from low to high. The Y-axis represents various
market characteristics, including industry competition, degree of innovation,
level of mergers & acquisition activities, regulatory impact, product
substitutes, and regional expansion. For instance, the market is fragmented,
with many small players entering the market and launching new innovative
products. The degree of innovation is medium, the level of mergers &
acquisitions activities is medium, and the threat of substitutes is low. The
impact of regulations on the market is high, and the regional expansion of players
is low. Innovations,
such as integrating AI and machine learning into various platforms, reflect a
broader shift in healthcare consumer behavior toward seeking immediate and
convenient care options. For instance, XiFin has been recognized by Healthcare
Business Outlook as one of the “2024 Top 10 RCM Solution Providers.” This
accolade highlights the company’s commitment to providing advanced revenue
cycle management (RCM) solutions that leverage AI to assist healthcare
providers in effectively managing their billing, reimbursement, and compliance
processes. The market saw
notable consolidations as larger operators sought to expand their reach and
capabilities. Key industry players, including the SSI Group, Inc.;
eClinicalWorks; McKesson Corporation; Allscripts Healthcare, LLC; athenahealth,
Inc.; NXGN Management, LLC; Epic Systems Corporation; and Oncospark, Inc., are
involved in merger & acquisition activities to expand their industry
presence. For instance, in December 2023, R1 RCM, Inc. acquired Acclara, a
technology-driven RCM company from Providence, the largest health system, for
USD 675 million in cash and a warrant to buy 12.2 million shares of R1 stock at
a strike price of USD 10.52. This acquisition aimed to deliver innovative &
cost-effective solutions to support healthcare providers across the U.S.,
enhance patient experience, maintain regulatory compliance, and minimize
administrative burdens. The continuous policy changes and upgradation of
regulations are expected to hinder market growth. RCM is relatively low due to
changes in regulatory frameworks, specific demands of healthcare organizations,
and varying reimbursement policies across the U.S. However, with the growing
adoption of digital healthcare solutions and the increasing need for efficient
RCM, the market is expected to witness significant growth in the coming years. Case Study:
Revenue Cycle Optimization Challenge: A West Coast acute care provider with
over 350 beds and USD 1.1 billion NPR faced significant challenges in revenue
generation & management. Decreased revenue and increased denials posed a
serious threat to its financial health. The root causes included authorization
backlogs, billing inconsistencies, and subpar workflow prioritization and
governance. Recognizing critical performance gaps, the organization sought
expert guidance to identify opportunities and implement changes aimed at
enhancing net revenue & accelerating cash collections. Solution: An acute care provider partnered with
Savista, a reputable RCM firm, to address these challenges. Savista conducted a
comprehensive assessment that showcased deficiencies in process
standardization, visibility & confidence in metrics, and accountability.
The company devised a multifaceted solution: •
Process Standardization: Savista outlined 25+ new policies and
procedures to prevent denials and review unbilled accounts, ensuring
consistency & efficiency across workflows. •
Enhanced Metrics Visibility: Automation of 10 daily-use dashboards
provided the organization with greater visibility of performance metrics,
enabling informed decision-making & proactive management. •
Accountability Reinforcement: Savista defined productivity metrics and
Key Performance Indicators (KPIs) to hold staff accountable and ensure
adherence to established standards. Results: The
implementation of Savista's RCM solution yielded remarkable results: •
48% Increase in Cash Collections > 365 Days: The organization
observed a substantial improvement in cash collections, enhancing its financial
resilience. •
81% Reduction in Average Daily Claims on Hold: Reducing claims on hold
streamlined the billing process, leading to faster revenue realization. •
USD 75.4 Million Collected in 1 Month: The organization generated
significant revenue, surpassing expectations. •
USD 24 Million in Denial Recoveries: Savista's expertise in denial
management resulted in substantial recovery of previously denied claims. •
9+ Day Improvement in Days Out Authorizations: Streamlined authorization processes led
to improved efficiency and reduced delays. Analyst
Perspective: RCM
outsourcing services represent the transformative impact of strategic
interventions in healthcare revenue management. By addressing process flaws,
enhancing metrics visibility, and reinforcing accountability, substantial
improvements have been made in cash flow, revenue generation, and denial
management for acute care providers. This case highlights the significance of
partnering with RCM companies to navigate complex revenue cycle challenges
effectively and sustainably. Private
Equity Investment In RCM Companies Financial
Sponsor RCM
Companies Business
Description Veritas
Capital Fund Management, L.L.C. Coronis
Health Provides
outsourced medical billing and revenue cycle management (RCM) solutions to healthcare
practices and facilities in the U.S. and around the world. Coronis Health was
purchased from 424 Capital in August 2022. Welsh,
Carson, Anderson, and Stowe. (WCAS) EnableComp Provides
claims revenue services, including RCM for workers' compensation and recovery
of underpayments for hospitals and healthcare providers. EnableComp was
formed when EnableComp and Argos Health merged. Argos Health was purchased by
WCAS from NaviMed Capital in September 2021. Berkshire
Partners LLC., Warburg Pincus LLC Ensemble
Health Partners Provides
technology driven RCM solutions for health systems, including hospitals and
affiliated physician groups. Ensemble was acquired from Golden Gate Capital
in March 2022.
U.S. Revenue
Cycle Management Market Segmentation Insights Product
Insights The integrated
system segment dominated the U.S. revenue cycle management market with the
largest share in 2024. This is attributed to the constant technological advancements
and rapid adoption of integrated RCM solutions by healthcare organizations.
Furthermore, integrated solutions provide a synchronized and streamlined
platform for financial activities with a standardized data collection and
analysis process, which is expected to drive the market over the forecast
period. Integrated
systems are end-to-end systems enhancing an organization’s data sharing and
interoperability capabilities. Integrated solutions enable the healthcare
workforce to enhance productivity, minimize costs, and increase net operating
margins. Lastly, the growing need to reduce human errors and accelerate
administrative functions can contribute to the growth of integrated RCM
solutions. Component
Insights The services
segment dominated the U.S. revenue cycle management market with the largest
share in 2024. The incorporation of electronic health records (EHR) has
generated vast amounts of unstructured data. RCM services assist in managing
this data effectively, ensuring accurate coding and billing, and facilitating
better patient engagement. The software
segment is the fastest growing in the U.S. revenue cycle management market
during the forecast period. Efficient claims and denial management are crucial
for maintaining revenue flow in healthcare organizations. The increasing
complexity of insurance claims has heightened the demand for robust claims
management solutions. Delivery
mode Insights The web-based
segment dominated the U.S. revenue cycle management market with the largest
share in 2024. The ability of web-based RCM systems to seamlessly integrate
with existing hospital infrastructures is an important advantage. This
interoperability ensures that various departments within a healthcare
organization can communicate effectively, leading to streamlined operations and
improved data sharing. Such integration is crucial for maintaining cohesive
workflows and ensuring that financial and administrative processes are aligned. Specialty
Insights The cardiology
segment dominated the U.S. revenue cycle management market with the largest
share in 2024. The complexity of cardiology billing, with its various procedure
codes and frequent updates to coding standards, necessitates specialized RCM
systems. These systems make certain accurate coding, timely claims submission,
and effective denial management, crucial for optimizing revenue in cardiology
practices. Further, the integration of advanced technologies such as AI and
cloud-based solutions has improved the efficiency in cardiology, enabling
better data management and streamlined workflows. Sourcing
Insights The in-house
segment dominated the U.S. revenue cycle management market with the largest
share in 2024. Healthcare providers often prefer in-house RCM systems to maintain
direct control over their financial processes. This approach allows for
tailored solutions that align closely with the organization’s specific
workflows and policies. The outsourced
RCM services segment is the fastest growing in the U.S. revenue cycle management
market during the forecast period. Navigating the complex regulatory landscape
and ensuring data security are critical challenges for healthcare providers.
Outsourcing RCM allows organizations to leverage the expertise of specialized
firms that stay abreast f regulatory changes and implement robust data
protection measures, thereby mitigating financial and compliance risks. Function
Insights The claim
management segment dominated the U.S. revenue cycle management market with the
largest share in 2024. The intricacies of insurance policies and reimbursement
procedures have intensified, leading to a higher incidence of claim denials.
Effective claim management systems are essential to navigate these
complexities, reduce denial rates, and optimize revenue cycles. The care
management segment is the fastest growing in the U.S. revenue cycle management
market during the forecast period. Payers, including Medicare and private
insurers, provide financial impetus for effective care management schemes.
These incentives are designed to inspire healthcare providers to carry out care
management practices that can contribute to cost savings and improved patient
care. As a result, healthcare organizations are growingly investing in care
management solutions to capitalize on these financial benefits. End-use
Insights The physician
back-office segment dominated the U.S. revenue cycle management market with the
largest share in 2024. It results from addressing economic challenges through
outsourcing, leveraging technological advancements, and engaging in strategic
partnerships. These efforts collectively lead to more efficient financial
operations and improved patient care within physician practices. The hospitals
segment is the fastest growing in the U.S. revenue cycle management market
during the forecast period. Hospitals handle a significantly higher patient
volume than clinics and private practices, leading to a more complex billing
and reimbursement process. Unlike small practices, hospitals must manage
inpatient and outpatient services, requiring distinct billing codes and
compliance with government regulations. U.S. Revenue
Cycle Management Market Top Key Companies: •
athenahealth, Inc. • Cerner
Corporation •
eClinicalWorks • Epic Systems
Corporation • McKesson
Corporation • NXGN
Management, LLC • Oncospark,
Inc. • R1 RCM, Inc. • The SSI
Group, Inc. • Veradigm LLC
(Allscripts Healthcare LLC) Recent
Developments • In January
2025, Access Healthcare received a strategic investment from New Mountain
Capital, LLC. This investment is noteworthy because it originates from a
reputable, growth-focused firm that manages around USD 55 billion in assets.
The partnership intends to enhance Access Healthcare's capabilities and support
its expansion into new markets. • In September
2024, CorroHealth, completed the acquisition of the Xtend healthcare revenue
cycle management business from Navient. This strategic move is significant for
several reasons, which will be explored in detail below. As part of this
transaction, over 925 employees from Xtend have joined CorroHealth’s workforce.
This addition not only expands CorroHealth’s team but also brings in valuable
expertise that can enhance their operational capabilities. • In June
2024, Provana declared it is expanding its footprint in tech-enabled end-to-end
revenue cycle management solutions via a strategic growth method. • In January
2024, Aidéo Technologies and MedEvolve, Inc. announced a strategic partnership
aimed at enhancing the efficiency of healthcare organizations through the
integration of AI-powered coding and revenue cycle workflow automation. This
collaboration is designed to streamline operations within healthcare settings
by leveraging advanced artificial intelligence technologies to improve coding
accuracy and optimize revenue cycle management. • In February
2024, Janus entered into a partnership agreement with Availity, which operates
the largest real-time health information network in the U.S. This collaboration
aims to improve healthcare revenue cycle operations by leveraging both
companies’ strengths in automation and operational intelligence. U.S. Revenue
Cycle Management Market Report Segmentation This report
forecasts revenue growth and country levels and provides an analysis of the
latest industry trends in each of the sub-segments from 2019 to 2034. For this
study, Statifacts has segmented the global U.S. Revenue Cycle Management Market By Product • Integrated
System • Standalone
System By Component
• Software • Services By Delivery
Mode • On-premise • Web-based • Cloud-based By Specialty
• Oncology • Dermatology • Plastic
Surgery and Aesthetics • Cardiology • Anesthesia • Radiology • Pathology • Pain
Management • Emergency
Services • Others By Sourcing • In-House • External RCM
Apps/Software • Outsourced
RCM Services By Function • Product
Development • Member
Engagement • Network
Management • Care
Management • Claim
Management • Risk and
Compliances By End-use • Physician
Back Office • Hospitals • Diagnostic
Laboratories • Other
Settings Immediate
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