Automated RCM: How Providers Unlock Revenue with Intelligent Automation

When Community Care Partners, an urgent care management services organization with 290 providers, resolved to stem revenue leakage, it knew it had to shift from manual to automated RCM processes. 

The organization’s RCM team sought to drive organic revenue growth, but healthcare underpayments kept confounding efforts. They did not know whether the actual payments coming in from payers matched contracted rates. Worse, they had little insight into which payers and CPT codes were triggering underpayments. Manual contract management processes missed patterns and anomalies in claims. Juggling complex CPT codes and payer rules, their staff couldn’t act on underpayments at scale. 

Once Commonwealth brought in an automated RCM system, they quickly found $160,000 in underpayment recovery from just one CPT code. Within three months, they realized a positive ROI. After unfolding this program against their entire cost spectrum, they identified even more missed revenue.

Manual revenue cycle management (RCM) involves healthcare staff performing billing, coding, claims processing, and payment tasks by hand—a process that is inherently time consuming and susceptible to errors.  Here, you can review the benefits and opportunities afforded by automated RCM. 

What is automated RCM? 

Automated revenue cycle management (RCM) is the use of software systems and advanced digital technologies to streamline and optimize the financial processes involved in healthcare billing, claims, and payment collection. It minimizes human intervention and manual workflows, helping provider organizations increase efficiency, accuracy, and compliance.

Automated RCM leverages artificial intelligence, machine learning, robotic process automation (RPA), and integrated data platforms to handle tasks such as insurance verification, contract management, denial management, coding, claims submission, and payment posting with minimal manual input. These systems can quickly process large volumes of transactions, identify errors or omissions, and provide real-time analytics that support compliance and financial health.

Key benefits of automated RCM

Motivated by McKinsey’s projection that technology could unlock $350 to $410 billion in annual healthcare value by 2025, revenue cycle managers, vice presidents, and physician group CEOs are increasingly weaving AI-powered automation into their operations. 

What’s driving this momentum is the clear evidence that technology investments are paying off. A recent NAHRI State of the Revenue Integrity Industry Survey reported that 73% of respondents saw positive financial results after automating revenue cycle processes. Similarly, a Black Book survey of more than 1,300 healthcare finance professionals revealed that organizations using automation tools achieved a 27% drop in cost-to-collect along with a 6% boost in net patient revenue.

Further reinforcing the value of automation, research from the Institute for Robotic Process Information and Artificial Intelligence, highlighted in a KPMG analysis, found that robotic process automation can cut healthcare organizations’ costs by 25 to 50%. Beyond financial benefits, employee experience appears to improve as well: in a recent Salesforce survey, 79% of automation users said such tools made them more productive, and 89% reported higher job satisfaction after adoption.

We call that a win for automation. But there’s more.

In a recent Health IT Answers post, a dozen experts share their visions for technological advances in RCM. 

Sameer Bhat, Vice President and Co-Founder, eClinicalWorks asserts that, 

“99.9% of RCM processes can be fully automated through AI-powered agents… AI-generated eligibility insights curate precise coverage details for specific patient visits and identify potential eligibility issues and deductible information. [It can also] automate the generation of billing coding and manage appeals, saving valuable time and resources.” 

On the other hand, the executive director of AGS Health Ryan Chapin recognizes that, “Denials and payer relationships will remain the top challenge for healthcare providers in 2025.”  He adds that, denials, coupled with:

“... the ongoing strain due to shortages in the revenue cycle workforce will lead providers to further integrate AI and predictive analytics into RCM to stay ahead of denial trends by allowing providers to proactively address issues that result in denials and prioritize denials with the highest return on investment.” 

Automated revenue cycle management (RCM) is being widely adopted as healthcare leaders see compelling returns. 

Several reputable industry publications and research organizations report strong, positive statistics about automated revenue cycle management (RCM) in 2025, demonstrating clear financial and operational benefits for healthcare providers.

• Cost reductions: As mentioned above, automated RCM is credited with reducing cost-to-collect by up to 27%—meaning providers can capture their revenue at significantly lower administrative expense.
  
• Revenue growth: Healthcare leaders also report increased revenue after implementing RCM automation solutions.
• Claim denial reductions: Organizations that adopt automation report reductions in claim denials and faster payment cycles. Real-world case studies—such as Geisinger Health System—report more than 10% reductions in claims denials and lower administrative costs after automation.
  
• Improved clean claim rates: Automation-first RCM models improve clean claim rates because they can detect and correct errors before submission, ensure consistent application of payer rules, and streamline data validation, resulting in fewer rejections and resubmissions.
  
• Labor efficiency: Automated RCM systems see labor cost per claim decrease because, with tasks handled by bots, organizations need fewer staff for coding and claims processing.
  
• Boosted cash collections: Automated RCM helps organizations improve cash collections due to speedier payments, fewer delays, and better denial management.

In summary, the adoption of automated revenue cycle management consistently leads to lower costs, higher revenue, reduced denials, and improved cash flow for healthcare organizations. 

Why manual RCM processes fall short

Manual RCM requires employees to enter patient data, verify insurance, code procedures, submit claims, and post payments using paperwork, spreadsheets, or basic software with little automation. Each step depends on individual accuracy and careful attention, often leading to repetitive, tedious tasks and delays in processing.

Drawbacks

• High risk of errors: Manual entry can result in frequent mistakes like incorrect patient information, coding errors, or missed claim deadlines, causing rejected or denied claims.
• Slower workflows: Staff must handle each task sequentially, increasing turnaround times and delaying revenue payments.
• Resource intensive: More personnel hours are required to check and re-check data, resolve errors, and follow up on outstanding claims—raising labor costs and reducing efficiency.
• Operations sink:  Inefficiencies and frequent mistakes in manual RCM can lead to substantial revenue loss, increased administrative workloads, and staff burnout. Organizations relying on manual processes often struggle to keep pace with regulatory changes and payer requirements, further compounding errors and delays.

Ultimately, manual RCM puts organizations at a disadvantage compared to those using automated solutions, making it difficult to sustain high standards of financial and operational performance.

End-to-end or point solutions: Where will you automate? 

Revenue cycle management starts at patient registration and doesn’t end until final payment posting. The 10 steps are: 

While huge health systems and hospitals tend to gravitate to end-to-end revenue cycle software solutions like Waystar, R1 RCM and Change, physician groups and healthcare MSOs are discovering that point RCM solutions offer agile solutions to the specific challenges they face. Built to integrate with other point solutions as well as EHR and practice management (PM) systems, point solutions go in depth in certain RCM tasks. They stake their reputations on their product’s accuracy and effectiveness. 

Provider organizations with well-functioning coding software in place, may find they only need to centralize, analyze, and optimize their healthcare contract management. Contract management software catches every payment and denial coming in, comparing it to the rates and terms documented in the contract. Discrepancies are listed in clear dashboards, ready for staff to examine and present to payers. 

Take a quick, self-guided tour through a powerful contract management and underpayments identification tool:

Denials are another area where provider organizations prefer point or “bolt-on” solutions. Some have solid automated RCM solutions in place in the front end of the revenue cycle, but need to support staff in identifying and appealing denials. 

It’s no wonder. 

Kaiser Family Foundation reports that, as of this year, HealthCare.gov payers now deny 19% of in-network claims and 37% of out-of-network claims, amounting to a combined average of 20% of all claims. That’s a big hit to net revenue. 

Denial management software significantly enhances provider organizations' ability to manage and recover denied insurance claims by leveraging data analytics, automation, and streamlined workflows. These platforms analyze historical and real-time claim data to pinpoint root causes of denials—such as authorization gaps, documentation issues, or payer-specific patterns—allowing organizations to proactively address problem areas and prevent future rejections.

Key functionalities include:

•  automated sorting and assignment of denials by category (payer, CPT code, denial reason, etc.)
•  guided appeal generation
• status tracking through customizable work queues

Sophisticated dashboards provide executive-ready views into denial trends, while robust analytics deliver actionable insights for workflow improvement, contract negotiations, and compliance. 

Take a quick, self-guided tour through powerful denial management and underpayment detection software. 

By embedding denial management tools, provider organizations can systematically increase their clean claims rate, accelerate cash recovery, maximize reimbursement, and transform denial management from a reactive process into a strategic driver of financial performance.

When a provider organization needs more than just the data and insights into their operations, some revenue cycle companies offer denial recovery and underpayment recovery services to complement their software solutions. 

Should your automated RCM be a comprehensive or point solution?

A revenue cycle management team can determine whether to implement an end-to-end automated RCM solution or adopt one or more point solutions by evaluating the organization’s unique needs, gaps, and pain points. Take these  three steps: 

1. Assess needs and current processes

The team should first analyze which RCM functions are already performing well and where the most critical inefficiencies or revenue leaks exist. If challenges are limited to specific areas—such as prior authorizations, contract modeling, underpayment recovery, or denial management—a targeted point solution may be preferable because it delivers deeper customization for those functions while integrating smoothly with existing tech stacks.

2. Conduct a pros and cons analysis

End-to-end solutions provide comprehensive coverage from patient registration to payment posting, offering system-wide visibility and reducing data fragmentation, which is valuable for organizations needing broad process improvements and simplified management. However, smaller organizations with tighter budgets, or those with high performance in most RCM areas, may benefit from cost-efficient point solutions that address only their weakest links without major disruption.

3. Determine integration and scalability needs

The team must also consider the complexity of current systems, interoperability requirements, and future growth—if scaling operations and eliminating vendor management are top priorities, an integrated end-to-end platform is likely a better long-term fit. Conversely, if organizational complexity is manageable and only targeted improvements are needed, point solutions provide cost containment and quick onboarding.

In summary, thorough evaluation of organizational workflow, technology integration, budget constraints, and strategic objectives will guide RCM teams toward the best approach—comprehensive end-to-end automation for broad needs or specialized point solutions for focused challenges.

Steps to shift from manual to automated RCM

Making the transition from manual to automated revenue cycle management requires a clear strategy and stepwise execution to ensure successful integration and sustainable results. As healthcare organizations face increasing complexity and pressure to optimize revenue, adopting automation is essential to reduce errors, improve efficiency, and stay competitive in the evolving landscape. The following steps outline how to move from manual processes to an automated RCM model for lasting operational improvements. 

1. Assess current processes: Evaluate existing manual workflows to identify bottlenecks, error-prone tasks, and data gaps in your RCM operations. 
2. Define automation goals: Set clear objectives for cost savings, denial reduction, increased accuracy, and improved cash collections to guide technology adoption.
3. Select the right automation solution: Research and choose an RCM platform with proven automation capabilities tailored to your organization’s size and specialties.
4. Integrate systems and data: Plan for the seamless integration of new tools with your EMR, billing software, and payer networks, ensuring unified data flow. 
5. Train staff for new workflows: Conduct training to help team members understand the automated system, re-assign roles, and address resistance to change.
6. Test, monitor, and optimize: Roll out automation in phases, monitor performance metrics, and continuously refine processes based on analytics and user feedback.

Following these steps will help organizations achieve a smooth and effective transition from manual RCM to automation, driving sustainable improvements in financial and operational outcomes.

Generative AI and RCM automation

Generative AI and automation are rapidly emerging as key drivers of transformation in healthcare revenue cycle management, creating new efficiencies and opportunities. 

While traditional AI and automation have already streamlined many RCM tasks, generative AI is starting to be used for tasks like predictive patient communication, drafting appeal letters, and personalizing billing interactions.

Major platforms like Epic are integrating ChatGPT 4.0 for health records processing, and Doximity uses generative AI to draft preauthorization and appeal letters—combining AI’s language capabilities with automated workflows to improve patient access and administrative speed. Some RCM vendors are actively exploring generative AI for crafting personalized payment plans that match a patient’s unique financial situation, which both saves staff time and enhances collection rates.

Healthcare organizations such as Ochsner Health and UNC Health have adopted generative AI chatbots to address clinical questions and operational inquiries, streamlining staff communications and supporting internal navigation. According to leading analysts, the combination of AI and automation can boost labor productivity. 

Early adopters will likely gain the most competitive advantage, as automation remains the foundational technology that enables the practical benefits promised by new AI models. Healthcare leaders are focusing on business processes when deploying AI, knowing that process optimization is the catalyst for improved revenue performance and patient satisfaction.

MD Clarity’s automated RCM optimizes provider revenue 

By reducing manual workloads, minimizing costly errors, and providing greater visibility into claims and payments, automated RCM empowers teams to capture more revenue and operate with a higher level of efficiency and control. Forward-thinking healthcare leaders agree: embracing automated RCM is fundamental for sustained success and growth.

RevFind by MD Clarity optimizes contract and denial management by equipping internal teams with sophisticated automation for contract management, denial tracking, underpayment identification, and revenue maximization. Rather than relying on labor-intensive manual reconciliation or outdated spreadsheets, RevFind digitizes and organizes payer contracts, benchmarks performance against industry norms, and seamlessly distinguishes denials from true underpayments. This power enables staff to focus on high-value work, not administrative burdens.

With RevFind, provider organizations gain hassle-free, transparent reporting, maintain hands-on control of their revenue cycle, and achieve consistent reimbursement optimization. This depth of automation and clarity ensures reliable revenue protection, enhanced compliance, and greater patient trust—all without outsourcing critical financial operations or losing institutional knowledge. 

Schedule a demo to see how RevFind’s sophisticated automation optimizes your revenue cycle, protecting net revenue and lowering costs to collect.  

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