Revenue cycle management (RCM) solutions for healthcare providers are software for carrying out activities associated with healthcare organizations' billing and payments. They integrate with other platforms—such as practice management and electronic health records solutions—to streamline revenue operations from appointment to final payment. These programs can also help you comply with laws such as the No Surprises Act, which requires healthcare providers to give estimates of expected charges to self-paying or uninsured patients.
Keep reading to learn about the 10 best revenue cycle management software for healthcare.
Top 10 Revenue Cycle Management Software for Healthcare
1. MD Clarity
2. Change Healthcare
MD Clarity has been providing RCM solutions since 2010. Since then, it has automated workflows for over 3,000 facilities, 150,000 providers, and 20,000,000 patient encounters across the United States.
MD Clarity serves various healthcare institutions, including ambulatory surgical centers, health systems, ophthalmology practices, and managed service organizations. It aims to boost healthcare providers' bottom line and patient experience by automating patient cost estimates, contract optimization, and payer underpayment detection.
- Clarity Flow offers transparency for patients and the staff who serve them. It encourages patients to pay upfront by projecting out-of-pocket costs at a high accuracy rate. It can also auto-send No Surprises Act-compliant Good Faith Estimates via text, email, or letter.
- Contract Analysis lets you know how your insurance contracts perform, compare contract performance, and project cash flow impacts of contract modifications.
- RevFind promotes transparency for your revenue cycle staff. It lets you spot insurance company underpayment patterns, ensure you are setting chargemasters optimally, and assign appeals and investigations to staff.
Notable clients: Notable MD Clarity clients include Minnesota Eye Consultants, Providence Anesthesiology Associates, Tahoe Fracture, and EyeSouth Partners.
Headquarters: MD Clarity's headquarters is in Seattle, Washington, United States.
Rating: MD Clarity has a score of 4.7/5 stars on G2.
Change Healthcare was known as Emdeon before rebranding in 2015. Its revenue cycle management and payment software helps healthcare providers, payers, and consumers improve financial and clinical outcomes so everyone in the healthcare system can thrive.
Change Healthcare services pharmacies, healthcare systems, third-party administrators, and other healthcare organizations.
- Artificial intelligence: Change's RCM and payment platform uses artificial intelligence to remove collaboration barriers and administrative inefficiencies. This includes natural language processing (NLP), AI-powered virtual assistants such as chatbots, and machine learning-based predictions for improving internal and external workflows.
- Application programming interface (API) integration: Change's plug-and-play APIs increase adoption speed, streamline onboarding, and boost workflow efficiencies to help healthcare organizations meet rising patient expectations.
- Data and analytics solutions: These tools help healthcare providers access timely, comprehensive data to improve patient outcomes, grow their business, and reduce costs. Change provides many data and analytics solutions, including Clinical Trials Access Network, which helps recruit patients for clinical trials. Healthcare providers can use Clinical Trials Access Network to pre-screen patients, complete referrals, and match patients to advanced treatments.
Headquarters: Change Healthcare is headquartered in Nashville, Tennessee, United States.
Rating: Change Healthcare has a score of 3.7/5 stars on G2.
Waystar was founded in 2017. Built on the legacy of two mature RCM leaders, Navicure and ZirMed, Waystar is a 16-time Best in KLAS winner or Category Leader and a Black Book top-rated vendor. Like the other companies on this list, Waystar aims to help healthcare organizations understand their revenue cycle more clearly. It also helps patients understand what they're paying and why, modernizing what has traditionally been an opaque and stressful experience.
- Financial Clearance: This platform uses the latest technology and predictive analysis to simplify prior authorization processes and eligibility verification, give providers visibility into patients' propensity to pay, and help patients understand their financial duties.
- Revenue Capture: Healthcare organizations often lose significant revenue due to missing charges, underpayments, and coding mistakes. Revenue Capture uncovers missing revenue by helping you spot and correct these problems. It offers access to a dedicated team of certified coding experts.
- Claim Management: This suite helps prevent preventions and denials before they happen, streamline attachments, and automate claim monitoring. It also lets you work on government and commercial claims in one place.
- Payment Management: This tool collects patient payments, automates payer remittances, and gives you insight into outsourced agencies' effectiveness.
- Denial Prevention and Recovery: Get paid faster and more fully by avoiding, tracking, and appealing denials.
- Analytics and Reporting: Waystar offers actionable intelligence and generates easy-to-understand reports.
Notable clients: Waystar's notable clients include CHRISTUS Health, Piedmont Healthcare, Lehigh Valley Health Network, East Tennessee Children's Hospital, Maimonides Medical Center, and Halifax Health.
Headquarters: Waystar is headquartered in Louisville, Kentucky, United States.
Rating: Waystar has a score of 4.5/5 stars on G2.
Infinx was founded in 2012. It uses automation and artificial and human intelligence to help healthcare providers overcome their revenue cycle challenges. Providers who partner with Infinx stay several steps ahead of ever-changing payer guidelines and government regulations, giving them more time and energy to grow their businesses. Infinx was awarded straight As by KLAS Research and is ranked as one of the top 10 end-to-end RCM software by Black Book Research.
- Medical Coding Solutions: Infinx's coding experts can help you generate more revenue by preventing coding denials.
- Revenue Integrity: This suite utilizes certified coders, artificial intelligence, automation, payer compliance experts, and billing specialists to ensure accurate charge capture is submitted the first time around. This, in turn, maximizes your revenue.
- Revenue Acceleration: Maximize reimbursements from denied claims and accounts receivable inventory and reduce future denials with billing specialists, automation, artificial intelligence, predictive analytics, and intelligent workflow management.
- API integrations: Infinx features API integrations for patient access, prior authorization, clearinghouse, and practice management software.
Headquarters: Infinx Healthcare is headquartered in San Jose, California, United States.
Rating: Infinx has a score of 89.5/100 on KLAS Research.
TriZetto Provider Solutions started as Gateway EDI in 1984. It signed its 1,000th provider in 1998, established the 99% Club in 2004, processed its five-millionth claim in 2006, and rebranded as TriZetto in 2011. In 2014, it was acquired by Cognizant.
TriZetto works to disrupt the healthcare industry positively. Its RCM management services simplify the business of healthcare by combining customer-focused services and products with in-depth industry knowledge.
- Claims Management: These services accelerate payment while minimizing administrative burdens. They offer over 8,000 payer connections and longstanding partnerships with over 650 practice management vendors.
- Patient Engagement: These solutions let you verify patients' eligibility, discover hidden insurance coverage, have informed conversations about financial responsibility and eligibility, and collect more upfront.
- Denials and Contract Management: TriZetto's denials and contract management solutions monitor every transaction to detect errors and automate appeals. They are designed to increase earnings and remove administrative hurdles.
- Billing and coding: TriZetto's in-house billing and coding experts eliminate the need to hire and manage billers and coders.
- Credentialing: These services let you eliminate data-gathering redundancies, easily manage documents from one hub, and ensure compliance with payer regulations.
- Analytics: TriZetto's analytics tools allow you to drill down and manipulate data, spot and isolate issues for decisive action, utilize comprehensive data for competitive benchmarking, and use in-depth insights for making data-driven decisions.
Notable clients: TriZetto clients include Bucksport Regional Health Center, North Medical Billing, and Griebenow Eyecare.
Headquarters: TriZetto Provider Solutions is headquartered in Earth City, Missouri, United States.
Rating: TriZetto has a rating of 4.3/5 stars on G2.
TruBridge offers an arsenal of RCM services and products so you can focus on what they do best: caring for patients. According to the latest HFMA Peer Review Survey, 93% of respondents said that TruBridge RCM exceeded expectations. In comparison, the highest vendor average was 59%.
- Patient Liability Estimates (PLE): This RCM tool boosts your odds of getting paid faster and more. This tool can maximize point-of-service collections and reduce bad debt by giving patients accurate out-of-pocket estimates before service.
- Eligibility Verification: This boosts cash flow, reduces claim denials, improves customer service, and decreases workload by automating eligibility checking.
- Denial and Audit Management: This system offers cross-department workflow management tools that help spot and fix denied and audited claims. It will help you get paid faster and minimize repetitive paper pushing.
- Remittance Management: This web-based solution accepts and normalizes over 800 types of remittance data into compatible files for electronic posting. It will help your team save time and energy and reduce posting errors.
- Reporting and Data Mining: This software will help you stop wasting time searching for hidden data. It reports on every financial detail in remits and claims, and lets you view via over 350 standard reports, 200 drill-down graphs, and unlimited ad hoc reports.
- Deposit Bank Reconciliation: This simplifies deposit bank reconciliation by matching deposits and remits automatically. Any mismatches instantly flow into customizable work queues for resolution.
- Intake Management Service: TruBridge's team acts as your in-house team's backup, reducing denials and increasing paid claims.
Notable clients: Notable TruBridge clients include Door County Medical Center (DCMC), Adirondack Health, and Kearney Hospital.
Headquarters: TruBridge is headquartered in Mobile, Alabama, United States.
Rating: TruBridge has a rating of 3.4/5 on G2.
FinThrive was founded in 2016. It develops award-winning RCM solutions that free payers and providers from inefficiency and complexity. So far, it has delivered over $10 billion in net revenue and cash to over 3,200 customers globally.
- A 360-degree view of finance data: FinThrive gives you a comprehensive view of your company's financial performance. You can use this data to make data-driven business decisions that maximize revenue and customer experience.
- Accurate patient estimates: Like the other companies on this list, FinThrive offers accurate patient estimates that give patients the confidence to pay upfront. This, in turn, can reduce accounts receivable days.
- Near-perfect clean claim rates: FinThrive can dramatically boost your clean claim rates.
Notable clients: FinThrive's notable clients include West Tennessee Healthcare, Colquitt Regional Medical Center, North Mississippi Health Services, and Prospect Medical.
Headquarters: FinThrive is based in Alpharetta, Georgia, United States.
Rating: FinThrive has an overall score of 85.1/100 on KLAS Research.
DrChrono was founded in 2009 by two innovators frustrated with the current healthcare system. It is an electronic health record (EHR) and RCM provider that lets you focus on providing quality patient care. It offers medical billing software, practice management tools, a mobile EHR app, RCM services, customizable clinical notes for specialty clinics, and telehealth tools.
- Medical Coding: DrChrono's certified medical coders review clinical notes and code accurately to prevent lost revenue. They can also help you with clinical documentation compliance.
- Rejection Analysis and Resolution: DrChrono's expert billers work on all rejections within 48 hours. DrChrono's team has deep knowledge of rejections and work closely with insurance and clearinghouse companies.
- RCM Task Manager: This tool gives you real-time updates on your claims. Team members can use it to see which uncompleted tasks must be finished to receive payment and talk to billers.
- Business Intelligence (BI) Tools: DrChrono's BI tools provide up-to-date reports on your organization's performance to increase your income and bottom line.
- Front-end Advice: DrChrono's RCM team can give feedback on improving front-end transactions for a higher clean claim rate.
Notable clients: Notable DrChrono clients include CityHealth, Integrated Musculoskeletal Care (IMC), New Day Therapy, and Regenerative SportsCare Institute (RSI).
Headquarters: DrChrono is based in Sunnyvale, California, United States.
Rating: DrChrono has a rating of 3.6/5 stars on G2.
Dentrix Dental Systems was founded in 1985 and acquired by Henry Schein, Inc. in 1997. As an RCM for dentists, Dentrix has a rich history — it was the pioneer system for Windows in 1989 and the first one to receive approval for Windows 98.
Dentrix strives to meet the ever-changing needs of dental offices through its innovative product development. It has invested significantly in establishing top-notch technical services in dentistry, allowing it to create high-quality products. It has also made substantial investments in research and development.
- Business Management: Dentrix offers built-in business solutions for improving patient care and your bottom line. Features include the Dentrix Daily Huddle Report, an easy-to-create and easy-to-read report which helps your team work together to meet your practice goals. Another helpful business management tool is the Dentrix Practice Advisor, which lets you determine and analyze your practice performance like a business expert. It offers key performance indicators (KPIs) for various areas of your practice, including collections, continuing care, production and case acceptance, and schedule management.
- Practice Marketing: Leverage these online tools to attract and retain patients automatically. This suite of tools can find holes in your existing marketing plan, expand your marketing reach, automate patient communications, and expand your online presence through website design and hosting, targeted email campaigns, and educational web content.
- Clinical Efficiency: This suite improves the patient experience by giving you access to powerful software tools for treatment planning, charting, and progress notes. Some of these tools include Dentrix Smart Image, which expands your ability to provide quality care by combining your financial and clinical processes into one efficient workflow.
- Billing and Collections: These tools help you earn more profit by encouraging patients and insurance carriers to pay sooner. With these solutions, you can streamline electronic claim submissions, manage debit and credit card payments, create and send billing statements on the go, and collect more payments in less time.
- Integrated Dental Technology Solutions: Dentrix offers integrated dental technology products and services to help you succeed. These solutions can eliminate information technology integration and installation problems, back up your files, and protect your data.
Notable clients: Notable Dentrix clients include Butterman Dental PC and Cedar Creek Smiles.
Headquarters: Dentrix is headquartered in American Fork, Utah, United States.
Rating: Dentrix has a rating of 4/5 stars on G2.
StrataPT was founded in 2010. It is a full-service RCM and EMR for physical therapy providers. It simplifies workflows, increases revenue, and enhances patient experiences. Its recent reimbursement rate is 99.99946%, and it has collected over $200,000,000 in recent reimbursements.
- End-to-end billing: StrataPT doesn't just submit claims. It handles all your billing needs, from patient eligibility to payment.
- Financial transparency: The Strata Clarity Panel gives you a clear and real-time status update of every patient's billing charges.
- Online bill pay: Keep your patients updated by scheduling real-time balance alerts. Patients can quickly pay the balances online with just a few clicks.
Headquarters: StrataPT is headquartered in Osprey, Florida, United States.
Rating: StrataPT has received a rating of 4/5 stars on Software Advice.
Which Revenue Cycle Management Software is Right for You?
The best RCM software depends on your size and specialty.
If you're a large hospital system or health insurance company, Change Healthcare is your best bet. It offers intuitive plug-and-play APIs that you can customize according to your needs.
However, if you're a dental practice, you should pick Dentrix. As one of the most mature RCMs on this list, Dentrix was specifically designed for dentists. It offers integrated dental technology solutions, including software tools for progress notes, charting, and treatment planning.
If you're an outpatient physician group or practice, pick MD Clarity. MD Clarity has intuitive tools that can help you maximize revenue, such as Clarity Flow and RevFind. Interested in experiencing the MD Clarity difference? Get a demo to see it in action.