Revenue cycle management companies come in all shapes and sizes. But, they all promise to help you manage your healthcare organization’s revenue cycle. However, the services they provide are usually better suited for specific types of healthcare organizations. They also take different approaches to how they help organizations manage their revenue cycle.
Types of Revenue Cycle Management Companies
There are two primary types of RCM companies: software and outsourcing. Both can provide valuable solutions to healthcare organizations, but one may be a better fit for your practice than another.
Revenue cycle management software company
RCM software companies provide the platform and tools you need to manage your revenue cycle with your own team. These tools streamline the RCM process and automate much of the data entry process. You can track your revenue, monitor cash flow, and reduce errors with RCM software.
Some RCM software solutions also include features that allow you to provide patient estimates so that you can comply with the No Surprises Act. This feature uses data from insurance plans to generate accurate estimates for various services. Many healthcare organizations provide advanced estimates to all their patients, not just those covered under the No Surprises Act, because it improves the patient experience and increases revenue.
Other features that may be included in RCM software include:
- Real-time eligibility
- Denial management
- Underpayment detection
- Payer contract analytics
Although RCM software provides many helpful tools for managing your revenue cycle, it’s up to you to do the work. Your RCM department will be responsible for learning and using the software in a way that benefits your organization.
Revenue cycle management outsourcing company
Revenue cycle management outsourcing, on the other hand, is primarily a service rather than just a software platform. An RCM outsourcing company will handle RCM tasks on your behalf. This solution can be ideal if you don’t have an adequate RCM staff or your staff lacks the expertise to efficiently manage the revenue cycle.
RCM outsourcing companies frequently offer a range of services, such as billing, coding, claims management, and collections. Outsourcing the entire RCM management process can be cost-efficient because you don’t have to hire specialized RCM employees, and you’ll reduce errors associated with manual processes.
However, you lose some control by outsourcing RCM and may run into friction points such as slower turnaround and possible security risks.
Whether an RCM outsourcing company or RCM software is best for your organization will depend on various factors, including your current staff, the complexity of your billing codes, and the services your RCM department performs. We’ve rated the top RCM software and RCM outsourcing companies so you can choose the best option for your organization.
Top 10 Healthcare Revenue Cycle Management Companies
1. MD Clarity
2. Change Healthcare
5. Ensemble Health Partners
9. R1 RCM
MD Clarity is a revenue cycle management software company that helps organizations optimize revenue collection, improve their financial health, and offer transparency in healthcare. The company's solutions provide a platform that allows you to automatically detect payer underpayment, provide patient cost estimates, optimize your contracts, and ultimately increase your revenue.
MD Clarity serves several healthcare organizations, such as managed services organizations, ambulatory healthcare practices, ophthalmology practices, and health systems. Since its inception in 2010, the company has automated workflows in over 20,000,000 patient encounters for over 150,000 providers and over 3,000 facilities in the United States.
- No Surprise Act compliance with Clarity Flow: With Clarity Flow, you can provide cost estimates, which makes it easier for patients to pay out-of-pocket costs and make payments online. You can also automate your Good Faith Estimates and send them via text, email, or letter.
- Denial management with RevFind: You can spot, rectify, and appeal underpayments and denied claims from payers automatically. RevFind makes it easy to monitor contract appeals by allowing you to assign them to staff and view the progress in one place. You can also detect underpayment patterns, analyze how your payer contracts perform, and negotiate better contracts.
- Contract Modeling: Helps you track and compare the performance of insurance contracts. You can also see beforehand how contract changes will impact cash flow, which will assist in contract negotiations.
Notable clients: MD Clarity's notable clients include Providence Anesthesiology Associates, Seattle Radiology, Minnesota Eye Consultants, Tahoe Fracture, San Ysidro Health, and EyeSouth Partners.
Headquarters: MD Clarity is headquartered in Seattle, Washington, United States.
Change Healthcare provides solutions that help organizations with revenue cycle management, cost transparency, payment cycle management, health information exchange, and patient engagement. The company provides innovative software solutions to healthcare organizations, including payers, providers, pharmacies, and third-party administrators.
- Payment Accuracy: The company's payment accuracy tools help payers enhance payment integrity, claims adjudication, and payment operations to increase provider satisfaction and reduce costs. They also help providers reduce appeals, improve payment accuracy, and minimize costs.
- Revenue Cycle Management: Change Healthcare offers solutions that help providers increase staff efficiency, promote patient engagement, and optimize revenue. The tools also integrate claims management to help automate your workflows, prevent denials, and improve your cash flow.
- Data Analytics: With data analytics, you can access robust data, which will help enhance patient outcomes, reduce costs, and grow your business. You can gain insight into your healthcare data to make informed decisions that will help you improve the quality of care, increase revenue, and meet compliance guidelines.
- Patient Engagement: Helps providers to create a seamless patient experience that drives engagement, loyalty, and revenue. You can reduce the cost to collect and the risk of bad debt by giving patients digital options and customized billing communications.
- Application programming interface (API) integration: Change's robust APIs boost connectivity between payers, providers, and patients. It's built to enable payer-to-member interactions, so members can seamlessly access and pay for care.
Headquarters: Change Healthcare’s headquarter is in Nashville, Tennessee, United States.
Rating: Change Healthcare has a score of 3.8/5 stars on G2.
Guidehouse was founded in 2018 when PwC sold off its public sector consulting arm to private equity firm Veritas Capital. A year later, Guidehouse acquired Navigant Consulting to expand into the commercial sector. Guidehouse offers consulting services in different areas, including financial management, business intelligence, operational strategy, enterprise risk management, and technology consulting, to both public and private entities, especially in highly regulated industries such as healthcare, defense and security, and financial services. The firm provides comprehensive RCM outsourcing, extended business office solutions, and revenue cycle consulting.
- Revenue Cycle Advisory: The firm helps hospitals, health systems, and other providers to minimize operating costs without compromising on providing high-quality care. They provide revenue cycle capabilities, which can enable your staff to work across patient access, mid-revenue cycle, and patient financial services. They also provide EHR expertise and strategic managed care solutions.
- Health Managed Services: Guidehouse's revenue cycle outsourcing services are designed to help healthcare organizations improve quality, decrease costs, scale their businesses, and increase efficiencies. They can help you at different stages of your revenue cycle, including revenue integrity, patient access, utilization management, CDI, coding, and patient financial services.
Headquarters: Guidehouse is headquartered in NW Washington, District of Columbia, United States
Rating: Guidehouse has a score of 92.6 on KLAS Research.
Waystar was founded in 2017 by the merger of two RCM leaders, Navicure and ZirMed. The company, like other top revenue cycle management companies, helps healthcare organizations simplify healthcare payments across the complete revenue cycle. Its RCM solution automates manual work, empowering you to gain insight into processes and performance and ultimately collect more revenue. Waystar also brings transparency into healthcare billing, which was an opaque experience, by providing patients with a breakdown of their healthcare bills.
- Financial Clearance: The platform using innovative technology and predictive analytics helps simplify eligibility verification and prior authorization processes, which helps providers understand a patient's likelihood to pay and inform patients of their financial responsibility.
- Revenue Capture: Many healthcare organizations lose significant amounts of revenue because of coding mistakes, missing charges, and DRG underpayments. With Waystar’s Revenue Capture solution, which is powered by predictive analytics and machine learning and supported by a team of certified coding experts, you can identify and correct these errors.
- Claim management: Waystar’s Claim Management suite can help your organization prevent rejections and denials, monitor claims automatically, and streamline attachments.
- Payment Management: Provides a simpler way to collect payments. By giving your team the solutions they need to maximize payment from both patients and payers, you can provide a more transparent and positive financial experience for patients.
- Denial Prevention and Recovery: This helps organizations manage appeals and prevent denials to minimize revenue loss.
- Analytics and Reporting: Waystar’s business intelligence and analytics tools simplify accessing and reporting important business data. By identifying, analyzing, and resolving problems as they occur, you can boost efficiency and performance.
Notable clients: Waystar has many notable clients, including Halifax Health, Aultman, Catholic Health Initiatives, Clinicient, One Ortho Northeast, and Piedmont Healthcare.
Headquarters: Waystar’s headquarter is in Louisville, Kentucky, United States.
Rating: Waystar has a score of 4.5/5 stars on G2.
Ensemble Health Partners
Ensemble Health Partners is a Best in KLAS revenue cycle outsourcing, tech-driven company that helps healthcare providers focus on what matters most. Founded in 2014, the company adapts emerging technologies to practical uses by delivering concrete solutions that impact providers’ bottom line.
- Patient Access: This helps providers improve access and communication at every step of the healthcare journey. Providers can avoid denials and prevent missed revenue by efficiently and accurately registering patients, running eligibility verification, providing financial counseling, and collecting upfront payments.
- Revenue Capture: You can leverage advanced technology to detect missing charges and coding errors before billing. Ensemble helps providers prevent errors that lead to revenue loss and avoid compliance risks with comprehensive auditing, education, and process improvement.
- Revenue Collection: The company’s revenue collection service helps providers achieve efficient claim submission, account resolution, and accurate reimbursements by eliminating silos, inefficient processes, and other root causes that delay reimbursement.
- Process Optimization: Ensemble reviews healthcare organizations’ revenue cycle processes and systems to identify the real issues and prioritize improvement.
Headquarters: Ensemble's headquarter is in Cincinnati, Ohio
Rating: Ensemble Health Partners has a score of 92.9 on KLAS Research.
Founded in 1984 as Gateway EDI, TriZetto Provider Solutions aims to simplify the business of healthcare. It provides revenue cycle management services that help healthcare organizations succeed by combining extensive industry knowledge, intuitive products, and customer-centric services.
- Claims Management: Trizetto’s claim management services speed up payment and at the same time decrease administrative burdens.
- Patient Engagement: Helps organizations to provide a seamless financial experience. You can verify eligibility, uncover hidden insurance coverage, simplify the prior authorization process, and provide cost estimates.
- Denials and Contract Management: Maximize revenue recovery by using this service to efficiently monitor all transactions to spot mistakes and automate the appeal process.
- Billing and coding: You can work with the company’s team of in-house experts, so you don't have to hire billers and coders.
- Credentialing: Use the services of TriZetto’s expert and intuitive portal for your organization’s credentialing needs. The company’s guided workflow can help you gain compliance quickly, save time, and allow you to earn reimbursements for your services as soon as possible.
- Analytics: With analytics, you can easily gain visibility into your revenue cycle. Whether you need to meet a short-term or long-term goal, you can use analytics for comparative benchmarking to improve your overall performance.
Notable clients: TriZetto's notable clients include Genesis Healthcare System, Bucksport Regional Health Center, North Medical Billing, and Griebenow Eyecare.
Headquarters: TriZetto’s headquarter is in Earth City, Missouri, United States.
Rating: TriZetto has a rating of 4.3/5 stars on G2.
TruBridge helps healthcare organizations solve the business problems that get in the way of providing care. As an outsourcing company, TruBridge works with organizations to develop a custom plan designed to address their unique needs. TruBridge product suites help to increase cash flow, boost productivity, and speed up reimbursement, which frees up more time you can devote to providing care.
- Medical Coding: TruBridge's HIPAA-compliant medical coding service can help you with accurate coding. Depending on your specific needs, you can choose a full or partial coding outsourcing solution and improve cash flow, reduce risk, and decrease expenses.
- Intake Management Service: Using TruBridge’s intake management service, you can verify eligibility, begin obtaining authorization, create patient liability estimates, and collect copays and deductibles. This helps you collect more upfront payments and improve your bottom line.
- Denial Management and Prevention: TruBrdige’s Denial Management Program helps organizations take care of their claim process and avoid denials by identifying and eliminating the root causes of denial. With the program’s customizable, three-step approach, you can reduce delays in payments and lost revenue associated with denials.
Notable clients: Some of TruBridge’s notable clients include Weatherford Regional Hospital, Door County Medical Center (DCMC), Promise Healthcare Group, and Adirondack Health.
Headquarters: TruBridge is headquartered in Mobile, Alabama, United States.
Rating: TruBridge has a rating of 3.4/5 on G2.
FinThrive’s end-to-end revenue management platform offers a seamless revenue experience that reduces cost, increases cash collection and revenue, and ensures regulatory compliance.
The company develops revenue management solutions for providers and payers, freeing them from revenue cycle complexity and inefficiency so they can focus on providing care.
- Patient Access: FinThrive’s patient access solutions help to provide price transparency, improve upfront collections, and digital patient registration and check-in.
- Patient Finance: The company’s scalable patient finance solutions help to reduce denials, enhance accurate contract pricing, and minimize claim rejections. FinThrive Patient Finance solutions exceed federal and state price transparency requirements and are compatible with most PAS and EMR systems.
- Revenue Integrity: This gives providers a single source of truth to generate correct charges and defensible pricing. This solution also helps revenue integrity teams work faster using industry-leading charge capture and chargemaster technology.
- Revenue Recovery: With revenue recovery, Finthrives helps providers reduce financial uncertainty and improve revenue recovery processes. Providers can receive reimbursement from unexplored sources of revenue by optimizing their collections strategies. The company helps the healthcare industry recover $1.2 billion annually.
Notable clients: FinThrive's notable clients include Midwestern Hospital, West Tennessee Healthcare, North Mississippi Health Services, Colquitt Regional Medical Center, Prospect Medical, and Phoebe Putney
Headquarters: FinThrive is located in Alpharetta, Georgia, United States.
Rating: FinThrive has an overall score of 83.7/100 on KLAS Research.
R1 RCM aims to make healthcare simpler by offering technology-driven solutions that transform providers' financial performance and promote patient satisfaction. As an outsourcing company, R1 RCM provides end-to-end RCM services to help providers improve net patient revenue, reduce total cost to collect, and enhance the patient experience.
- Patient Billing: R1 RCM empowers providers to offer multiple payment options, such as automated payment plans, online payment, and omnichannel customer service.
- Coding Management: A combination of R1 RCM talent, expertise, and technology helps to promote greater efficiency, so providers can increase revenue.
- Patient Access: R1 RCM helps you combine scheduling, clearance, registration, patient intake, and online payment capability, enabling patients to self-serve.
Notable clients: R1 RCM's notable clients include Rush, Intermountain Healthcare, Ascension, Quorum Health, PennState Health, and VillageMD.
Headquarters: R1 RCM is headquartered in Murray, Utah, United States
Rating: R1 RCM has an overall score of 77.4/100 on KLAS Research.
Dentrix was founded in 1985. In 1997, Henry Schein, Inc. acquired it. The company offers dental practice management software specifically for dental clinics. The platform practice technology is designed to manage the complexities of multilocation practices or integrated health centers.
- Patient Payment: Dentrix payment solution has features that help you reduce costs and increase revenue. It integrates directly with two modern patient payment systems – Dentrix Enterprise Pay and AxiaMed, which gives you the option to choose the solution best suited for your practice.
- eClaims: Dental practices can get paid faster by using Dentrix eClaims to simplify the insurance claims process. eClaims ensures that your claims contain all vital components, which reduces the number of rejected claims.
- Automated Patient Billing: With Dentrix QuickBill, dental practices can retain control associated with manually producing billing statements without the hassle or cost. You can send dental insurance billing statements directly to patients from the Dentrix Enterprise.
Notable clients: Dentrix's notable clients include Cedar Creek Smiles and Butterman Dental PC.
Headquarters: Dentrix's headquarter is in American Fork, Utah, United States.
Rating: Dentrix has a rating of 4/5 stars on G2.
Which Revenue Cycle Management Company is Best for You?
The best RCM company to work with depends on your organization’s needs.
If you’re a large health system, pick Change Healthcare. The company’s interoperability solutions offer customization capabilities that large organizations need.
If you’re looking to outsource revenue cycle management to a consultancy, pick Guidehouse. The company has deep expertise in helping healthcare organizations minimize costs without sacrificing quality care.
If you’re a practice or provider group looking for revenue cycle software to automate RCM workflows in-house, pick MD Clarity. Interested in seeing how MD Clarity can be a game changer in your revenue cycle management? Get a demo to see it in action.