Largest revenue cycle management (RCM) vendors

Behind every great hospital or healthcare organization is a great revenue cycle management (RCM) system. After all, a successful RCM process helps healthcare practices stay financially viable and focused on treating patients and saving lives.

Because the healthcare revenue cycle can be very complex, many healthcare organizations rely on RCM software to properly manage every step of the medical billing process.

What is revenue cycle management?

Revenue cycle management is exactly what it sounds like—a strategy that healthcare organizations can use to manage the administrative and clinical processes in their revenue cycle. This involves processing claims, collecting patient payment, communicating with health insurance payors, and more.

What is an RCM vendor?

While the revenue cycle management process can be done manually, the complexity of the steps involved in the cycle means that there are many opportunities for costly errors to occur. In-house RCM teams can also be an expensive investment, as the healthcare company must hire and train staff, purchase software, and manage operations.

That’s where an RCM vendor can come in and help. RCM vendors offer external support and software so healthcare providers can track their financials and stay organized—potentially at a lower price and with no mistakes.

RCM software automates the process and can help healthcare organizations properly navigate their revenue cycle, identify errors or leakage points, and ensure the facility is fairly paid for the services they provide.

What are the steps of the revenue cycle in healthcare?

The revenue cycle comprises seven steps:

1. Collect patient info: The cycle begins when a patient makes an appointment with a healthcare provider and provides personal information. This includes home address, date of birth, insurance info, phone number, and other details.
2. Charge capture: At this point, details about the services rendered are sent to billing.
3. Coding: CPT codes are assigned to diagnoses and medical services that insurance providers can refer to for reimbursement.
4. Claim submission: Once a charge is captured and coded, the claim gets sent to the insurance provider.
5. Insurance review: At this stage, the healthcare organization and the insurance provider may follow up on what has and hasn’t been paid.
6. Billing and collection: Once the claim has been verified and processed, it will become the patient’s responsibility to cover some of the service costs. Generally, these costs are determined during the first appointment so the facility can receive payment sooner rather than later.
7. Revenue cycle review: RCM software can make the most impact at this final stage of the cycle. Now that everything has been paid for, it’s time to review how the process went. What were the stumbling blocks? Is there any way to tweak the process to make it smoother for patients? This is where the organization can look at inefficiencies in the process and make improvements.

Below, we rank the most popular revenue cycle management software based on the number of installations in hospitals.