U.S. Revenue Cycle Management Market - Focused Insights 2025-2030

U.S REVENUE CYCLE MANAGEMENT MARKET INSIGHTS

The U.S. revenue cycle management market was valued at USD 141.61 billion in 2024 and is projected to reach USD 272.78 billion by 2030, expanding at a CAGR of 11.55% during the forecast period.

The market growth is driven by the increasing complexity of healthcare billing and reimbursement processes due to evolving regulations, value-based payment models, and insurance requirements, making efficient RCM systems essential for healthcare providers. In addition, the growing prevalence of high-deductible health plans has shifted more financial responsibility to patients, necessitating streamlined processes for managing payments and minimizing outstanding balances, further propelling market expansion.

Revenue Cycle Management (RCM) is a financial process utilized by healthcare organizations to track patient care episodes, from initial registration and appointment scheduling to the final balance payment. It encompasses administrative and clinical functions related to claims processing, payments, and revenue generation, ensuring a seamless financial workflow.

UNITED STATES REVENUE CYCLE MANAGEMENT MARKET TRENDS & GROWTH DRIVERS

Transition from Computer-Assisted Coding (CAC) to Autonomous Coding

The healthcare industry is shifting from Computer-Assisted Coding (CAC) to Autonomous Coding, driven by advancements in AI and machine learning. Unlike CAC, which assists coders by suggesting codes using NLP, autonomous coding fully automates the process, minimizing human intervention. This transition enhances efficiency, accuracy, and cost-effectiveness in medical coding and billing while addressing human errors, fatigue, and evolving standards. A 2023 Frost & Sullivan report states that over 30% of healthcare organizations are either piloting or planning to implement autonomous coding solutions. In addition, a TruCode report highlights that these systems can cut coding time by up to 50% while improving accuracy. Autonomous coding is expected to transform Revenue Cycle Management (RCM) by increasing operational efficiency, ensuring compliance, and enhancing revenue collection as AI-driven systems become more sophisticated and adaptive.

Rising Adoption of Outsourced RCM Solutions

The increasing reliance on outsourced Revenue Cycle Management (RCM) solutions is reshaping the US healthcare sector as providers navigate financial pressures, regulatory changes, and a shift toward value-based care. Outsourcing RCM enables healthcare organizations to streamline operations, enhance cash flow, and reduce costs, allowing them to concentrate on patient care. A 2023 Healthcare IT News survey indicates that 40% of healthcare providers outsource RCM functions, primarily to cut operational costs associated with in-house teams. Third-party vendors offer specialized expertise in billing, coding, and collections, alongside advanced technologies such as automation and AI, improving efficiency and reducing errors. A KPMG report notes that 56% of providers outsource non-core functions like RCM to prioritize clinical excellence. This trend highlights the growing demand for cost-effective, expert-driven solutions that optimize revenue cycles while enabling healthcare providers to focus on delivering high-quality patient care.

INDUSTRY CHALLENGES

Cybersecurity and Data Protection Concerns

Cybersecurity and data protection remain significant challenges in the revenue cycle management (RCM) market due to the sensitive nature of healthcare data and increasing cyber threats. RCM systems manage vast amounts of personal, medical, and financial data, making them prime targets for cyberattacks. Compliance with regulations such as HIPAA adds complexity, necessitating robust security measures to safeguard data and maintain operational integrity. Many healthcare providers and RCM vendors struggle to address these risks due to budget constraints, outdated systems, and a shortage of cybersecurity expertise. Cyber threats, including ransomware attacks, data breaches, and system downtimes, can disrupt the revenue cycle, leading to financial losses, reputational damage, and potential legal repercussions.

US REVENUE CYCLE MANAGEMENT MARKET INSIGHTS

BY COMPONENT TYPE: The U.S. revenue cycle management market is segmented by component type into post-cycle, pre-cycle, and mid-cycle. In 2024, the post-cycle segment held the largest market share of over 57%. This segment is gaining traction due to evolving regulatory requirements, technological advancements, and financial pressures on healthcare providers. The focus on claims submission, denial management, and collections is critical for optimizing revenue and maintaining financial stability. A key trend in this segment is the increasing adoption of automation and AI-driven tools to minimize claim denials by detecting errors and suggesting corrections automatically. Furthermore, the outsourcing of RCM services is becoming increasingly popular, particularly among smaller healthcare providers, who benefit from expert-driven solutions that ensure compliance and improve cash flow.

BY DELIVERY MODE: The U.S. revenue cycle management market by delivery mode is categorized into cloud-based and on-premises solutions. The cloud-based segment is witnessing substantial growth, with the highest projected CAGR of 12.22% during the forecast period. Cloud-based RCM solutions are revolutionizing financial operations in the US healthcare sector, driven by the need for efficiency, cost reduction, and enhanced patient experiences. These solutions are experiencing strong adoption, supported by advancements in automation, AI, and cybersecurity. Cloud-based platforms enable seamless workflows in billing, coding, and claims management while ensuring interoperability with insurers and other stakeholders. The integration of AI-powered analytics helps reduce claim denials and optimize revenue collection.

COMPETITIVE LANDSCAPE

The U.S. revenue cycle management market report provides exclusive insights on 55 vendors. This dynamic and competitive landscape is characterized by a rising demand for technology-driven solutions, increasing consolidation among market players, and new entrants leveraging cutting-edge technologies such as AI and automation. Leading companies, including Change Healthcare, Epic Systems Corporation, Experian, McKesson Corporation, Oracle, R1 RCM, Veradigm, and SSI Group, dominate the market by offering comprehensive RCM solutions for billing, claims management, and regulatory compliance. These firms maintain strong relationships with major healthcare providers and are expanding their offerings through strategic acquisitions and partnerships to sustain their market leadership.

RECENT VENDOR ACTIVITIES

• In 2024, leading healthcare technology and RCM company CorroHealth completed the acquisition of Xtend Healthcare’s revenue cycle management business from Navient, further strengthening its position as a leader in revenue cycle management consultancy and technology.
• In August 2024, R1 RCM announced its acquisition agreement with private equity firms TowerBrook Capital Partners and Clayton, Dubilier & Rice in a deal valued at $8.9 billion. The transaction is anticipated to be finalized by the end of 2024.