Best Revenue Cycle Management (RCM) Software

Healthcare organizations are embracing digitization and automation opportunities to optimize financial performance. It takes partnering with the best revenue cycle management (RCM) software companies to automate workflows in a way that cuts costs and staff burdens and streamlines operations. Because each healthcare organization has its own unique challenges and opportunities, finding your best automation partner takes a thorough knowledge of both. Overall, however, today’s healthcare organizations are benefiting from using the automation provided by the best RCM software. 

Data from these five industry sources reflect how healthcare profits with modernization:

1. The Healthcare Financial Management Association (HFMA) reports that 74% of revenue cycle leaders in US hospitals and health systems have implemented automation in some aspect of their revenue cycle. This strategic move has yielded enhanced productivity, reduced cost-to-collect, and fewer claim denials and errors.
2. The National Association of Healthcare Revenue Integrity's State of the Revenue Integrity Industry Survey finds that 73% of respondents experienced positive revenue effects from automating revenue cycle processes.
3. A Black Book survey of 1,302 healthcare financial professionals revealed that implementing revenue cycle automation software resulted in: 

•  27% decrease in cost-to-collect
• 6% increase in net patient revenue

4. The Institute for Robotic Process Information and Artificial Intelligence, as cited in a KPMG analysis, suggests that robotic process automation can lead to 25-50% cost savings for healthcare organizations.
5. A recent SalesForce survey of automation users has:

• 79% reporting increased productivity
• 89% reporting higher job satisfaction after implementing automation tools

These statistics underscore the significant impact that advanced RCM solutions, powered by automation and AI, are having on the healthcare industry's financial landscape and operational efficiency. 

6 considerations when evaluating the best RCM software 

Every new year brings new features and technology to RCM software. Recently, AI has dominated the headlines. Review these five key considerations to build your checklist of “must haves,” “would be nice,” and “can skip.” 

Consideration #1: End-to-End vs. Point Solutions

Some RCM companies provide comprehensive solutions that cover the entire revenue cycle, from patient registration to final payment collection. While end-to-end RCM executes surface-level improvements to the 13 steps in revenue cycle management, point solutions limit their offerings to selected points and are built to go deep on each. 

The developers of point solutions place a high premium on their products' precision and efficacy. They understand that in the complex healthcare ecosystem, their reputation hinges on delivering accurate results and demonstrable effectiveness. Again, your choice depends on the opportunities and limitations your organization currently faces. 

For instance, if your most dire need is contract insights for negotiation strategy and payer performance, contract modeling, and underpayment identification, you should evaluate the best contract management software. Designed with interoperability in mind, these solutions are built to seamlessly connect with various healthcare technology platforms.

‍

On the other hand, if prior authorizations are slowing patient care and draining revenue, several RCM software companies offer an extensive list of features that speed processing and get you paid. Look for:

• end-to-end automation of the entire prior authorization process
• automatic population of required information from patient records
• real-time eligibility and coverage checks
• automated submission of authorization requests to insurers
• real-time status monitoring of authorization requests
• pre-checking of submissions to eliminate preventable errors

We mention above that most organizations are already using software to automate key aspects of their operations. At this point, you most likely need only a point solution to round out your revenue cycle efficiency. 

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

‍
Consideration #2: software accuracy

Despite the critical nature of accuracy, some RCM software solutions produce inaccurate results due to human errors in data entry, system limitations or bugs, and integration issues stemming from poor interoperability between different systems. A review of these solutions on G2 reveal which companies prioritize accuracy and which do not. Healthcare organizations should prioritize investing in robust RCM software that features automated data validation, regular updates, and comprehensive staff training programs.

Achieving a high level of accuracy is critical because even minor errors and glitches can lead to claim denials and poor contract negotiations. More, accurate denials and underpayment identification, contract performance determination and modeling are crucial for optimizing revenue and winning favorable contract rates and terms. The reliability of RCM data also plays a vital role in informed decision-making and resource allocation.  

Consideration #3: AI-driven automation

Many RCM software companies use the term “AI-driven.” Traditional AI includes machine learning (ML) which has become a cornerstone in modern healthcare revenue cycle management (RCM). This form of AI, often described as "problem-solving AI," leverages large datasets to identify patterns and execute specific tasks based on human-defined algorithms. Its ability to detect patterns that are sometimes overlooked makes it an invaluable tool in RCM.  

Software buyers must take particular care to fully understand the differences between traditional AI and generative AI (the version getting all the buzz as you can read in our AI in RCM article.) Falling for hype is costly. Much of the AI some software companies promote is really machine learning, famous for its ability to adapt over time.

It’s machine learning that executes:

• Eligibility verification - AI algorithms swiftly verify patient eligibility, benefits, and coverage, reducing the risk of providing services to ineligible patients. This streamlines the revenue cycle by minimizing claim denials or delays due to eligibility issues.
• Prior authorization enhancement - AI analyzes patient data, compares it with predefined rules, and assesses clinical necessity, resulting in more accurate and faster prior authorization decisions. It automates workflows and ensures adherence to specific guidelines.
• Schedule optimization - AI-powered systems evaluate patient demand, physician availability, and resource utilization data to optimize appointment scheduling. This automation minimizes wait times, reduces no-show rates, and enhances resource utilization, ultimately increasing revenue.
• Billing accuracy improvement - AI automates coding and billing processes by extracting relevant data, ensuring accurate coding and appropriate billing. This leads to fewer claim denials and faster reimbursement.
• Claims processing automation - Sophisticated AI algorithms detect errors, inconsistencies, and potential fraudulent activities, improving claims processing accuracy. This automation reduces the need for additional RCM staff, thereby lowering labor costs.
• Denials management -  AI analyzes historical claims data to identify patterns leading to denials, reducing revenue leakage. It also implements corrective actions, helping providers improve coding, documentation, and charge capture processes.
• Revenue cycle analysis - AI algorithms, coupled with automation, analyze vast amounts of healthcare data to identify patterns and trends related to insurance claims, reimbursement rates, patient profiles, and physician performance. These insights enable healthcare organizations to make informed financial decisions, accurately forecast revenue, identify potential risks, and strategize to optimize revenue generation.By leveraging traditional AI in these areas, healthcare organizations can significantly enhance their RCM processes, leading to improved financial performance and operational efficiency.

Generative AI – the technology getting all the hype – generates new assets. Still in the development process, GenAI is mostly appearing in solutions aiming to speed and streamline physicians notes, patient access, and prior authorizations. EHR Epic incorporated ChatGPT to process some health records. Google Cloud now offers gen-AI-enabled prior authorization processing. Doximity, a telemedicine platform, developed a ChatGPT tool that can draft preauthorization and appeal letters. 

When discussing “AI-driven” automation and data analytics capabilities, providing actionable insights to improve financial performance with vendors, show them you know that their solutions are more likely machine learning rather than generative AI. 

Consideration #4: EHR and PM compatibility 

The best RCM solutions seamlessly integrate with various Electronic Health Record (EHR) systems, ensuring smooth data flow and reducing manual data entry errors. They should also prioritize healthcare data integrations of multiple PM systems and the other software platforms you use. The best RCM providers offer cloud-based solutions, allowing for scalability, remote access, and reduced IT infrastructure costs. 

Consideration #5: benchmarking and KPIs

Top RCM companies provide comprehensive benchmarking tools and key performance indicators (KPIs) to measure and improve financial performance against industry standards. They are committed to ongoing optimization, regularly updating their systems and processes to adapt to industry changes and client needs.

Consideration #6: Software flexibility

MSOs and physician groups should evaluate each RCM software company’s tolerance for flexibility for several reasons. Healthcare organizations in growth mode need to add new features, efficient scaling to accommodate expanding patient volumes, and quick modifications to comply with evolving healthcare regulations.

Tailored RCM software can be designed to integrate with existing workflows and systems specific to the organization, ensuring compatibility with unique billing processes, streamlined integration with existing EHR and practice management systems. RCM solutions can be optimized for the organization's specific needs, automating routine tasks to reduce manual errors and improve staff productivity, implementing AI functionalities for tasks like coding and claims scrubbing, and incorporating customizable validation rules and alerts to prevent claim denials. 

Now that you know what to look for, keep reading to learn about the 10 best revenue cycle management software companies for healthcare.

Best 10 Revenue Cycle Management Software Vendors

1. MD Clarity

2. Change Healthcare

3. Waystar

4. Infinx

5. DrChrono

6. TriZetto

7. TruBridge

8. FinThrive

9. Medsphere RCM Cloud

10. Dentrix

MD Clarity

Since 2010, MD Clarity has provided automated, accurate contract management and modeling software. Serving over 3,000 facilities and 150,000 providers, it has earned a 4.8/5 star rating on G2, the internet’s most trusted software review platform.

Working with some of the largest MSOs and healthcare organizations in the United States, MD Clarity has been perfecting its contract management software for 14 years.

Features:

• Underpayment detection: MD Clarity’s RevFind automatically detects underpayments from payers by comparing actual payments to contract terms and notifying staff about discrepancies. Pursuing these underpayments can result in significant cash recovery and improved profit margins. Additionally, it ensures you can track underpayment recovery. 
• Contract optimization: RevFind provides data on your highest and lowest paying contracts, helping you justify improvements in contract fees and terms. Evaluate managed care contract performance so you can negotiate from a position of confidence and clear insights. 
• Contract modeling: Payer changes and renewals often go unnoticed by providers. RevFind processes proposed payer changes and so you can model potential contract rate changes. With just 30 to 60 days to respond, it’s critical to act swiftly on change notices. Additionally, RevFind allows you to input your own variables and create more favorable scenarios to propose to payers.
• Denials management: RevFind highlights the CPT codes most frequently involved in payer denials, enabling you to trace issues to their root causes and reduce your denial rate.

• Good faith and patient payment estimates for No Surprises Act Compliance: Drawing on uploaded payer contracts and patient data, MD Clarity’s Clarity Flow tool verifies eligibility, generates patient payment estimates (good faith estimates), and sends them to patients upon scheduling. Every dollar collected upfront stays out of A/R and bad debt. 
• Upfront collections:  Accurate out-of-pocket patient cost estimates help providers collect more upfront and more overall. Fully custom and based on individual provider preferences, these patient cost estimates reach patients through text, email, or letter. All comply with the No Surprises Act as a good faith estimate solution (GFE).‍ Research shows patients want upfront treatment estimates. 

Take a quick tour of how you can simplify upfront collections when you automate eligibility verification and estimate generation here:

Notable clients: MD Clarity's notable clients include OrthoAlliance, EyeSouth Partners, Radiology Imaging Associates, Providence Anesthesiology Associates, Minnesota Eye Consultants, Seattle Radiology, Tahoe Fracture, and San Ysidro Health. 

‍Headquarters: MD Clarity is headquartered in Seattle, Washington, United States

Change Healthcare

Change Healthcare became an integral part of Optum following a significant $13 billion acquisition completed in October 2022. The union of these two healthcare technology giants represents a shared vision to create a more streamlined, intelligent, and adaptable health system that benefits patients, payers, and care providers alike. By combining Optum's robust data analytics solutions with Change Healthcare's intelligent health care network and extensive claims transactions data, the merged entity aims to simplify and connect core clinical, administrative, and payment processes across the healthcare ecosystem. 

Change Healthcare provides software and data analytics, technology-enabled services, and research, advisory, and revenue cycle management offerings to make healthcare work better for everyone

Features:

• 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

Waystar was founded in 2017. Built on the legacy of two mature RCM leaders, Navicure and ZirMed, Waystar offers end-to-end revenue cycle solutions. Waystar’s  integrated platform automates and streamlines claims management, payment processing, prior authorizations, and patient financial care. Its technology leverages artificial intelligence and advanced algorithms to enhance billing accuracy, reduce labor costs, and improve operational efficiency. 

Features:

• 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.

Infiinx Revenue Cycle Managment

Founded in 2012, Infinx uses automation and artificial and human intelligence to help healthcare providers overcome revenue cycle challenges. As an end-to-end revenue cycle management (RCM) solution, Infinx offshores much of their more complex RCM workflows to Indian human resources. A cloud-based solution like most, Infinx integrates artificial intelligence, automation, and human expertise to address various aspects of RCM, including prior authorization, eligibility verification, charge capture, coding, claims submission and tracking, denial management, and accounts receivable recovery. Combining advanced technology with human intervention for complex cases, can be more pricey than a simple software play executed by a healthcare organization’s existing staff. 

Features:

• 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. These human resources can swell your revenue cycle budget. 
• Revenue acceleration: Infinx’s specialists work on denied claims and accounts receivable inventory. They send back the insights from billing specialists that help healthcare organizations reduce future denials. 

Headquarters: Infinx Healthcare is headquartered in San Jose, California, United States.

Rating: Infinx has a score of 89.5/100 on KLAS Research. 

DrChrono

DrChrono was founded in 2009 by two innovators frustrated with the current healthcare system. It is an electronic health record (EHR) and RCM provider. 

Features:

• Medical coding - DrChrono's certified medical coders review clinical notes and code accurately to prevent lost revenue.  
• Rejection analysis and resolution - DrChrono's billers work rejections. It works with insurance and clearinghouse companies.
• RCM task manager - Tea, members can use Dr. Chrono to see which uncompleted tasks must be finished to receive payment and talk to billers.
• Business intelligence (BI) tools - DrChrono's BI tools provide reports on your organization's performance.
• Front-end advice: Get 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.

TriZetto

TriZetto RCM management services combine customer-focused services and products with in-depth industry knowledge. Trizetto was acquired by Cognizant in 2014.

Features:

• Claims management - accelerate payment while minimizing administrative burdens.  
• Patient engagement - 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 transactions 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 -  Eliminate data-gathering redundancies, 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

TruBridge offers end-to-end solutions for healthcare providers, particularly those in rural and community settings. The company's unique value proposition lies in its range of integrated services and technologies that address both clinical and financial aspects of healthcare delivery. TruBridge's solutions span electronic health records, coding services, patient access management, and advanced analytics, all designed to work seamlessly together. TruBridge's commitment to serving smaller hospitals and clinics – often overlooked by larger vendors. By combining innovative technology with personalized service and a deep understanding of the challenges faced by community healthcare providers, TruBridge positions itself as a trusted partner that not only improves financial performance but also enhances patient care and community health outcomes.

Features:

• Patient liability estimates (PLE) - the Trubridge tool aims to maximize point-of-service collections and reduce bad debt by giving patients accurate out-of-pocket estimates before service.
• Eligibility verification - boost cash flow, reduce claim denials, improve customer service, and decrease workload by automating eligibility checking.
• Denial and audit management -  spot and fix denied and audited claims. 
• Remittance management: accept and normalize remittance data into compatible files for electronic posting. Reduce posting errors.
• Reporting and data mining - get reports on financial detail in remits and claims. View via over 350 standard reports, 200 drill-down graphs, and unlimited ad hoc reports.
• Deposit bank reconciliation - Deposit bank reconciliation by matching deposits and remits automatically. Mismatches flow into customizable work queues for resolution.
• Intake management service - reduce denials and increase 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

FinThrive was founded in 2016. It develops RCM solutions aimed at improving RCM efficiency. 

Features:

• A 360-degree view of finance data - FinThrive provides a view of your company's financial performance. Use this data to make data-driven business decisions that maximize revenue and customer experience.
• Accurate patient estimates: FinThrive offers accurate patient estimates that inform patients of their medical financial responsibility.  
• Near-perfect clean claim rates: FinThrive aims to improve 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.

Medsphere RCM Cloud

Medsphere’s RCM Cloud is a web-based end-to-end revenue cycle management solution. It aims to use digital solutions to replace manual, resource-intensive medical billing processes and optimize workflow through automation.

RCM Cloud and all associated services are delivered via the Medsphere Cloud Services platform. RCM Cloud is a suite of browser-based patient access and revenue cycle components designed to improve operational efficiency in healthcare organizations.

Features:

• Enterprise Scheduling: This tool features a drag-and-drop user interface that users can use to create customized views of their schedules. This is the coordinator for patients' resources that helps promote effective and timely scheduling of procedures and services.
• Patient Registration: This solution features several dynamic work queues that help users optimize their workflow. The tool also includes eligibility verification, POS payment entry, medical necessity checking, authorization processing, and optional propensity-to-pay.
• Patient Accounting: This tool provides a comprehensive billing solution tailored to help you maintain accurate control of financial data, with the flexibility to streamline your tasks.
• Collections and Payments: The Payer and Self Pay Collections module is a suite of integrated capabilities with a vast catalog of drill-down reports that automate and streamline payments.
• Informatics: The Informatics tool features a wide array of cutting-edge business intelligence dashboards, reports, and dynamic work lists that empower key healthcare decision-makers to analyze and act upon patient service and financial data.

Headquarters: Medsphere RCM Cloud is based in Sandy, Utah, United States.

Rating: Medsphere RCM Cloud has a rating of 4.6/5 stars on G2.

Dentrix

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.

Features:

• Business management - Dentrix offers business solutions for improving dental patient care. Determine and analyze your practice performance. Get key performance indicators (KPIs) for various areas of your practice, including collections, continuing care, production and case acceptance, and schedule management.
• Practice marketing - 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 - 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 - Encourage 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.

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.

Which Healthcare Revenue Cycle Management Solution is Best For You?

The best RCM software depends on your size and specialty. 

Large hospital systems tend to choose end-to-end solutions like Waystar or Trizetto.    

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 quickly optimize revenue. Get a demo to see how RevFind can identify your denials and underpayments and simplify recouping the revenue you’ve already earned.