The revenue cycle management (RCM) landscape in healthcare is set for significant changes in the coming years. As the industry continues to evolve, RCM providers and their clients are navigating a complex mix of challenges and opportunities. Some of the key trends influencing RCM in 2025 include:
Rising Costs Driven by Cybersecurity, Regulatory Compliance, and Increasing Patient Bad Debt Rates
The cost of operations is on the rise. RCM providers are investing in robust cybersecurity measures while also managing the complexities of regulatory compliance. This includes FDA oversight, federal and state-specific regulations, and the intricacies of payor policies, all of which demand considerable attention and resources. Margins are being further squeezed by the increasing rates of patient bad debt across the healthcare sector.
Workforce Challenges
The competitive job market and the growing demand for specialized skills in RCM are creating difficulties in recruiting, retaining, and upskilling talent. The need for expertise in handling payor-specific requirements and utilizing advanced technologies has never been more critical.
Payor Policy Complexity
Payor regulations are becoming more granular and fragmented, requiring healthcare providers and laboratories to adjust to multi-layered rules at every level—ranging from federal mandates to plan-specific requirements. This shift underscores the importance of data-driven decision-making and operational flexibility.
Integration and Interoperability with EMRs
Payor regulations are becoming more granular and fragmented, requiring healthcare providers and laboratories to adjust to multi-layered rules at every level—ranging from federal mandates to plan-specific requirements. This shift underscores the importance of data-driven decision-making and operational flexibility.
Anticipated Impact on RCM Customers
RCM customers face several challenges and opportunities, including:
Cost Optimization Is Essential
With rising costs in cybersecurity and compliance, laboratories must find ways to optimize efficiency elsewhere. Automating RCM processes has become a necessity to ensure financial stability and operational flexibility. Tools designed to boost patient engagement and improve payment collection will be highly valuable.
Outsourcing to Leverage Expertise
Outsourcing RCM functions to specialized providers enables access to economies of scale, advanced technology, and a skilled talent pool capable of navigating regulatory and payor complexities.
Increased Use of RCM Data
RCM data will increasingly be relied upon by customers, extending its role beyond financial operations to inform strategic decision-making across various levels of the organization.
Strategies and Innovations to Address Emerging Challenges
To help laboratories adapt to this evolving landscape, we are focusing on providing practical solutions and future-forward technologies:
Leveraging Artificial Intelligence (AI) and Machine Learning (ML)
While many customers take a cautious “wait and see” approach to generative AI, targeted applications of Natural Language Processing (NLP) and ML are already delivering value. Examples of how we’ve used these technologies to enhance claims processing include:
- Prioritizing claims based on reimbursement likelihood or value
- Automatically routing claims to the most appropriate team members
- Minimizing manual interventions by implementing automatic RCM updates
- Reducing patient call volume by automating the gathering of insurance or demographic information
- Simplifying and consolidating system architectures
There is a growing focus on reducing the number of systems in use, aligning with our vision of delivering an RCM platform that offers broader functionality and seamless integration, thus reducing inefficiencies and improving data flow with EMRs and other systems.
Expanding API-Driven Connectivity
APIs facilitate real-time data exchange, ensuring laboratories have access to up-to-date information for both front-end systems and operational decisions. Our emphasis on API utilization highlights our commitment to enhancing connectivity across systems.
