Find the best Revenue Cycle Management Software

Here's what we'll cover:

What is revenue cycle management software?

Essential features of revenue cycle management software

Benefits and competitive advantages of using revenue cycle management software

Current challenges of revenue cycle management software buyers

How to choose the best revenue cycle management software for your business

Check out more resources on medical billing and accounting

Revenue cycle management software essentials

Revenue cycle management (RCM) software helps healthcare providers and medical practices track and manage revenue generated throughout the patient lifecycle. It streamlines patient accounts management, from providing services to receiving payments. This software helps track various revenue cycle stages, including patient registration, insurance verification, coding, billing, claims submission, and payment posting.

RCM software is primarily used by revenue cycle, billing, and collections managers within healthcare and medical practices. It may also be utilized by other healthcare professionals who work in multidisciplinary practices. To give you an idea of the market, we have over 100 unique revenue cycle management vendor profiles on our site, and we’ve published 1,300+ reviews for RCM products in the past year alone.

Most RCM solutions are priced on a “per-month” basis. Entry-level plans cost an average of $170 per month and offer basic features, such as patient management and insurance verification. Enterprise-level plans cost an average of $500 per month and may include additional features, such as advanced analytics, automated claims processing, and reporting tools. [1]

If you’re a new buyer, selecting the best revenue cycle management software is about finding a solution that meets your specific needs. Consider factors such as budget constraints, total number of users, and necessary integrations. Here are some questions you should ask software vendors before making a purchase:

• Are there any additional costs for setup, training, or support?

• What integrations are available with other systems we currently use?

• How does the software handle updates and compliance with regulatory changes?

• What kind of customer support is offered, and what are the response times?

• How secure is the software in protecting patient data and financial information?

With several different vendors, choosing the right option can be daunting. In this guide, you’ll learn about the essential components of revenue cycle management software, get step-by-step guidance on how to choose the right solution for your practice. Or, if you’d prefer to chat with one of our experienced medical software advisors, such as Jonathan Schultz and Bobby Waldron—who have led buyers to the right medical software over a combined 15 years—schedule a call or start a chat with us.

What is revenue cycle management software?

Revenue cycle management (RCM) software is a digital tool used primarily in healthcare organizations to manage and streamline the financial processes related to patient care. From the moment a patient schedules an appointment until the final payment is collected, RCM software helps healthcare providers manage billing, payments, and various other related financial processes.

RCM software automates and integrates key functions, including patient registration, insurance verification, appointment scheduling, coding, billing, claims processing, payment collection, and financial reporting. The software includes automated patient reminders about outstanding balances, analytics tools to identify bottlenecks in the payment process, and compliance checks to ensure billing accuracy according to regulatory standards.

Given its operational importance and breadth of functionality, choosing the best RCM software for your unique needs is all the more critical.

Essential features of revenue cycle management software

To choose the best revenue cycle management software for your practice, it’s important to know your requirements and what features to expect. Jonathan Schultz, an advisor specializing in medical software, emphasizes that most professionals looking for RCM software are looking to automate and manage their insurance billing processes. [2] Here’s a detailed breakdown of the core and common features:

Core features of revenue cycle management software

Common features of revenue cycle management software

Benefits and competitive advantages of using revenue cycle management software

• Enhances medical billing: Traditional paper or spreadsheet-based billing methods often involve a series of manual steps that are time-consuming and prone to errors. Revenue cycle management software automates and streamlines these processes, ensuring bills are submitted accurately and promptly. This automation reduces the administrative burden on your healthcare staff and accelerates the revenue collection cycle. Additionally, RCM systems can integrate with electronic health records (EHRs) to pull patient data, reducing the likelihood of errors due to data entry.

• Improves financial reporting and forecasting: Revenue cycle management software includes analytics and reporting tools that offer insights into financial metrics, including total revenue, expenses, claims statuses, and payment trends. Having access to real-time financial data lets you better predict future revenue streams and identify areas for cost reduction. For example, the software can help identify trends in claim denials and inform strategies to reduce them. Moreover, accurate financial forecasting helps in budgeting and resource allocation, enabling you to maintain operational efficiency while meeting patient care demands.

• Facilitates denial management: RCM software supports denial management by providing tools to identify, analyze, and address the root causes of claims denials. The software automates the tracking of denied claims, categorizing them based on the reasons for denial, such as coding errors, missing information, or eligibility issues. This categorization helps you pinpoint common issues and implement corrective measures. Moreover, the software often includes real-time alerts and notifications, ensuring that denials are addressed promptly. Advanced analytics and reporting features offer insights into denial patterns, enabling you to develop strategies to prevent future denials.

• Strengthens compliance: The software helps you keep up with healthcare regulations, such as HIPAA, ICD-10, Current Procedural Terminology (CPT), and other coding standards. By integrating these regulations into its framework, the software ensures that all billing and coding activities adhere to current legal and regulatory requirements. This reduces the risk of errors that could lead to audits, fines, or legal issues. The software includes automated checks to flag potential compliance issues before submitting claims, allowing for timely corrections. By automating compliance tasks, RCM software mitigates regulatory penalties and frees your staff to focus on patient care.

Current challenges of revenue cycle management software buyers

Based on 230+ phone interactions with medical billing and services software buyers from June 2023 to June 2024, we observed that over 26% of buyers have implemented a system to manage their daily billing and service operations. However, approximately 4% still rely on manual methods, such as pen-and-paper billing and insurance claims tracking. Additionally, nearly 42% of buyers have no system to automate their billing and insurance claims management processes.

These discussions shed light on businesses' real-life challenges with their existing methods. These included new business opportunities (29%), functionality sufficiency (22%), and efficiency (16%).

• Inability to benefit from new business opportunities: Individuals who rely on manual methods for revenue cycle management often find themselves unable to capitalize on new business opportunities. This is primarily because manual processes are slower and less flexible than automated systems. Manual methods can create bottlenecks when a new opportunity arises, such as a partnership with a new insurance provider or the introduction of a novel service line.

• Limited functionality: Unlike automated systems that offer a wide range of features such as real-time data analytics, automated billing, and integrated communication channels, manual methods rely heavily on human intervention. This can lead to errors and inconsistencies in data entry and processing. Moreover, lacking advanced functionalities such as predictive analytics and automated alerts means businesses cannot proactively manage their revenue cycles. This insufficiency can result in delayed payments, increased denials, and a lack of actionable insights.

• Inefficiency: Manual processes are time-consuming and labor-intensive, requiring human resources to handle tasks such as data entry, billing, and follow-up on unpaid claims. This increases operational costs and the risk of human error, which can lead to delays. Additionally, manual methods lack streamlined workflows and automation capabilities that can expedite processes and improve accuracy.

How to choose the best revenue cycle management software for your business

Step 1: Determine your business requirements and goals

Assess the gaps in your current processes

Identify the inefficiencies, bottlenecks, and pain points that hinder your financial operations. These issues could include delayed billing, frequent claim denials, or lack of integration with other systems. By pinpointing these gaps, you can better understand what specific functionalities and improvements you need from RCM software.

Consider the size of your practice

Small practices, medium-sized clinics, and large healthcare organizations have different needs and resources. For instance, a small practice may require a more straightforward, cost-effective solution with basic features. In contrast, a large hospital might need a comprehensive system with advanced features, such as multi-location support, detailed analytics, and security measures. Understanding your business size helps you select software that scales appropriately with your operations and provides the necessary support without overwhelming your team.

According to Bobby Waldron, an advisor specializing in medical software, there are three primary RCM software implementation options for small businesses: 

• Option A: Engage a local RCM service that uses its own billing software and integrates with the practitioner’s EMR system to pull codes. This method is cost-effective as it saves on software expenses.

• Option B: Use a billing tool and handle the process internally by the service provider or office admin.

• Option C: Opt for an RCM service their existing software vendor provides, which assists with billing. However, this option often involves additional costs and percentages for claim reimbursement.

Waldron also recommends third-party RCM services to those who want to avoid handling billing internally, as it can be simpler. He notes that it is uncommon to find RCM as a standalone feature. Typically, RCM is an added service or integrated option provided by software vendors rather than a best-of-breed standalone solution. [2]

For more information on revenue cycle management-specific features and recommendations, feel free to schedule an appointment with Jonathan or Bobby, or one of their colleagues.

Identify the must-have and good-to-have features

Must-have features are essential for your business operations, such as automated billing, claim management, patient scheduling, and compliance with healthcare regulations. On the other hand, good-to-have features are additional functionalities that can enhance your operations but are not critical, such as advanced reporting tools, patient portals, or mobile access. By distinguishing between these two categories, you can prioritize your requirements and make informed decisions when evaluating different RCM software options.

Our interactions with buyers show that medical billing is the most important application requirement sought by more than 95% of callers. Additionally, 6% of software buyers report electronic medical records as another important requirement.

Step 2: Understand the cost of revenue cycle management software

The cost can vary significantly based on factors such as your business's size, the software's complexity, and the range of features it offers. It is important to consider the initial purchase price and ongoing expenses, such as subscription fees, maintenance costs, and potential updates or additional features charges. Most revenue cycle management software solutions are priced on a “per-month” basis.

• Entry-level plans cost an average of $170 per month. These plans are suitable for small practices with basic revenue cycle management needs, such as patient registration and insurance verification. 

• Mid-tier plans cost an average of $336 per month and include advanced features, such as claims scrubbing and payment posting. These plans are suitable for practices that have outgrown entry-level RCM tools but don’t require the full range of functionality offered by enterprise-level systems.

• High-end plans cost an average of $500 per month and include additional features, such as integration with electronic health records (EHRs), advanced analytics, and customized reporting. These plans suit larger enterprises with complex RCM needs and customized support requirements.

The conversations between our software advisors and medical practices seeking billing services software indicate that the typical monthly budget is approximately $338 per provider.

Step 3: Shortlist top-rated revenue cycle management software

Once you have gained clarity on the requirements and total cost of ownership, you can move on to shortlisting the best software for your business. Here’s how we can help you pick the right one:

Get qualified help from an advisor

At Software Advice, our advisors like Schultz and Waldron have helped hundreds of medical and healthcare providers. We’re here to help you find solutions that meet your needs and budget.

If you need guidance, you can chat online now with an advisor or schedule a phone call. You can get tailored recommendations about software that best fits your unique revenue cycle management needs.

Explore the high-rated RCM software on Software Advice

You can visit our revenue cycle management software category to shortlist relevant solutions. Software Advice uses reviews from real software users to spotlight high-rated software products.

Here are the top 5 revenue cycle management software with an average rating higher than 4 on Software Advice:

• MDaudit Enterprise

• TRIARQ Health

• StrongBox Dental

• NorthStar

• Euclid 

Step 4: Select the best revenue cycle management software

Ask for product demos from vendors

Once you’ve compiled your shortlist of RCM software systems, you can start scheduling demo sessions with each vendor to learn more about their product. During these sessions, you can ask questions about their features, pricing, technical support, training tools, and anything else important in choosing the best revenue cycle management software for your practice.

Here are some common questions to ask software vendors:

• What security measures are in place to protect patient data?

Healthcare organizations handle highly sensitive information, subject to stringent regulations, such as HIPAA in the United States. Asking about the security measures to protect patient data helps you understand the vendor's commitment to data security and compliance. It is important to know if the software employs encryption, secure access controls, regular security audits, and other best practices to safeguard patient information. Understanding these measures can help mitigate risks associated with data breaches, unauthorized access, and other security threats, ensuring that patient data remains confidential and secure.

• What customer support options are available?

The level and quality of support can impact your organization’s ability to use the software effectively. Knowing whether the vendor offers 24/7 support, a dedicated account manager, or other support services can help you gauge how responsive and helpful the vendor will be in resolving issues, providing training, and offering ongoing assistance. This is especially important in healthcare settings where downtime or technical issues can directly affect patient care and revenue cycles. Reliable customer support ensures that your team can quickly address any problems and continue to operate smoothly.

• Is the software customizable to meet the specific needs of our organization?

Healthcare organizations vary widely in their operations, specialties, and patient demographics, so a one-size-fits-all solution may not be effective. Customizable software allows you to tailor features, interfaces, and functionalities to better align with your organization's specific needs. This can improve efficiency, better user adoption, and enhance overall performance. Understanding the extent of customization options can help you determine if the software will be a good fit for your organization in the long term.

Check out more resources on medical billing and accounting

• How Expense Management Automation Simplifies Your Financial Workflow

• Automating Reconciliation to Improve Financial Accuracy for Small Business

• 5 Top-Rated Affordable Medical Billing Software   

• What Is Patient Intake for a Modern Healthcare Organization

About our contributors

Author

Barkha Bali is a writer at Software Advice. She provides insights to help small businesses identify the right software for their needs by analyzing more than 550,000 Software Advice user reviews and nearly 48,000 interactions between Software Advice software advisors and buyers. 

Prior to joining Software Advice, she covered finance, lifestyle, education, and medical topics. Her work has been featured in Medium and Indian educational publications such as Oswal Books.

Editor

Parul Sharma is a content editor at Capterra with expertise in curating content for various niches, including SaaS, digital marketing, and search engine optimization. With over half a decade of experience in content writing and editing, Parul has the expertise to simplify complex terms into engaging, valuable content for targeted audiences. She completed her graduation and post-graduation in English literature from Delhi University and was awarded the Dr. Asha Sahni Memorial Award for being the highest scorer in her graduating class. 

Parul has contributed to the news, lifestyle, education, and health verticle of DNA India, India’s premier media channel. Outside of work, she can be found curating healthy recipes, coloring in mandala books, and spending quality time with her family.

Advisors

Jonathan Schultz is a senior advisor. He joined Software Advice in 2014 as a software advisor, and is based in Austin, TX.

As part of the software advisor team, Jon helps medical and legal professionals who are seeking case management, document management, medical billing, and inventory software. He provides a short list of personalized technology recommendations based on budget, business goals, and other specific needs. 

Jon’s favorite part of being a software advisor is helping buyers understand and navigate the software search process—he enjoys demonstrating that a software search does not need to be complicated or intimidating.

Bobby Waldron is a senior advisor. He joined Software Advice in 2019, and he is based in Austin, TX.

Bobby works directly with small business leaders to connect them with best fit software providers. He assesses the technology needs of small businesses seeking medical and telemedicine software through one-to-one conversations and provides a short list of potential matches. 

His favorite part of being a software advisor is helping buyers create realistic expectations of the software market.

Sources

1. Software Advice software pricing data: Only products with publicly available pricing information and qualified software products within the category, as of Aug 27, 2024, are included in the pricing analysis.

2. Software Advice advisor call notes: Findings are based on data from telephonic conversations that Software Advice’s advisor team had with small-to-midsize businesses seeking ophthalmologic tools. For this report, we analyzed phone interactions from July 31, 2023, to July 31, 2024. Read the complete methodology.