Healthcare Revenue Cycle Management – 2025 Health IT Predictions

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! We reached out to our incredible Healthcare IT Today Community to get their insights on what will happen in the coming year and boy did they deliver. We in fact got so many responses to our prompt this year, that we have had to narrow them down to just the best and most interesting. Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions!

Check out our community’s Revenue Cycle Management predictions:

Blake Sollenberger, Managing Director, Revenue Cycle Transformation at Nordic Global
In 2025, revenue cycle management (RCM) will see the decline of broad outsourcing as healthcare organizations realize their shortcomings in contributing to upstream process improvements, including reducing denials prevention or improving charge capture. Vendors on transactional or contingency fee structures are inherently incentivized to recover instead of prevent errors and oversights, which leaves CFOs questioning their strategic value and the loss of critical operational levers within their own oversight.

With AI and machine learning redefining efficiency by codifying staff’s knowledge, workflow best practices, and automation handling higher volumes with leaner teams, healthcare providers will reclaim these gains in-house instead of those gains falling to the vendor’s margins. Outsourcing will pivot to a more surgical, targeted strategy, focusing on high-impact, specialized areas like revenue integrity, underpayment recovery, and the more commonplace out-of-state Medicaid and small balance recovery work where RCM outsourcing supplements streamlined, automation-empowered teams instead of replacing them.

Linda Perryclear, Senior Director, Product Management at Availity
I believe there will be a spotlight on two specific areas that contribute to a healthy revenue cycle – staffing and security. Finding a skilled workforce or having the ability to upskill existing staff should be one of the most critical areas of focus for 2025. Additionally, the security of systems and vendors must be top-of-mind for all revenue cycle leaders. RCM solutions need technology that is driven by responsible AI, analytics that are accessible in real-time and provide actionable insights, and automation that is low maintenance and accurate. The pressures around margins and the cost to collect will continue to make automation increasingly important. Automation will need to evolve to support administrative actions using clinical data to begin to drive the waste out of the administrative side of the business.

Stuart Newsome, VP of Marketing at Infinx
By 2025, AI in Revenue Cycle Management will become a game-changer, blending tools like cognitive AI, machine learning, and automation to make workflows smoother and more efficient. It’ll help predict and prevent denials by spotting trends in payer history, leading to cleaner claims and faster approvals. But it’s not just providers leveling up, payers are using their own AI to stay ahead, making it even more crucial for healthcare organizations to adopt these tools. Success will come down to using AI to boost efficiency and stay compliant while keeping up with ever-evolving payer strategies. The key will be finding the right balance between innovation and regulatory requirements to truly transform healthcare operations.

Dr. Michael Gao, Co-Founder and CEO at SmarterDx
Over the past few years, there’s been a dramatic increase in the number of denials that hospitals are getting and much of that is due to the wide adoption of AI by payers. It’s a David vs. Goliath situation, where well-resourced payers have adopted AI to meticulously comb through claims in seconds; and often nonprofit hospitals are spending hours and hours to justify care. 2024 was certainly a year where hospitals were outperformed in the move to embrace AI.

In 2025, we predict that hospitals will prioritize investment in the types of AI tools that allow them to even the playing field. There’s an opportunity for AI to help hospitals accurately represent the care that they deliver and trace each line on each claim to the supporting evidence to tell an accurate patient story. Hopefully, that doesn’t just help hospitals get paid fairly but also helps payers know that the claim really does represent what happened and the medical decision-making behind it.

Wes Cronkite, Chief Technology and Innovation Officer at TruBridge
Revenue cycle automation rapidly evolved in 2024 with the introduction of new technologies including AI, ML, and RPA. Advancements were particularly notable in cash posting, data analytics, and claims management, with four widely recognized objectives: 1) streamline the payment process, 2) protect revenue, 3) minimize human error, and 4) increase staff efficiencies to relieve the workforce shortage.

Looking ahead to 2025 and the years following, I predict revenue cycle automation will continue to advance and fully eliminate repetitive administrative tasks, thereby freeing staff to work on more complex responsibilities. The use of nascent technology in the revenue cycle will also provide better visibility into an organization’s financial metrics and performance. Dashboards will evolve into real-time KPI analytics giving leadership deeper insights into claims, denials, and reimbursements. For health systems to achieve automation success and remain competitive going forward, advanced revenue cycle technology is necessary sooner rather than later. Finally, new and flexible training practices will ensure staff are ready and able to evolve their skills.

Amy Raymond, SVP of Revenue Cycle Operations and Deployments at AKASA
In 2025, the integration of generative AI across healthcare is not merely a possibility, it’s a given. The shift from traditional automation to advanced generative AI marks a transformation as pivotal as the introduction of the PC or the internet. The revenue cycle, with its unique challenges, is the ideal place to harness this innovation. And more and more leaders are taking notice. Generative AI unlocks patient records, acting as a vital clinical assistant that revolutionizes tasks like coding, prior authorization, and denial management.

Far from replacing the RCM workforce, this technology empowers teams and allows them to work smarter and more efficiently. It unifies clinical knowledge across roles, enabling smarter, faster, and more accurate workflows. For healthcare leaders, success in 2025 will depend on selecting vendors capable of scaling this new AI across all revenue cycle functions, driving operational efficiency and revenue opportunities while also improving patient care.

Kyle Hicok, EVP, Chief Commercial Officer at R1
In 2025, providers will leverage AI to tackle staffing challenges in revenue cycle management by automating repetitive tasks like claims processing, eligibility verification, and denial management. This shift will reduce reliance on manual labor, freeing clinical staff to focus on higher-value responsibilities. By boosting efficiency and scalability, AI will empower providers to handle increasing workloads while maintaining performance and prioritizing staff well-being.

Bhushan Jayeshkumar Patel, Senior Member at IEEE
According to data from The Impact of Technology in 2025 and Beyond: An IEEE Global Study, 28% of global technologists surveyed identified automating customer service as a top AI use case. We will see this trend across patient services in 2025, as revenue cycle management (RCM) will become a strategic lever for both healthcare providers and patients, transcending its traditional role as a back-office operation.

One of the most transformative developments will be the implementation of dynamic payment systems powered by AI. For instance, the patient will receive a treatment plan accompanied by a flexible payment structure that adjusts as their financial situation changes. AI will no longer just expedite billing but will introduce predictive revenue mapping, analyzing patient demographics and treatment trends to forecast revenue streams and financial risks. For instance, the system that flags potential insurance denials before claims are submitted enables corrections in real time.

Patty Hayward, General Manager of Healthcare and Life Sciences at Talkdesk
In the coming year, we will see even more emphasis on efficiency and driving positive returns on investment. Margins are tight, IT teams are being asked to rationalize and evaluate their budgets, and the new administration will emphasize accountability in programs like Medicare. To prepare, provider organizations must protect their margins by getting more value from their data in ways that increase operational efficiency and improve patient outcomes in value-based and at-risk models. I expect to see more provider organizations in 2025 relying on AI-based customer support platforms that can enable self-help, personalize the patient journey, identify care gaps, and improve outcomes.

Diana Ortiz, RN, JD, CCDS, CCDS-O, Senior Manager of Global Content at Solventum
I predict that automation within the revenue cycle will drive down the organizational cost to collect and keep work at the top of the license, ultimately helping organizations improve the quality and accuracy of patient claims. Improving the accuracy of patient claims helps connect patients with the best resources and help that they need to get better, stay better, and prevent disease progression. Leveraging emerging technologies within the revenue cycle positions organizations to drive better quality of care through accurate documentation and clarification of disease progression, reducing the inefficiencies well recognized in healthcare today.

Matt Seefeld, EVP and Chief Commercial Officer at MedEvolve
Operational margin will continue to be a front-and-center concern in 2025, and the primary question providers need to ask is: How am I going to stay financially viable? There are two realities that are not going away. The cost to collect is increasing, from overhead to increased patient responsibility to bad debt, and reimbursements are declining. These macro trends are not new, but healthcare organizations have reached a tipping point where there is no wiggle room with operational margin. Given that so much of this remains outside of a healthcare organization’s control, financial leaders will have to consider how to impact the one area left that they can in 2025: labor effectiveness, especially as it relates to the revenue cycle.

When it comes to efficient and effective use of staff resources, current stats related to U.S. administrative waste in healthcare tell the tale. It’s abysmal, currently accounting for approximately 25% of total healthcare spending. Providers will have to take action to address this waste to improve margins in 2025. Many will likely turn to remote billing workforces to cut costs. Regardless of where staff are located, reducing waste requires that financial leaders answer basic and hard questions such as: Am I staffed correctly in accounts receivable? How many human touches does it take to get a claim paid? What is the cost of “wasted touches”? Across more than 10 million human touches related to provider billing tracked within MedEvolve’s database, we find that upwards of 50% are wasted on a consistent basis. That will have to change in 2025 if provider organizations want to stay financially viable.

Frank Forte, CEO at EnableComp
2025 will be a transformative year in healthcare revenue cycle management, especially for specialty payers like the VA, with AI technology reshaping the complex claims landscape. As interoperability initiatives expand veterans’ access to care, the complexity of VA claims requires precise, agile solutions to complement EHRs; automation will be the linchpin, underscoring the need for an AI-driven RCM partner. By leveraging AI fine-tuned with irreplaceable human regulatory expertise, providers will see unprecedented accuracy and faster reimbursements, refocusing time and resources back to the mission of veteran care, and serving those who served us.

Laxmi Patel, Chief Strategy Officer at Savista
Investment in managed RCM services will become increasingly more attractive due to persistent workforce challenges. Investment in managed RCM services has become an increasingly popular option for RCM managers grappling with persistent workforce challenges and navigating the intricate landscape of payer policies. Outsourcing will continue to become a strategic solution to address staffing shortages and limited resources.

Kulwant Gill, SVP of Management Consulting at Pivot Point Consulting
In 2025, RCM will be significantly more efficient, data-driven, and most importantly, patient-centric. The blending of technology with traditional processes will minimize errors, enhance security, improve patient engagement, and better support healthcare providers in delivering quality care while maintaining financial sustainability. The driving forces in RCM’s transformation include AI advancements, automation, cybersecurity optimization, patient experience enhancements, and shifts in the healthcare workforce.

RCM will have advanced threat detection to safeguard patient and financial information against cyber threats, and the systems will increasingly support value-based care models, integrating financial data with clinical outcomes data to align revenue with patient health improvements. We will likely see more cross-functional teams that include finance, IT, and clinical staff collaborating to streamline processes and improve the overall revenue cycle. AI will automate processing, creating new roles focused on strategy, patient relations, and more.

Lynne Chou O’Keefe, Managing Partner at Define Ventures
After a period of slowed VC funding last year, health tech investment is showing signs of recovery, mirroring broader market trends with a promising rebound by H1 2024. In 2025, early-stage healthtech startups that can deliver rapid results, whether through AI or other technologies, will attract the bulk of Series A and B investments. Investors will prioritize companies with shorter time-to-value, favoring those that can demonstrate quick ROI and measurable impact. Speculative investments, however, may continue to face slower funding, with the focus continuing to shift toward innovations that align closely with practical, near-term healthcare outcomes.

Clarissa Riggins, Chief Product Officer at Experian Health
I think it’s safe to say the adoption of AI in healthcare will be much slower than we had hoped for. Experian Health’s latest Claims Survey found providers are quite hesitant to move forward with technological advancements such as automation and AI. Over the last year, we’ve expected organizations to evaluate their largest pain points and integrate advanced technologies, but 28% of survey respondents have not even considered introducing automation technology to their systems. There’s a general acknowledgment that the current state of claims technology is insufficient to address existing revenue cycle demands, but little is being done to implement the required change the industry needs.

Given the ongoing challenges within the revenue cycle industry, leading health systems are outsourcing RCM to support financial sustainability and growth. I suspect we will continue to see this trend increase, alongside the hopes that healthcare organizations increasingly turn to automation and AI to streamline processes and reduce administrative burdens. I expect more sophisticated systems will be used to provide accurate price transparency, helping providers comply with regulations and offer clearer pricing to patients. AI-based tools are a promising way to reduce RCM costs and improve both the employee and patient experience. Embracing these technologies will be key for revenue cycle leaders to stay ahead in an evolving landscape.

Thank you so much to everyone who took the time out of their day to submit a prediction to us and thank you to all of you for taking the time to read this article! We could not do this without all of your support. What do you think will happen for Revenue Cycle Management in 2025? Let us know on social media. We’d love to hear from all of you!

Be sure to check out all of Healthcare IT Today’s Revenue Cycle Management content and our other 2025 Health IT Predictions.