Healthcare leaders see Gen AI transforming RCM operations
An overwhelming majority (85%) of senior healthcare executives surveyed believe AI will improve efficiencies in revenue cycle management (RCM) operations over the next five years, according to the results of a new Everest Group report, supported by Omega Healthcare, titled “Realizing the Promise of Tech-Enabled, AI-Driven Revenue Cycle Management (RCM): Outsourcing in the New Era.” The study highlights how healthcare providers are leveraging AI-enabled technology services (such as gen AI and agentic AI) and a shift to more strategic outsourcing partnerships to address challenges, enhance financial performance, and streamline revenue cycle processes.
“The hope and promise of AI, gen AI and agentic AI are no longer just hype,” said Anurag Mehta, CEO and Co-Founder, Omega Healthcare. “While the technology is important, it is only part of the equation. To fully harness the power of AI it will become increasingly critical for healthcare providers to work with the right partners.”
Shift to More Strategic RCM Outsourcing Partnerships
As gen AI investments continue to accelerate, more than half (51%) of healthcare leaders polled expect an increase in RCM outsourcing budgets by 2030, emphasizing the significance gen AI will have on the sector.
“More than seven in 10 (71%) healthcare executives surveyed are planning to evolve from transactional relationships to strategic partnerships, and nearly half (49%) are interested in end-to-end RCM outsourcing to a single service provider,” noted Mehta. “Long-term success will be defined by selecting a partner who can serve as a trusted advisor capable of delivering not only the technology, but also a comprehensive fusion of ongoing digital innovation, healthcare expertise, services as solutions, and proven operational and cybersecurity excellence.”
Gen AI: Propelling RCM Transformation
Interestingly, the survey found that more than half (51%) of healthcare providers are actively exploring gen AI in RCM, with 22% already testing proof-of-concept initiatives and 29% in the consideration stage, evaluating use cases and potential challenges. Although adoption varies by organization size, the overwhelming consensus is that gen AI will play a critical role in automating manual processes, improving billing accuracy, and reducing claim denials.
“As a benefit of the gen AI investments we have already made so our customers do not have to, our clients are already putting gen AI use cases into action and are seeing meaningful results across RCM functions,” said Vijayashree Natarajan, SVP & Head of Technology, Omega Healthcare. “The Omega Digital platform, powered by AI/gen AI/agentic AI solutions, is helping to enhance business outcomes for our customers, such as ~20-25% collections improvement; ~ 25-30% aged AR reduction; and ~ 30-35% improvement in charge lag.”
Top Five Gen AI Use Cases
RCM leaders’ top five gen AI use cases are: Real-time eligibility and benefits verification; Claims data analysis and pattern recognition to avoid future rejections; Gen AI chatbots to resolve patient queries (billing, payments, scheduling) and enhance experience; Documentation improvement through AI scribing; and Synthetic data generation and automated medical coding from clinical documents.
Barriers to Adoption
Major challenges to gen AI adoption in RCM include a lack of in-house expertise, with about 80% of executives citing it as a key hurdle, and barriers integrating with existing electronic health records systems. Additionally, 46% of survey respondents consider gen AI a high priority but are awaiting regulatory clarity before committing to large-scale investments.
Future Investment Priorities
Emerging RCM challenges, including the need for real-time claims tracking, the transition to value-based care models, and increasing regulatory scrutiny and compliance, are also influencing investment decisions.
Looking ahead, RCM leaders are prioritizing cybersecurity, payer collaboration, and AI-driven automation:
- Cybersecurity: 63% of respondents identified cybersecurity as the top priority investment in 2025, emphasizing the need for robust protections against data breaches and ransomware attacks.
- Payer collaboration: Improved provider-payer coordination is seen as a key strategy for reducing reimbursement delays and enhancing patient outcomes.
- AI and automation: By 2030, AI/ML investments are expected to be the top priority for RCM leaders, with 66% of respondents considering it a high priority area.
The post Healthcare leaders see Gen AI transforming RCM operations first appeared on AI-Tech Park.
