Healthcare leaders are embracing Generative AI (Gen AI) to enhance efficiency in Revenue Cycle Management (RCM), with 85% expecting improvements over the next five years.
A recent study by Everest Group, backed by Omega Healthcare, highlights how AI-powered solutions like Gen AI and agentic AI are reshaping the financial and operational aspects of healthcare. The report, titled “Realizing the Promise of Tech-Enabled, AI-Driven Revenue Cycle Management (RCM): Outsourcing in the New Era”, showcases how industry players are leveraging AI to streamline processes and optimize financial performance.
Transitioning to Strategic RCM Outsourcing
The growing investment in Gen AI is pushing healthcare providers toward more strategic outsourcing models. Over 51% of surveyed leaders anticipate increased RCM outsourcing budgets by 2030. Additionally, 71% of executives are shifting from transactional relationships to long-term strategic partnerships, with nearly half (49%) opting for end-to-end RCM outsourcing with a single provider.
According to Anurag Mehta, CEO and Co-Founder of Omega Healthcare, “AI’s promise is no longer just hype. To maximize its capabilities, healthcare providers must collaborate with the right partners who offer not only technology but also expertise, cybersecurity excellence, and continuous digital innovation.”
Gen AI’s Role in Transforming RCM
The study reveals that 51% of healthcare providers are actively exploring Gen AI in RCM. While 22% have already initiated proof-of-concept projects, 29% are evaluating its potential use cases. Adoption varies by organization size, but the consensus is clear—Gen AI will play a crucial role in automating manual tasks, improving billing accuracy, and reducing claim denials.
As part of this transition, companies are leveraging next-generation AI training infrastructure to accelerate model development. Ceramic.ai’s latest advancements in AI model training are set to further enhance the capabilities of Gen AI in streamlining RCM processes.
Top 5 Gen AI Use Cases in RCM
- Real-time eligibility and benefits verification
- Claims data analysis and pattern recognition to prevent future rejections
- Gen AI-powered chatbots for patient inquiries (billing, payments, scheduling)
- AI-driven documentation improvement through automated AI scribing
- Automated medical coding and synthetic data generation from clinical documents
Challenges in Gen AI Adoption
Despite its potential, Gen AI adoption in RCM faces significant hurdles. Around 80% of executives cite a lack of in-house expertise as a major challenge. Additionally, integrating AI with existing electronic health records (EHR) systems remains a key concern. Furthermore, 46% of respondents consider Gen AI a high-priority investment but are awaiting regulatory clarity before making large-scale commitments.
Investment Priorities for the Future
As healthcare organizations navigate the complexities of AI adoption, several key investment areas are emerging:
- Cybersecurity: 63% of respondents identified cybersecurity as the top investment priority for 2025, emphasizing the need for robust protection against data breaches and ransomware threats.
- Payer Collaboration: Strengthening provider-payer relationships is seen as essential for minimizing reimbursement delays and improving patient outcomes.
- AI & Automation: By 2030, AI and machine learning (ML) investments will be a core focus, with 66% of leaders prioritizing automation-driven innovations.
With AI-powered solutions becoming increasingly sophisticated, the healthcare industry is poised for a significant transformation in revenue cycle management. As organizations continue to invest in AI-driven efficiencies, the future of healthcare finance looks more streamlined and resilient than ever.
