PUBLISHER: Grand View Research | PRODUCT CODE: 1750690
PUBLISHER: Grand View Research | PRODUCT CODE: 1750690
The global AI in revenue cycle management market size was estimated at USD 20.63 billion in 2024 and is projected to grow at a CAGR of 24.16% from 2025 to 2030. Rising healthcare claim denials & complexity in payer rules, shift from transactional to value-based revenue cycle management (RCM), and growing focus on interoperability & ecosystem integration are factors contributing to market growth.
One of the most significant drivers of artificial intelligence in the revenue cycle management market is the increasing volume and complexity of healthcare claim denials. Claim denials are rising in volume and are increasingly difficult to appeal due to varying payer policies and frequent regulatory shifts.
AI-enabled solutions offer predictive denial management, real-time eligibility checks, and automated appeals processing, significantly improving denial resolution rates. Healthcare providers are thus investing in AI to reduce denials, predict them, and intervene earlier in the billing cycle. For instance, in December 2024, Care.fi launched RevNow, an AI-powered RCM platform for hospitals in India to manage insurance claims. This platform uses advanced analytics and automation to streamline the insurance claims process, including patient admission through to final discharge, pre-authorization to post-authorization, and claim adjudication to settlement.
"By harnessing AI and automation, we're enabling hospitals to overcome the traditional challenges of claims processing-delays, rejections, and inefficiencies-and transform them into streamlined, transparent workflows."
Sidak Singh, Co-founder, Care.fi.
Moreover, healthcare facilities are outsourcing RCM software solutions owing to the multiple advantages associated such as easy availability of trained and skilled professionals, enhanced efficiency, compliance, adherence to required regulations, and cost-effectiveness. A survey by Salucro Healthcare Solutions in January 2024, involving 176 healthcare professionals, found that 50% of respondents are generally satisfied with their organization's revenue cycle management, with 34% considering it somewhat efficient and 16% very efficient. However, hands-on revenue cycle leaders are less likely to view the system as efficient compared to executive leaders.
Furthermore, acute workforce shortages in medical billing and coding departments drive market growth further. AI helps offset staffing gaps by automating routine, manual RCM tasks such as charge entry, coding validation, claims status checks, and payment posting. For instance, in July 2024, Thoughtful AI launched human-capable AI agents' CAM, EVA, and PHIL to reduce human intervention in healthcare providers' RCM departments.
"Back office staffing and reimbursement are core reasons why the U.S. healthcare system is so expensive and inefficient," explained Zekoff. "In many industries, collections cost less than a penny on the dollar, but collections can cost 10 times that in healthcare. Imagine a healthcare provider making $100 million a year yet having to spend $10 million to collect that revenue. Those dollars should go to the patient experience, not inefficient collections processes."
Alex Zekoff, Thoughtful AI co-founder and CEO
AI solutions that can seamlessly integrate with existing RCM platforms, electronic health record (EHR), and payer systems are gaining traction. Interoperability is essential for enabling real-time claims processing and ensuring payment integrity workflows. Vendors are increasingly providing APIs and cloud-based platforms that improve data flow between clinical and financial systems. AI plays a crucial role in unifying various revenue cycle processes, ranging from prior authorizations to denial appeals, resulting in a more cohesive and real-time financial environment.
Global AI In Revenue Cycle Management Market Report Segmentation
This report forecasts revenue growth at the global, regional & country level and provides an analysis of the latest trends and opportunities in each of the sub-segments from 2018 to 2030. For this report, Grand View Research has segmented the global AI in revenue cycle management market report based on product, type, application, delivery mode, end use, and region: