Revenue Cycle Management (RCM) Companies

    Showing 10 of 10 companies

    Accuity
    Mount Laurel, New Jersey, United States

    Description
    Accuity is a tech‑powered, physician‑led provider of clinical documentation review and revenue cycle integrity services for hospitals and health systems. The company’s mission is to bolster health systems’ community impact by optimizing financial results through complete, compliant capture of the clinical record, resulting in higher‑quality documentation, accurate coding and improved quality measures. Accuity combines proprietary AI‑enabled technology (Amplifi) with a multi‑specialty physician, coder and CDI team to ensure that every inpatient chart is accurate, complete and compliant, bridging the gap between care delivered and reimbursement received.
    Type
    Private
    Founded
    2016
    Funding
    Not disclosed
    Private Equity
    Core Services
    • Post‑discharge secondary clinical documentation review and coding of inpatient charts covering all DRG payers
    • AI‑enabled Amplifi technology that analyzes charts and identifies documentation and coding opportunities
    • Physician education programs using hospital performance data to improve documentation practices
    • Denials and appeals support, including appeal letter creation and regulatory compliance assistance
    • Data‑driven analytics and monthly reporting through a business‑intelligence platform
    • Turnkey 60‑day proof‑of‑concept pilot with minimal IT effort, followed by full service implementation
    • Clinical documentation integrity and revenue cycle management consulting with a dedicated client success team
    Target Customers
    • Hospitals and health systems seeking to improve mid‑revenue cycle performance
    • Academic medical centers and teaching hospitals
    • Children’s hospitals
    • Small and medium‑sized single‑site hospitals
    • Large multi‑hospital health systems, including some of the top U.S. News & World Report‑rated hospitals
    • Non‑profit integrated health systems such as Sentara Health and MultiCare Health System
    Specialties
    • Clinical documentation integrity (CDI) and DRG management
    • Revenue cycle integrity and optimization
    • AI and machine learning algorithms for clinical documentation analysis
    • Natural language processing and clinical rules engines to process unstructured data
    • HIPAA‑compliant data security with HITRUST r2 and NIST Cybersecurity Framework certifications
    • Physician‑led peer education and denials appeals expertise

    Aptarro
    Tallahassee, Florida, United States

    Description
    Aptarro is a privately held healthcare technology firm formed from the union of Alpha II, RCxRules and Health eFilings. It provides AI‑driven revenue cycle management software that simplifies medical billing and coding, reduces administrative burdens and maximizes financial outcomes for healthcare organizations. The company’s mission is to remove billing obstacles so providers, partners and patients can focus on quality care.
    Type
    Private
    Founded
    1983
    Funding
    Not disclosed
    Unknown
    Core Services
    • RevCycle Engine – an AI‑enabled rules engine that reviews every charge leaving the EMR to ensure coding accuracy, reduce denials and increase revenue
    • HCC Coding Engine – real‑time code review that scans encounters for missed hierarchical condition category codes, boosts coder productivity and improves risk adjustment factors
    • ClaimStaker – a comprehensive claims scrubber that proactively catches errors before submission, integrates with existing EMR/PM systems and reduces denial rates
    • MIPS reporting – a CEHRT‑certified solution that automates Merit‑Based Incentive Payment System data management, optimizes measure selection and submits quality reporting directly to CMS
    Target Customers
    • Healthcare providers including hospitals, physician practices and long‑term care facilities
    • Billing and revenue cycle management services that need to reduce denial rates and improve revenue integrity
    • Healthcare payers and government entities requiring accurate, rule‑based fee calculations
    • Clearinghouses seeking to enhance claim accuracy and accelerate payments
    • Practice management and EHR developers integrating coding and billing functions into their platforms
    • Software vendors and consultants serving healthcare organizations of all sizes
    Specialties
    • AI‑powered revenue cycle automation and rules‑based charge accuracy
    • Medical coding and risk adjustment optimization for HCC and RAF scoring
    • Comprehensive claims scrubbing and denial prevention using extensive edit libraries
    • MIPS and quality reporting compliance with ONC‑certified CEHRT submission
    • Seamless integration with EMR, practice management and clearinghouse systems
    • Secure healthcare data management compliant with HIPAA, NIST and HITRUST frameworks

    Ensemble Health Partners
    Blue Ash, OH, United States

    Description
    Ensemble Health Partners is a private revenue cycle management firm that works with hospitals, health systems and physician groups to streamline financial operations. Founded in 2014, the company combines expert operators and AI-powered technology to manage every component of the revenue cycle, helping providers improve cash flow, reduce administrative friction and focus on delivering exceptional patient care.
    Type
    Private
    Founded
    2014
    Funding
    Not disclosed
    Private Equity
    Core Services
    • Digital patient engagement and convenient scheduling
    • Registration, financial clearance and financial counseling
    • Prior authorization and automated coding with charge validation
    • Health information and documentation management
    • Prompt, accurate billing and comprehensive insurance collections
    • Underpayment and denial detection and recovery
    • Managed care strategy, payer performance reporting and advocacy support
    • Epic EHR readiness and optimization
    Target Customers
    • Mid-sized to large hospitals
    • Integrated health systems
    • Community and regional healthcare providers
    • Physician practices affiliated with hospitals
    • Non-profit healthcare organizations
    Specialties
    • Revenue cycle management and outsourcing
    • Healthcare financial management
    • AI-powered decisioning and predictive analytics
    • Denial and underpayment recovery
    • EHR optimization (especially Epic)
    • Managed care negotiation and payer strategy

    Fira Health
    New York, NY, United States

    Description
    Fira Health is a young healthcare‑technology company that uses artificial‑intelligence agents to remove the administrative burden from home health and outpatient providers. The company’s platform combines full‑service revenue‑cycle management with smart clinical tools so that nurses and administrative teams spend less time on paperwork and more time on care. By automating tasks such as eligibility verification, prior authorizations and documentation, Fira enables faster reimbursement and lets clinicians focus on every patient and visit.
    Type
    Private
    Founded
    2025
    Funding
    Not disclosed
    Core Services
    • Full‑service revenue cycle management (RCM) for home‑health and outpatient providers
    • Real‑time eligibility & benefits verification through the ELIZABETH AI agent
    • Automated prior authorization management using the PAIGE AI agent
    • AI‑powered home health charting with OASIS documentation pre‑fills and voice‑to‑text scribing
    • Billing workflows (planned future service)
    • Accounts receivable management (planned future service)
    Target Customers
    • Home health agencies and providers
    • Outpatient healthcare practices that require revenue‑cycle management
    • Nursing and clinical teams seeking voice‑driven charting tools
    • Healthcare organizations using EHR systems such as Homecare Homebase and Kantime
    • Administrative staff responsible for insurance verification and prior authorizations
    Specialties
    • AI‑enabled revenue cycle management and medical billing
    • Automated eligibility and benefits verification
    • Prior authorization automation with payer‑specific rule engines
    • Voice‑based clinical documentation and OASIS pre‑fill
    • Agentic workflows integrated with home‑health EHR systems
    • Workflow automation for insurance and claims processes

    Granted Health, Inc.
    New York, NY, USA

    Description
    Granted Health is an AI‑native digital health company that aims to simplify healthcare costs and insurance administration. Its platform links users’ health, dental, vision and supplemental insurance accounts, imports claims and benefits data, and uses machine‑learning to uncover unused benefits, flag billing errors and negotiate bills. Backed by top investors, the company pairs experienced human advocates with proprietary AI developed by engineers who built Oscar Health Insurance to provide comprehensive benefits guidance, bill negotiation and insurance navigation for U.S. consumers.
    Type
    Private
    Founded
    2023
    Funding
    $15 million
    Series A
    Core Services
    • Insurance account linking and data aggregation
    • AI‑powered claims review and bill negotiation
    • Instant benefits discovery and coverage Q&A
    • In‑network doctor search and plan selection assistance
    • Filing insurance claims on behalf of users
    • Personalized guidance on insurance plan selection
    Target Customers
    • Individual healthcare consumers in the United States
    • Patients dealing with complex medical bills and insurance claims
    • Families seeking support for multiple members’ health plans
    Specialties
    • AI and machine learning for healthcare billing analysis
    • Health insurance benefits optimization
    • Medical bill negotiation and advocacy
    • Secure data integration compliant with HIPAA and SOC 2
    • Multi‑plan insurance linking technology

    Iodine Software
    Austin, Texas, USA

    Description
    Iodine Software is a leading healthcare AI company that provides mid-revenue cycle solutions for hospitals and health systems. Its AI-powered platform analyzes clinical data in real time to automate complex documentation and billing processes, helping healthcare organizations improve documentation accuracy, optimize reimbursement, and streamline operations.
    Type
    Private
    Founded
    2010
    Funding
    Not disclosed
    Private Equity
    Core Services
    • AwareCDI Suite for Clinical Documentation Integrity (AI-driven CDI workflow software)
    • AwareUM Utilization Management solution (AI-powered patient status and utilization review)
    • AwarePreBill revenue recovery solution (post-discharge pre-bill review to prevent leakage)
    • CognitiveML proprietary AI engine (integrated machine learning and NLP platform powering all products)
    Target Customers
    • Enterprise hospitals and multi-hospital health systems
    • Academic medical centers and large healthcare networks
    • Clinical documentation and utilization management teams in U.S. provider organizations
    Specialties
    • Clinical Documentation Integrity (CDI)
    • Healthcare Revenue Cycle Management
    • Artificial Intelligence (AI) and Machine Learning
    • Natural Language Processing (NLP)
    • Utilization Management Optimization
    • Healthcare Data Analytics

    PsychPlus
    Houston, Texas, United States

    Description
    PsychPlus is a mental health care provider and technology company that offers an integrated ecosystem of psychiatric and therapy services backed by its proprietary electronic health record (EHR) platform. The organization delivers in-person and virtual care across a network of clinics while empowering providers and partners with practice management, revenue cycle and patient engagement tools. Its mission is to make high-quality mental health care accessible and affordable, reduce suicide rates and support patients and providers through every stage of the mental health journey.
    Type
    Private
    Founded
    N/A
    Funding
    Not disclosed
    Unknown
    Core Services
    • In-person and virtual psychiatry services
    • Individual, group and couples/family therapy and counseling
    • Psychiatric urgent care and crisis intervention
    • Intensive outpatient programs and partial hospitalization
    • Specialized therapies including TMS, ECT, Spravato and applied behavior analysis
    • Substance detoxification and substance use disorder treatment
    • Business services such as consult-liaison coverage, hospital and nursing home psychiatric programs, employer EAPs and practice acquisition
    • Proprietary Galaxy Electronic Health Record and practice management solutions
    Target Customers
    • Individuals of all ages seeking mental health care
    • Employers and self-insured organizations seeking employee mental health and EAP programs
    • Hospitals, emergency departments and behavioral health facilities requiring psychiatric coverage
    • Colleges, schools, nursing homes and assisted living centers needing mental health services
    • Independent psychiatric practices and mental health providers seeking practice management and EHR technology
    Specialties
    • Telehealth and virtual psychiatric care
    • Proprietary electronic health record and patient engagement technology
    • Revenue cycle management and practice management software
    • Consult-liaison psychiatry and hospital psychiatric coverage
    • Value-based mental health care and vertical care models
    • Intensive therapies such as TMS, ECT, Spravato and applied behavior analysis

    Regard
    Los Angeles & New York City, United States

    Description
    Regard is a healthcare technology company that applies artificial intelligence and clinical insight to transform raw patient data into actionable diagnoses and documentation. Its platform analyzes complete electronic health record data to recommend potential diagnoses with supporting evidence, generate draft notes and discharge summaries in the physician’s preferred style and deliver a real‑time clinical intelligence layer for health systems. By closing the clinical insights gap, Regard aims to improve care quality, reduce documentation burden and enhance financial performance for hospitals and physicians.
    Type
    Private
    Founded
    2021
    Funding
    $81 million
    Series B
    Core Services
    • Proactive clinical documentation platform that reviews entire patient charts to recommend diagnoses and treatment plans
    • AI‑generated draft notes, discharge summaries and attestations using SOAP/H&P and progress note formats
    • Real‑time clinical scribe integration that combines ambient audio with chart data to produce comprehensive notes
    • Clinical insights layer that surfaces relevant conditions and supporting evidence from unstructured EHR data
    • AI assistant "Max" for clinicians that answers questions about patient data and automates documentation
    • Customization tools to maintain clinicians’ preferred writing styles and integrate with existing workflows
    Target Customers
    • Enterprise hospital systems and integrated delivery networks
    • Mid‑size and rural health systems seeking to improve case mix index and reimbursement
    • Academic medical centers and teaching hospitals
    • Clinical documentation improvement (CDI) teams and revenue cycle departments
    • Physicians and providers requiring automated documentation assistance
    Specialties
    • Artificial intelligence and machine learning for clinical decision support
    • Natural language processing and large language models for documentation
    • Electronic health record (EHR) integration and chart review automation
    • Clinical documentation improvement (CDI) and revenue cycle optimization
    • Ambient clinical scribing and conversational AI
    • Data analytics and condition detection across structured and unstructured patient data

    SmarterDx
    New York, NY, USA

    Description
    SmarterDx is a physician-founded clinical AI company that helps hospitals analyze 100% of patient charts to fully capture the value of care delivered. Its platform uses proprietary AI to uncover missing diagnoses, improve documentation quality, and appeal insurance denials, enabling health systems to recover revenue and enhance care metrics. By ensuring every patient’s record is accurate and complete, SmarterDx drives significant financial improvements and better patient outcomes for hospitals.
    Type
    Private
    Founded
    2020
    Funding
    $71 million
    Series B
    Core Services
    • SmarterPrebill (AI-driven clinical documentation and coding review solution)
    • SmarterDenials (AI-powered claim denial analysis and automated appeals system)
    • Clinical AI platform for hospital revenue integrity and quality improvement
    • Healthcare revenue cycle analytics and insights
    Target Customers
    • Large hospitals and multi-hospital health systems
    • Academic medical centers and teaching hospitals
    • Community healthcare systems seeking revenue cycle improvement
    Specialties
    • Clinical natural language processing (NLP) in healthcare
    • Machine learning and AI for revenue cycle management
    • Clinical documentation improvement (CDI) and coding accuracy
    • Denial management automation and appeals generation
    • Healthcare data analytics and quality metrics optimization

    Zentist
    San Francisco, CA, United States

    Description
    Zentist is a U.S.-based fintech startup that provides cloud-based revenue cycle management software for dental support organizations (DSOs) and dental practices. Its flagship platform Remit AI uses machine learning and robotic process automation to parse explanation of benefits (EOB) and electronic remittance advice (ERA) data, reconcile remittances with bank transactions and accelerate payment posting
    Type
    Private
    Founded
    2015
    Funding
    Not disclosed
    Series A
    Core Services
    • Remit AI platform for dental revenue cycle management
    • Automated posting and reconciliation of EOB and ERA remittance data
    • Revenue cycle analytics and customizable KPI dashboards
    • Claims tracking and denial management workflows
    • Insurance check and virtual credit-card payment management
    • Pre-funding pilot program for real-time insurance claim payments
    Target Customers
    • Multi-location dental service organizations (DSOs)
    • Dental group practices and specialty clinics
    • Practice management and revenue cycle leaders seeking automation
    Specialties
    • Dental revenue cycle automation
    • AI-driven EOB/ERA parsing and remittance matching
    • Robotic process automation (RPA) for payment posting
    • Compliance with HIPAA and SOC 2 Type II security standards
    • Integration with existing practice management systems and clearinghouses