Kaizen RCM Solutions

In the era of digital transformation, scalability in healthcare is no longer a luxury but a necessity.

Top 10 RCM Challenges in Healthcare

Increased Claim Denials

10-15%Average denial rate

Increased Claim Denials

Increasing denial rates with some hospitals seeing up to 20% of claims rejected.

  • Coding errors and lack of prior authorization
  • Time-consuming appeals process
  • Each denied claim costs $25-$118 to rework

Complex Payer Policies

QuarterlyPolicy updates

Complex Payer Policies

Frequent updates in Medicare, Medicaid, and private insurer rules.

  • Stricter prior authorization requirements
  • Payer-specific coding demands
  • Constant need for staff retraining

Staffing Shortages

20-30%Annual turnover

Staffing Shortages

Shortage of skilled medical coders & billers (especially certified professionals).

  • High turnover rates due to burnout
  • Costly and time-consuming training
  • Remote work competition

Slow Payment Collections

30-40%Patient responsibility

Slow Payment Collections

Patient payments now account for 30-40% of revenue, but collection rates are low.

  • Outdated payment systems
  • Increasing bad debt write-offs
  • Inefficient follow-up processes

EHR Integration Issues

62%Report integration issues

EHR Integration Issues

Poor integration between EHRs, billing software, and payer systems causing data silos.

  • Manual data entry errors
  • Lack of real-time eligibility verification
  • Duplicate data entry requirements

Regulatory Pressures

$1.5M+Potential penalties

Regulatory Pressures

No Surprises Act (NSA) compliance challenges creating new administrative burdens.

  • HIPAA violations risks
  • State-specific billing laws
  • Increasing audit frequency

Outsourcing Costs

5-10%Of collections

Outsourcing Costs

Rising RCM outsourcing costs with some vendors charging 5-10% of collections.

  • Poor-performing vendors
  • Lack of transparency
  • Difficulty measuring ROI

Cybersecurity Risks

$9.2MAvg. breach cost

Cybersecurity Risks

Ransomware attacks targeting billing systems (e.g., Change Healthcare breach in 2024).

  • Fraudulent claims & upcoding
  • Patient data breaches
  • Sophisticated cyber attacks

Value-Based Care Shift

37%Revenue from VBC

Value-Based Care Shift

Fee-for-service to VBC transition requires new payment models and reporting.

  • Quality metrics complexities
  • Delayed reimbursements
  • Difficulty tracking measures

Price Transparency

$300-$5KDaily penalties

Price Transparency

CMS Price Transparency Rule compliance struggles (hospitals facing penalties).

  • Confusing medical bills
  • Lack of price estimation tools
  • Increasing patient expectations
Our Services

Revenue Cycle Management Solutions

We offer end-to-end revenue cycle management services designed to reduce your administrative burden and eliminate revenue bottlenecks, allowing you to focus on providing exceptional patient care.

Medical Billing

Maximize reimbursements and minimize denials

Coding & Documentation

Accurate coding and compliant documentation

Accounts Receivable

Accelerate cash flow and reduce outstanding balances

Claims Processing

Reduce errors and expedite payments

Revenue Analytics

Identify opportunities for optimization

Compliance Management

Ensure adherence to healthcare regulations

Elevate your Business with Us

We deliver exceptional value through our specialized expertise, innovative technology, and proven methodology.

Kaizen RCM's Insight Master

Empower your healthcare practice with unparalleled insights. Our expert consulting team crafts strategic solutions that redefine industry standards and drive innovation forward.

Kaizen RCM's Insight Catalyst

Unleash powerful data-driven insights to transform your strategies and propel your business into the future. Stay ahead of the curve with cutting-edge analyses and thought-provoking discussions tailored for visionary leaders.

Kaizen RCM's Synergy Grow

Our team channels a blend of diverse expertise and groundbreaking strategies to propel your organisation into the future. We're committed to redefining success through collaboration and innovation.

Conjure with Kaizen

We offer customised plan tailored to your needs where we bring in industry experts to dissect, identify and brew a unique solution designed only for you

US Healthcare RCM Outsourcing Market Forecast

The US healthcare RCM outsourcing market is estimated to increase by USD 2,930.4 million between 2022 and 2033, with a CAGR of 11.49%.

90%

Health Executives

Exploring cost savings by partnering with third-party

$312B

Global Market

Projected global healthcare outsourcing market by 2025

$66B

US Market

Expected size of the U.S. healthcare outsourcing market by 2025

$20B

Billing Errors

Annual cost of billing errors in the medical sector

US Healthcare RCM Outsourcing Market Growth

USD Billion | 2023-2033

Market Growth Insights

The US healthcare RCM outsourcing market is experiencing significant growth, driven by healthcare providers seeking to reduce operational costs and improve efficiency. With a CAGR of 11.49%, the market is expected to reach $17.53 billion by 2033.

This growth is fueled by increasing adoption among both large hospital systems and smaller physician practices, with 90% of US hospitals already outsourcing at least one process.

The rising complexity of medical billing, increasing patient financial responsibility, and the need for specialized expertise in coding and compliance are all contributing factors to this market expansion. Healthcare organizations are recognizing that outsourcing RCM functions can lead to improved cash flow, reduced denial rates, and better financial outcomes.

Ready to optimize your revenue cycle?

Join the 90% of healthcare providers who trust outsourcing for their RCM needs.