The revenue cycle management (RCM) landscape for healthcare is poised for significant transformation over the next few years. As the industry continues to evolve, RCM providers and their customers face a complex web of challenges and opportunities. Among the key trends shaping RCM in 2025 are:
- Rising Costs Driven by Cybersecurity and Regulatory Compliance Demands and Increasing Patient Bad Debt Rates
The cost of doing business is increasing. RCM providers invest in robust cybersecurity measures and navigate complex regulatory landscapes. FDA oversight, federal and state-specific regulations, and even plan-level nuances in payor policies demand significant attention and resources. Margins are being further shaved as patient bad debt rates rise across the healthcare sector.
- Workforce Challenges
A competitive labor market and growing demand for specialized skills in RCM pose challenges for recruiting, retaining, and upskilling talent. Expertise in navigating payor-specific requirements and leveraging advanced technologies is more critical than ever.
- Payor Policy Complexity
Payor rules are becoming more granular and fragmented, requiring laboratories to adapt to multi-layered regulations at every level—from federal mandates to plan-specific details. This shift places a premium on data-driven decision-making and operational flexibility.
- Integration and Interoperability with EMRs
As laboratories increasingly rely on seamless interfacing with electronic medical records (EMRs), the need for platforms with robust interoperability grows. Data integration challenges can impact claim accuracy, timeliness, and overall efficiency.
Anticipated Impact on RCM Customers
Among the challenges and opportunities for RCM customers:
- Cost Optimization Is Critical
As cybersecurity and compliance costs rise, laboratories must find efficiencies elsewhere. Automating RCM processes is no longer optional but essential to maintaining financial health and operational agility. And tools to increase patient engagement and improve propensity to pay will be highly desirable.
- Outsourcing to Leverage Expertise
Outsourcing RCM functions to specialized providers offers access to economies of scale, cutting-edge technology, and a talent pool equipped to navigate regulatory and payor complexities.
- Increased Use of RCM Data
Customers will deepen their reliance on RCM data, extending its use beyond financial operations to strategic decision-making across their organizations.
Strategies and Innovations to Address Emerging Challenges
To help laboratories navigate this evolving landscape, we are focusing on delivering practical solutions and forward-looking technologies:
- Harnessing Artificial Intelligence (AI) and Machine Learning (ML)
While many customers adopt a cautious “wait and see” approach to generative AI, they are finding targeted applications of Natural Language Processing (NLP), and ML are already proving effective. Examples of how we’ve used these technologies to optimize claims processing include:- Prioritization of claims based on reimbursement likelihood or value
- Automatically routing claims to the best-suited team members
- Minimizing manual intervention through automatic RCM updates
- Reducing patient call volume to gather insurance or demographic information
- Simplifying and consolidating system architectures
We are seeing a focus on reducing the number of systems they need, which matches our philosophy of delivering an RCM platform that delivers broader functionality and seamless integration, reducing inefficiencies and improving data flow with EMRs and other systems.
- Expanding API-Driven Connectivity
APIs enable real-time data exchange, ensuring laboratories can access up-to-date information for front-end systems and operational decisions. Our focus on API utilization reflects the great importance we place on connectivity.
About Kyle Fetter
Kyle Fetter is the Chief Opearing Officer XiFin, a healthcare information technology company that empowers healthcare organizations to navigate an increasingly complex and evolving healthcare landscape. Fetter currently oversees sales, implementations, customer service and analytics for XiFin in addition to the business process outsourcing divisions. Most recently serving as executive vice president & general manager of Diagnostic Services, he has implemented and overseen the commercialization, complex billing and reimbursement processes for over 100 hospital, molecular diagnostic, and medical device providers. He has driven 55% compound annual growth rate (CAGR) of XiFin’s outsourcing division. He came to the healthcare industry after working in venture capital (focused in energy and genetic testing) with a background in technology funding and commercialization.
