The RCM industry today stands at $201 billion. It began with modest roots—primarily offering manpower to handle repetitive tasks at lower costs, effectively capitalizing on labor arbitrage. As a result, offshoring became a significant component of the RCM model, with 22% of RCM spending in the US now offshored.

As healthcare billing in the US grew more complex, the RCM industry expanded alongside it. Technological advances drove greater use of software to improve efficiency and reduce costs in the RCM value chain. However, most of these advancements have been point solutions—designed to plug into existing workflows of payors, providers, or RCM companies. Functions like medical coding, transcription, and claims eligibility checks have evolved into standalone niches, each driving incremental gains. 
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Yet the core remains fragmented and siloed:

1. EMRs don’t integrate smoothly with financial systems
2. Front-office and back-office processes remain fragmented
3. Providers often need to chase payors through multi-step, manual, redundant processes

As a result, claim denials, revenue leakage, and delayed reimbursements are the norm. Hospitals struggle to forecast cash flows, patients face opaque bills, and administrative costs continue to rise

‍The Shift: GenAI and Regulatory tailwinds

The administrative burden in US healthcare is now widely acknowledged, with growing pressure on payors and providers to reduce patient friction, streamline access, and lower overall costs. The transition to ICD-11, persistent staffing shortages, and payors’ push to improve medical loss ratios all highlight the urgency to rationalize operational spending and modernize workflows. Much of the basic infrastructure already exists—and two powerful tailwinds are now enabling integration and reinvention: 

1. GenAI: Instead of marginal improvements, GenAI can reengineer the RCM stack For e.g.:
 a. Agents that auto-generate pre-auth letters or appeal denials
 b. Summarization of free-text clinical notes into billable codes
 c. Personalized cost explanations for patients pre-visit

2. Regulatory pressure: New rules are forcing greater transparency from payors. APIs must now expose eligibility, prior auth, and claims status. Interoperability standards (e.g., FHIR) are making data access more feasible.
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These create a wedge for startups to build new workflows, not just automate old ones.

‍What this means for builders

The next generation of RCM companies have to move beyond point solutions to deliver full-stack outcomes—combining automation, analytics, and patient engagement. Their customers—whether payors or providers—are under mounting pressure to transition to value-based care, ensure transparency, and enable interoperability. This will drive demand for solution-oriented RCM partners that can help them navigate this shift.

Indian founders, especially those with experience in offshored RCM operations, have a head start. But cost arbitrage and incremental plug in automation won’t be enough—what’s needed now are outcome-driven platforms that transform workflows end-to-end.

1. Move from Task Automation to Workflow Ownership

It’s not enough to build tools that do one task in the workflow (like coding a clinical note or verifying eligibility). What buyers really want are solutions that take ownership of an outcome—say, increasing the first-pass claim approval rate or reducing time to reimbursement.

That means moving from isolated automation to intelligent, end-to-end workflows.
For example: Instead of just summarizing charts, build a mid+back-revenue cycle layer that can code, validate, audit, and appeal ; seamlessly, in one flow.

2. Deliver Full-Stack Solutions, Not Point Tech

Customers want one partner who can improve accuracy, reduce turnaround time, and plug into their existing stack. They don’t want to manage or spend on a dozen vendors. We think full-stack RCM platforms tailored to provider segments (e.g. dental, home health, behavioral health) will win.
Playbook: Combine AI + workflow + managed services. Be the operational layer, not just a tool.

3. Build Around Incumbent Infrastructure, Not Within It

Major healthcare software platforms (like EHRs and billing systems) are increasingly embedding their own automation features—making it harder for startups to compete within their walls. Rather than trying to integrate tightly into incumbent platforms, builders should focus on areas they overlook, underperform in, or leave fragmented.

Where the whitespace lies:
a. Mid-sized and independent provider groups not tied to large EHR ecosystems
b. Underserved phases of the revenue cycle (e.g., denial management, patient collections)
c. Payor-facing operations (e.g., provider data management, risk adjustment) where direct partnerships are possible

The opportunity is to build adjacent, interoperable layers that enhance—not replace—existing systems.

4. Target the Consolidators

Private equity-backed provider rollups are buying hospitals and specialty clinics (e.g., orthopedics, radiology, home care) and investing heavily in operational efficiency. They are hungry for automation, especially in the mid-revenue cycle.

These are ideal early adopters: they have capital, scale pressure, and decision-making speed.

5. Rethink Your Go-To-Market Strategy
There’s no single way to win in RCM. The best companies pick a wedge that gets them early traction and then expand intelligently from there.
a. Sell RCM-as-a-Service to specific provider segments like behavioral health or dental, where workflows are messy and underserved. Companies like CareStack and Jupiter have gained traction by starting deep in a vertical.
b. Partner with legacy RCM firms that need to modernize. They already have distribution and ops muscle—but lack tech. Startups like AKASA have embedded AI workflows into existing revenue cycle operations this way.
c. Bundle into existing clinical software—EHRs, telehealth, or practice management platforms

The opportunity ahead

The RCM industry is primed for reinvention, and Indian founders are well-placed to lead this transformation—bringing together deep process knowledge, cost-efficient execution, and AI-native thinking. The next wave of winners won’t just automate existing tasks; they’ll redesign the workflows themselves. Success will be measured by real outcomes: faster reimbursements, fewer denials, improved provider productivity, and better patient experiences.

RCM remains the lowest-hanging operational fruit in US healthcare—but rethinking it unlocks the foundation for broader transformation, from care delivery to payments. For founders ready to rebuild the stack, this is a very promising time. 

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