Why Healthcare Organizations Reconsider Revenue Cycle Outsourcing

Healthcare organizations are taking a harder look at how their revenue cycle is structured.

Some are expanding outsourcing relationships. Others are bringing parts of the revenue cycle back in-house. And many are combining internal teams, technology, and specialized external partners rather than committing to one model across the entire function.

The shift raises a more important question than whether revenue cycle management should be outsourced:

How much visibility, control, and accountability does your operating model actually give you?

That question is becoming increasingly relevant. McKinsey’s 2026 revenue cycle research found that 60% of surveyed care-delivery leaders expect to change their RCM vendor strategy within the next two years. The research also points toward greater emphasis on vendor governance, measurable outcomes, technology integration, and more strategic operating models.

The issue, then, is not simply outsourcing versus insourcing.

It is whether the model helps the organization understand what is happening across the revenue cycle, respond when something goes wrong, and continuously improve performance.

Why are healthcare organizations reconsidering RCM outsourcing?

Healthcare organizations may reconsider RCM outsourcing when the relationship no longer provides the visibility, accountability, flexibility, or operational value they need.

That does not necessarily mean outsourcing itself is the problem.

In fact, external support remains deeply embedded in healthcare revenue cycle operations. Recent industry research shows healthcare organizations continue to outsource functions such as accounts receivable follow-up, coding, denials management, billing, and claims editing.

The bigger question is how those external capabilities fit into the organization’s overall revenue cycle.

A healthcare organization can have an external team performing significant amounts of work while internal leaders still struggle to answer questions such as:

• Where are claims getting stuck?
• What is driving recurring denials?
• Which workflows are creating backlogs?
• Who owns an exception when it crosses teams?
• How quickly can the operation respond to payer changes?
• Are recurring problems being resolved or simply processed?

When those answers are difficult to obtain, the problem becomes larger than vendor performance.

It becomes an operating-model problem.

RCM outsourcing does not have to mean losing control

Control is sometimes associated with keeping work in-house.

But where the work is performed does not necessarily determine how much control an organization has over it.

A healthcare organization can maintain meaningful control over externally supported processes when responsibilities, data, workflows, performance expectations, and escalation paths are clearly defined.

Likewise, bringing a process in-house does not automatically resolve poor visibility or inefficient workflows.

This distinction is becoming increasingly important as healthcare organizations reconsider how responsibilities should be divided.

The better question is not:

Should we outsource RCM?

It is: Which revenue cycle responsibilities should we own directly, and how should external partners work within the rest?

What does limited visibility look like in practice?

Visibility should mean more than receiving a monthly performance report.

Healthcare leaders need enough operational insight to understand what is happening behind the metrics.

Consider a growing denial backlog.

Knowing the number of outstanding denials is useful. Understanding why they are happening is much more valuable.

Is the problem coming from eligibility verification?

Documentation?

Coding?

Prior authorization?

A payer-specific change?

A workflow breakdown between internal and external teams?

If an organization sees only the backlog, the response may be to add capacity.

If it understands the cause, it has an opportunity to improve the process.

Processing more work is different from improving how the work gets done.

That distinction should be part of how healthcare organizations evaluate an RCM partner.

Where does accountability break down?

Revenue cycle management is not one isolated process.

Patient access, eligibility, authorization, coding, charge capture, claims submission, payment posting, denials, accounts receivable, and patient financial interactions are interconnected.

A problem upstream can create additional work downstream.

That becomes particularly challenging when different parts of the revenue cycle sit across multiple teams, vendors, technologies, or locations.

An external team may successfully complete its assigned task while the organization continues to experience the same underlying problem.

The internal team may also assume an issue sits with the provider when its root cause originates somewhere else in the workflow.

This is where responsibility can become blurred.

A stronger operating model defines not only who performs the task, but also:

• Who monitors the outcome
• Who investigates exceptions
• Who identifies recurring problems
• Who escalates issues
• Who changes the process when something is not working

Without that clarity, accountability can disappear into the handoffs.

Bringing RCM back in-house is not the only answer

One of the more visible examples of this operating-model reassessment came from CommonSpirit Health in 2026.

The health system announced that it would transition revenue cycle services currently provided by Conifer back into CommonSpirit over the following year.

But the story is more nuanced than simply “health system ends outsourcing.”

CommonSpirit’s CFO subsequently said the organization still expected to work with external vendors in areas including scheduling, coding, and billing, with vendor performance helping determine the longer-term structure.

That distinction matters.

Healthcare organizations do not necessarily need to choose one operating model for the entire revenue cycle.

Some activities may benefit from close internal ownership. Others may be supported effectively by specialized external teams. Technology may handle increasingly standardized work, while people focus on exceptions, judgment, quality, and improvement.

The opportunity is to determine what belongs where.

What should healthcare organizations look for in an RCM partner?

If the conversation is moving beyond simply adding capacity, healthcare organizations need different criteria for evaluating an external partner.

Visibility into the operation

Reporting should help leaders understand performance, backlogs, exceptions, trends, and recurring issues.

The organization should not need to chase its provider to understand what is happening.

Clear ownership and escalation

Both teams should understand where responsibilities begin and end.

When something falls outside the normal workflow, there should be clarity around who investigates it, who needs to be involved, and when it should be escalated.

Revenue cycle expertise

RCM requires more than executing a predefined task.

Teams need to understand the operational context surrounding their work, including how their activity affects upstream and downstream processes.

Quality and controls

Accuracy, documentation, quality assurance, security, and appropriate access controls need to be built into the operation.

These should not be treated as separate activities added after the work is completed.

Adaptability

Revenue cycle workflows change.

Payer requirements evolve. Volumes fluctuate. Technology changes. Organizations acquire practices, enter new markets, or redesign processes.

An external team needs to adapt with the operation rather than become another barrier to change.

Continuous improvement

Perhaps most importantly, healthcare organizations should ask whether the relationship is designed only to process work or also to improve it.

Recurring problems should create opportunities to examine root causes, redesign workflows, improve controls, and reduce unnecessary manual activity.

What role should technology and AI play in the RCM model?

Technology is becoming more capable across revenue cycle workflows.

Automation and AI can support repetitive administrative activities, coding workflows, claims processing, analytics, documentation, and other areas where large volumes of information need to be processed.

But technology introduces its own operating questions.

Who monitors automated workflows?

Who validates outputs?

What happens when the system encounters an exception?

Who is accountable when an automated decision affects another part of the revenue cycle?

Where should human review remain?

This is why an RCM strategy built primarily around implementing more technology can still fall short.

Technology needs to work within a defined process, and that process still needs people who understand the work.

The stronger model connects people, process, and technology rather than treating any one of them as the solution.

When is it time to reassess an RCM outsourcing relationship?

Reconsidering an RCM model does not automatically mean replacing a provider or bringing the work back internally.

Sometimes the operating relationship itself needs to evolve.

Healthcare leaders may want to reassess their current model when they consistently experience:

• Limited visibility into day-to-day performance
• Recurring problems without clear root-cause resolution
• Unclear ownership between internal and external teams
• Difficulty changing workflows as organizational needs evolve
• Increasing internal effort required to manage the provider
• Performance measured primarily through activity or headcount
• Technology improvements that do not translate into better operational outcomes

These are not necessarily signs that outsourcing cannot work.

They are signs that the current operating model may no longer be working well enough.

From outsourced work to an integrated operating model

A stronger RCM relationship does not begin with deciding how many people should sit externally.

It starts with understanding the operation.

Which workflows create the most friction?

Where are exceptions occurring?

Which responsibilities require close internal ownership?

Where could specialized expertise provide additional support?

What information do leaders need to make decisions?

What outcomes should improve?

At Infinit-O, our approach to healthcare operations starts with those questions. External support should strengthen the client’s existing people, processes, and technology while maintaining the visibility and accountability healthcare leaders need.

That means looking beyond where work is performed and considering how internal and external teams operate together.

The question is no longer simply in-house or outsourced

Healthcare organizations have more choices than keeping the entire revenue cycle internal or transferring it to an external provider.

The right answer may be different across different parts of the revenue cycle.

What matters is whether the operating model gives healthcare leaders enough visibility to understand what is happening, control to respond when circumstances change, and accountability to know who owns the outcome.

That is ultimately a more useful way to evaluate RCM outsourcing.

Because the value of an RCM partnership should not be measured only by where the work gets done.

It should be measured by how well the revenue cycle works.