The outsourced healthcare revenue cycle industry is a critical and fast-growing component of the healthcare system, responsible for managing the financial processes associated with generating revenue from payers for patient care. This includes coding, billing, claims submission, payment collection, and denial management. According to one source, the U.S. outsourced RCM market is expected to grow from $141.61 billion in 2024 to $272.78 billion by 2030, driven by increasing complexity in billing processes, regulatory changes, and technological advancements.
Key Growth Drivers
Key growth drivers for the industry include the following:
Technological Advancements: The integration of artificial intelligence, machine learning, robotic process automation, and cloud-based solutions is revolutionizing medical billing and RCM processes. These technologies improve efficiency by automating repetitive tasks like claims processing and coding while reducing errors and denials.
Shift Toward Value-Based Care: The transition from fee-for-service to value-based care models has introduced bundled payments and quality-based reimbursement structures. This requires sophisticated billing systems capable of tracking outcomes and handling complex payment arrangements.
Regulatory Compliance: Evolving regulations, such as those tied to Medicare, Medicaid, and HIPAA compliance, are driving demand for advanced billing solutions that ensure adherence to legal requirements while minimizing financial penalties.
Rising Healthcare Expenditures: Increasing healthcare costs and growing patient volumes are fueling demand for efficient billing systems to manage higher transaction volumes while optimizing cash flow for providers.
Outsourcing Trends: Many healthcare providers are outsourcing their increasingly complex medical billing functions to specialized firms to reduce administrative costs and focus on core patient care activities. Outsourcing also provides access to advanced technologies without requiring significant in-house investment.
Cybersecurity and Data Privacy: As digitalization grows, so do concerns about data breaches and cybersecurity risks in medical billing systems. Providers are investing heavily in secure platforms that protect sensitive patient information while ensuring operational continuity.
Outsourced Revenue Cycle M&A Trends
Announced RCM M&A transactions volumes have declined somewhat in recent quarters, alongside softness across much of the healthcare M&A market, but remain relatively strong compared to some sub-sectors. Announced deal volume peaked in late 2021 and remained elevated through 2023 before declining in Q1 2024 and remaining slow despite modest increases the past few quarters.
Experts expect the market to continue to improve as investors see opportunities for both organic and acquisition-driven growth in an industry with significant tailwinds. While the market remains highly fragmented, there are a large number of PE-backed and publicly-traded acquirers in the space who have been active over the past few years. The recently acquired R1 RCM has been the largest acquirer both in terms of deal volume and dollars invested since 2019, followed by Med-Matrix, Aspirion, Kovo, Meduit and Waystar.
There have been a handful of recently announced RCM services and technology platform deals, including GeBBs, MDaudit, and Access Healthcare, all of which have occurred at elevated multiples. According to a report from IonAnalytics, a number of larger RCM and RCM-related platforms are currently exploring a potential sale, including Greenway Health, Mudlytix, Accuity, Meduit, Elevate, and GetixHealth.
Outsourced Healthcare Revenue Cycle EBITDA Multiples
Small Outsourced Billing Companies (typically revenue under $5M):
These companies usually sell for lower multiples, ranging from 3x to 6x EBITDA. The lower multiple is often due to higher operational risk, lower revenue diversification, and limited geographic reach, as well as a heavy reliance on the owner / operator, which can lead to employer contract retention and business continuity concerns.
Mid-Sized Outsourced Billing Platforms (revenue $5-50M):
Larger, more established companies with proven profitability, a broader customer base, and possibly a unique niche, may command higher multiples. These can range from 6x to 11x EBITDA, depending on size, local market conditions, service mix, growth rate, and the stability of the cash flow.
Large Platforms, High-Growth, Tech-Driven Providers and RCM Software:
Leading RCM software companies and outsources service providers offering cutting-edge technology-driven solutions can command multiples in the 12x to 30x EBITDA range, especially if they have demonstrated the ability to grow quickly with favorable economics. While publicly-disclosed financial information is sparse for this portion of the market, our database includes a large number of precedent transactions across the RCM industry, including several recent deals with reported EBITDA multiples up to 30x (high-margin, high growth technology platform).
GeBBS Acquired by EQT for $850m (~17x EBITDA)
GeBBS Healthcare Solutions, a Los Angeles-based healthcare BPO firm, is being acquired by EQT for $850 million. GeBBS provides technology-enabled revenue cycle management (RCM) services and delivers comprehensive solutions across the entire billing process for healthcare providers, with specific expertise in medical coding. According to the press release issued by ChrysCapital:
ChrysCapital acquired GeBBS Healthcare in 2018 and has been instrumental in transforming GeBBS into a leading healthcare technology company. After the acquisition, the company expanded its portfolio of offerings through strategic acquisitions, including Aviacode in 2021, CPa in 2023, MRA in 2023, and CCD Health in 2024. The company has grown to over 13,000 employees with delivery centres in India, the Philippines, the USA, and the Dominican Republic. The portfolio of solutions also includes AI-powered tools for coding compliance, autonomous coding, automation of accounts receivable, and streamlined workflows for risk adjustment.
With reported revenue and EBITDA of $200 million and $50 million, respectively, the deal implies multiples of 4.3x revenue and 17x EBITDA, both of which are on the high end of the range for RCM-related businesses.
Prior to some new 2025 announcements, the only two acquisitions with higher implied multiples were R1 RCM's significantly larger acquisition of modular services provider CloudMed in early 2022 and health system -affiliated end-to-end services provider Acclara in late 2023. Acclara was similar in size to GeBBS, but that deal also included contracts to continue to roll out end-to-end RCM services at a number of Providence hospitals post-transaction, resulting in a visible path to substantial growth over the next five years. The implied multiple from the GeBBS deal is slightly higher than the multiples reported in the two most recent Ensemble deals (2019 and 2022).
Implied EBITDA multiples for larger RCM deals have generally increased over the past ten years, with the exception of a few outliers, which include a couple smaller deals and Frazier Healthcare Partners' acquisition of MedData in 2019, which reportedly experienced declining revenue and EBITDA in the period immediately proceeding that transaction.
Factors Impacting the EBITDA Multiple for Outsourced Revenue Cycle Providers
Acquisition multiples are a function of perceived risk and growth. Key considerations within the outsourced revenue cycle industry include the following:
Revenue Scale & Growth Rate – Larger firms with strong, consistent revenue growth typically command higher multiples due to economies of scale and predictable cash flow.
Client Diversification & Retention – Firms with a broad, stable client base (hospitals, physician groups, ASCs) and high retention rates are more attractive to buyers, reducing risk and increasing valuation.
Customer Contracts & Revenue Model – Long-term contracts with high recurring revenue (versus short-term or project-based billing) make a firm more valuable, increasing its EBITDA multiple.
End-to-End vs. Modular – End-to-end RCM providers and modular or niche services or technology firms can fetch different multiples, depending on their area of focus.
Technology & Automation – Companies leveraging AI-driven coding, automated claims processing, and proprietary software solutions receive higher multiples, as these technologies drive efficiency and reduce labor costs.
Regulatory & Compliance Risks – Firms with strong HIPAA compliance, adherence to CMS regulations, and limited legal risk are more attractive to buyers, mitigating potential liabilities.
Multiples From Active Medical Billing Listings
According to our database of precedent deals, smaller billing and RCM companies continue to sell in the 3-6x range (sub $1m EBITDA), while companies with $1 to $10m EBITDA tend to fetch 6-10x. This is corroborated by a number of deals in our active listings database currently being marketed for sale as well, including:
(links will break over time)
Billing/RCM for Labs and Physician Groups: Listed for sale at $4.8m, this company is marketed based on estimated 2024 revenue and adjusted EBITDA of $3.5m and $1.2m, respectively, implying multiples of 1.4x revenue and 4x EBITDA.
Proprietary Tech-Enabled Medical Records Billing in Southeast: Listed for sale at $11.5m, this company is marketed based on EBITDA of $2.8m, implying a multiple of 4.1x.
Medical Coding Business w/ 45 Employees: Listed for sale at $3.1m, this company is marketed based on revenue and adjusted EBITDA of $2.4m and $690,000, respectively, implying multiples of 1.3x revenue and 4.5x EBITDA.
Medical Billing / RCM Business in Southeast: Listed for sale at $2.5m, this company is marketed based on revenue and EBITDA of $1.3m and $500k, respectively, implying multiples of 2x revenue and 5x EBITDA.
Anesthesia Billing in West Virginia: Listed for sale at $2.2m, this company is marketed based on revenue and cash flow of $1.4m and $450,000, respectively, implying multiples of 1.6x revenue and 4.9x cash flow. Anesthesia is a hospital-based specialty that requires unique billing expertise that hospitals often do not have in-house.
consulMED Medical Billing and Consulting Specialists: Listed for sale at $1.5m, this company is marketed based on revenue and cash flow of $1.6m and $375,000, respectively, implying multiples of 0.94x revenue and 4x cash flow.
Healthcare Revenue Cycle Deals
Read Scope Research's take on revenue cycle and billing M&A transactions below:
About Scope Research
Scope Research compiles a variety of healthcare M&A databases and provides healthcare valuation services. The Scope Research Healthcare M&A Valuation Database currently has financial details for 59 revenue cycle management (RCM) and healthcare billing deals going back to 2010, 44 of which include reported EBITDA multiples. The revenue cycle data can be purchased individually, while our affordable annual subscriptions provide access to all of our healthcare M&A databases and segments, updated continuously.
Don't hesitate to reach out to Will Hamilton at will@scoperesearch.co with questions about our outsourced billing valuation services or healthcare M&A databases.