M&A activity snapshot
Revenue cycle management is in a heavy consolidation cycle. RCM and healthcare IT deals reached $28.6 billion in value across 211 transactions in 2025, both multi-year highs, according to Greenberg Advisors. The same report notes that billing and consulting were the two most active service offerings acquired in each of the past seven years.
This page covers outsourced billing and RCM labor: firms whose staff code, submit, and follow up on claims for practices and health systems. Software sold to practices is covered separately. The 2022 NAICS index assigns billing services to 541219, Other Accounting Services, while early-out and bad-debt collection sits in 561440, Collection Agencies.
The anchor deal of the cycle was R1 RCM. TowerBrook and Clayton, Dubilier & Rice took R1 private in an $8.9 billion all-cash deal, the largest sponsor-driven healthcare technology public-to-private deal on record. R1 serves more than 500 healthcare organizations, including 93 of the top 100 health systems.
Who is buying
Large-cap private equity sets the top of the market. KPMG's 2025 deal log lists Blackstone's $1,200 million purchase of AGS Health, Carlyle's $500 million Knack RCM deal, and New Mountain Capital's Access Healthcare investment at a $2,069 million enterprise value.
Pension and global sponsors are also active. Goldman Sachs Alternatives and Everstone Capital sold a co-control stake in Omega Healthcare to Ontario Teachers' Pension Plan in January 2025. EQT agreed to buy GeBBS, a technology-enabled RCM firm, for $850 million in 2024, per Scope Research.
Hospital-focused outsourcers draw repeat sponsor capital. Berkshire Partners and Warburg Pincus agreed to make a significant investment in Ensemble Health Partners, with Golden Gate Capital retaining a minority interest.
Below that tier, PE-backed platforms buy specialty billers as add-ons. Ventra Health, a Varsity Healthcare Partners portfolio company focused on facility-based physicians, combined with radiology biller ADVOCATE RCM in January 2024. Capstone data reported by HIT Consultant shows PE add-on acquisitions in healthcare IT grew 29.3% year over year through mid-2026, as sponsors bolt AI tools onto existing EHR and RCM assets.
What buyers look for
Buyers start with client results, because those drive retention and contingency fees. The AAFP says days in A/R should stay below 50 days, with 30 to 40 days preferable. It also says the adjusted collection rate should be 95% at minimum, with 95% to 99% the average.
Denial management is now the core of the pitch. MGMA reports a single-specialty first-submission denial rate of 8%, the same rate it documented in 2019. Yet in a March 2024 MGMA Stat poll, 60% of medical group leaders reported rising denial rates.
Hospital data is worse. Premier found nearly 15% of claims to private payers are initially denied. It put the average cost of fighting a denial at $43.84 per claim, or about $19.7 billion a year. Experian Health's 2025 survey found 41% of providers see more than 10% of claims denied, and 68% say clean claims are harder to submit than a year ago.
Delivery model is the other test. Scale outsourcers run large offshore teams: GeBBS has over 13,000 employees with delivery centres in India, the Philippines, the USA, and the Dominican Republic. Access Healthcare processes more than 400 million transactions a year. Buyers compare a target's cost per claim against that kind of labor base.
What makes a strong company
A billing company that draws platform-level interest typically shows:
- Client days in A/R inside the AAFP's 30-to-40-day preferred range. Strong firms track it by payer and report aging over 120 days separately.
- Denial rates at or below the 8% MGMA single-specialty benchmark, with root-cause reporting by payer and reason code.
- Multi-year client contracts and no single client or specialty dominating revenue.
- A signed business associate agreement with every client. Federal rules name billing, claims processing, and practice management as business associate functions. Gaps here surface fast in diligence.
- Documented offshore and subcontractor arrangements, with data-access controls a buyer can audit.
- Measurable automation in coding, eligibility, or denial follow-up, so margin does not depend only on adding staff.
Valuation and deal structure
Public multiple data covers mainly the largest outsourcers. Scope Research estimated R1's trailing multiple at 14.3x EBITDA based on $624.3m of adjusted EBITDA. It estimated EQT's GeBBS deal at 4.3x revenue and 17x EBITDA, calling both figures the high end of the range for RCM-related businesses.
Those are large, multi-thousand-employee platforms. No major data provider publishes a multiple series for small practice-billing firms, and this page does not estimate one. For context only, Capstone Partners' healthcare IT sector averaged 7.3x EV/revenue for 2025 through YTD 2026, a software-weighted proxy rather than a services benchmark.
Structure tends to follow the market tone. Greenberg Advisors describes a seller-friendly market with abbreviated closing timelines, aggressive deal structures, and premium multiples for top-tier businesses. Because client contracts carry the value, buyers commonly tie part of the price to client retention after close. That is a general pattern, not a sourced RCM-specific figure.
Outlook
Demand drivers look durable for the next 12 to 24 months. Greenberg Advisors reports that investors expect OBBBA and other insurance-market changes to create revenue cycle complexities that providers are generally not equipped to manage in-house.
AI is the main pressure on labor-heavy models. AI spend on coding and billing reached $450M in 2025, up from $200M, per Capstone data. Greenberg names claim denials, appeal letters, and coding as early AI adoption areas. Billing firms that pair offshore labor with automation should keep drawing platform bids, while purely manual shops face pricing pressure.
Own a medical billing or RCM business and want a baseline before you talk to buyers? Run the valuation tool. Back to Healthcare Services M&A. See also: why vertical-focused buyers source more deals.