The last several years has seen a huge growth in billing services or Revenue Cycle Management (RCM) outsourcing. As many provider offices are being squeezed by vendors, receiving lower payer reimbursements and dealing with a shortage of qualified physician office management staff, many offices are deciding to outsource their billing. Additionally , many PMS/EMR vendors and independent billing companies are ready to take over the provider billing business for a certain revenue percentage. These billing service companies who entered into the business early on are strategically placed for continued growth over the next year. They are positioned to capture a market and utilize the many RCM tools offered by clearinghouses and other IT companies. However, it is not too late to get started into a new billing service venture. With the extension date of ICD10 moved to October of 2015, there is still time to position a new billing service company in the mix. As we see in the industry, many providers are reluctant to change processes and often delay change. With a year left before the transition to ICD10, there is still time to add billing services to an existing business or for the entrepreneurial folks, build a new competitive high growth business poised to get new customers within the next year.