A total of 14 M&A transactions involving health care revenue cycle vendors were completed in the 12 months ended March 31 for a combined $310 million in deal value, according to Greenberg Advisors, an M&A advisory firm that compiled the report from information in its database.

The activity reflects a growing, highly fragmented, industry and includes service and technology companies generating EBITDA margins of 20% to 30% in some cases, says Brian Greenberg, CEO at Greenberg Advisors.

"Regulatory and legislative changes including the Affordable Care Act and ICD-10 implementation [code sets used to report medical diagnoses and inpatient procedures] have also contributed to the type and volume of opportunities in the market," according to a statement from Greenberg Advisors. "Given all of these attributes, the RCM [Revenue Cycle Management] segment of the lower middle market is experiencing an M&A renaissance and has garnered the interest of many strategic buyers seeking expansion and financial buyers [seeking to join the market]."

Last month, Greenberg Advisors reported on overall Q1 M&A activity, including debt buyer Encore Capital's Cabot Credit Management making headlines after buying Marlin Financial Group from Duke Street Capital for $484 million. Encore Capital acquired Cabot Credit in 2013 for $177 million.

Greenberg Advisors works not only in the RCM space but also Accounts Receivable Management (ARM), Business Process Outsourcing (BPO) and Specialty Finance.

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