Number of pages: 100 | Report Format: PDF | Published date: March 29, 2023
Historical Years – 2021 | Base Year – 2022 | Forecasted Years – 2023-2031
Report Attribute |
Details |
Market Size Value in 2022 |
US$ 118.45 billion |
Revenue Forecast in 2031 |
US$ 315.5 billion |
CAGR |
11.5% |
Base Year for Estimation |
2022 |
Forecast Period |
2023-2031 |
Historical Year |
2021 |
Segments Covered |
Product Type, Delivery Mode Type, Function, End User, and Region |
Regional Scope |
North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa |
According to the deep-dive market assessment study by Growth Plus Reports, the healthcare revenue cycle management market was valued at US$ 118.45 billion in 2022 and is expected to register a revenue CAGR of 11.5% to reach US$ 315.5 billion by 2031.
Healthcare Revenue Cycle Management Market Fundamentals
Healthcare revenue cycle management (RCM) refers to the process of managing the financial aspects of healthcare services provided to patients. It involves the steps healthcare providers take to ensure they receive payment for their services. The healthcare RCM process includes patient registration and insurance verification. This step involves collecting patient information, verifying insurance coverage, and obtaining prior authorizations. The charge capture step involves accurately documenting the services provided to patients and capturing charges for those services. The claims submission step involves submitting claims to insurance companies or other payers for payment. The payment posting step involves posting payments received from insurance companies or other payers and patient payments. The denial management step involves identifying and resolving denied claims, appealing denied claims, and correcting billing errors. The patient collections step involves collecting outstanding patient balances and managing payment plans. Effective healthcare RCM is critical for organizations to maintain financial stability and provide quality patient care. It helps providers improve revenue streams, reduce costs, and optimize operational efficiencies.
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Healthcare Revenue Cycle Management Market Dynamics
The global healthcare revenue cycle management market has been experiencing significant revenue growth in recent years, with several trends shaping the industry—the healthcare industry’s increasing adoption of RCM solutions to streamline and automate revenue cycle processes. The market is expected to register revenue growth at a significant CAGR as healthcare providers seek to improve their financial performance, reduce costs, and enhance the patient’s experience. Advanced technologies, such as artificial intelligence (AI), machine learning, and robotic process automation, are transforming the healthcare revenue cycle management market. These technologies enable healthcare providers to automate manual tasks, improve accuracy, and reduce administrative costs. The growing importance of data analytics is also driving global market revenue growth. Data analytics is becoming increasingly important in the healthcare industry, and this trend is expected to continue. RCM solutions providing actionable insights into revenue cycle performance, patient behavior, and payer trends are in high demand. Many healthcare providers are outsourcing their RCM processes to third-party service providers. Outsourcing enables healthcare providers to reduce costs, improve efficiency, and focus on core clinical activities. Emphasis on compliance and regulatory requirements is also one of the drivers for the global revenue cycle management market. With the increasing focus on compliance and regulatory requirements in the healthcare industry, RCM solutions are becoming more important to ensure compliance with HIPAA, HITECH, and other regulations. The global healthcare revenue cycle management market is experiencing consolidation as larger companies acquire smaller ones to expand their offerings and increase their market revenue share. This consolidation is expected to continue in the coming years. Therefore, the healthcare revenue cycle management market is expected to register notable revenue growth as healthcare providers seek to optimize their revenue cycle processes and improve their financial performance. The adoption of advanced technology, data analytics, and outsourcing will be key drivers of this market revenue growth.
However, the high pricing and maintenance of RCM solutions and the lack of proper IT infrastructure are projected to hinder the revenue growth of the global healthcare revenue cycle management market within the forecast period.
Healthcare Revenue Cycle Management Market Ecosystem
The global healthcare revenue cycle management market has been analyzed from five perspectives: product type, delivery mode type, function, end user, and region.
Healthcare Revenue Cycle Management Market by Product Type
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Based on product type, the global healthcare revenue cycle management market has been segmented into software and services.
The software segment accounts for the largest revenue share in the global healthcare revenue cycle management market. Due to growing data silos and the volume of data collected from numerous healthcare tasks, process digitalization and workflow streamlining are required for increased efficiencies and better patient care. Consolidation is necessary due to the increasing volume of disorganized data, driving up demand for RCM software solutions. Many data silos make it harder to evaluate data effectively and raise the possibility of data loss.
With the aid of an RCM software solution, a sizable amount of data can be managed, and the process for evaluating data and creating effective mitigation actions will be simple. The staff could then successfully decide on the course selection process and instantly document and review the performance. According to estimates based on Health Catalyst data, about 90% of healthcare businesses employ these IT solutions to boost quality and better RCM.
However, due to the development of cloud-based RCM and the rise in the demand for professional services, the services segment is projected to register revenue growth at the highest rate during the forecast period.
Healthcare Revenue Cycle Management Market by Delivery Mode Type
Based on delivery mode type, the global healthcare revenue cycle management market has been segmented into web-based and cloud-based.
The cloud-based segment is projected to register a high revenue CAGR during the forecast period. This is brought on by enhanced end-user cost-effectiveness and flexibility. Cloud-based technologies have made it simple and secure to share medical data. It facilitates the development and security of telehealth apps while automating backend procedures. Moreover, cloud-deployed solutions assist healthcare organizations in managing electronic health records (EHR), patient portals, big data analytics, and mobile applications while saving money on server maintenance. Products built on the cloud have been developed to reinforce operations, increase infrastructure dependability, and improve resource procurement.
Healthcare Revenue Cycle Management Market by Function
Based on function, the global healthcare revenue cycle management market has been segmented into electronic health records, claims and denial management, medical coding and billing, insurance, and others.
The claims and denial management segment is projected to register a high revenue CAGR in the forecast period. The denial procedure is reviewed as part of claims and denial management. Solution providers examine the core cause of the claim being denied by the insurer for denial and appeal management. This entails reviewing the patient’s records and resubmitting the claim.
Hospitals and other healthcare facilities commonly rely on outside solution suppliers because they lack a specialized team. These organizations respond to insurers with justifications and demands for payment since they are well-versed in and experienced with the insurer’s provider rules. Sometimes, the denials can be overturned through a phone chat with the insurer and a written appeal emphasizing why the claim cannot be rejected. Hospital facilities now place greater importance on organizations that offer claims denial and appeal services due to their growing popularity, which has helped the market under study grow throughout the forecast period.
Healthcare Revenue Cycle Management Market by End User
Based on end user, the global healthcare revenue cycle management market has been segmented into hospitals, physician’s offices, and others.
The hospitals segment is projected to register a high revenue CAGR during the forecast period. This is because regulatory authorities are introducing more regulations and recommendations related to patient safety. The adoption of RCM solutions in hospitals is being driven by the growing need to improve productivity and efficiency and streamline hospital procedures. Hospitals frequently employ an integrated RCM system, which unites patients and providers on a single platform. This technology allows for the upkeep of a comprehensive database of patient purchase history. It keeps clinicians, payers, and patients informed about the prescriptions billed to a patient.
Healthcare Revenue Cycle Management Market by Region
Based on region, the global healthcare revenue cycle management market has been segmented into North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa.
North America accounts for the largest revenue share in the global healthcare revenue cycle management market. Due to the increasing number of physician’s offices in the United States, the market has a sizable revenue share in the country. Healthcare systems underwent a digital revolution due to regulatory reforms, such as the ICD-10 revisions in 2015, and there has been a considerable increase in demand for healthcare IT solutions, such as RCM systems, to boost productivity and improve service delivery. Additionally, the region’s market is presented with significant revenue growth opportunities due to the presence of sizable famous hospitals and well-established healthcare facilities, the rise in the desire to reduce healthcare expenses, and favorable laws.
Europe accounts for the second-largest revenue share in the healthcare revenue cycle management market. The introduction and adoption of the service in the region are being accelerated by the provision of growth chances for start-ups to create efficient financial technology. For instance, the Chelsea and Westminster Hospital NHS Foundation Trust offered new opportunities for startups to create innovative financial management solutions. In the upcoming years, this factor is probably going to help the Europe market.
During the forecast period, Asia Pacific is projected to register a high revenue CAGR in the healthcare revenue cycle management market. This is due to an increase in positive government initiatives and support, an increase in the demand for higher-quality healthcare delivery, a rise in digital literacy, an increase in the adoption of healthcare IT solutions, improvements in the healthcare infrastructure, an increase in healthcare IT spending, and the unmet healthcare needs of emerging economies. Also, Asia Pacific provides cost-effective manufacturing rates and a readily available workforce, making it a convenient location for businesses.
Healthcare Revenue Cycle Management Market Competitive Landscape
The prominent players operating in the global healthcare revenue cycle management market are:
Healthcare Revenue Cycle Management Market Strategic Developments
The healthcare revenue cycle management market is expected to register growth at a revenue CAGR of 11.5% during the forecast period.
McKesson Corporation, Athenahealth, Inc., AllScripts Healthcare, LLC, Experian Health, and Formativ Health are among the key players in the healthcare revenue cycle management market.
The claims and denial management segment accounts for the largest revenue share in the global healthcare revenue cycle management market.
Asia Pacific is expected to register the highest revenue growth in the healthcare revenue cycle management market during the forecast period.
The inflated cost of RCM solutions is one of the key challenges for the global healthcare revenue cycle management market.
*Insights on financial performance are subject to the availability of information in the public domain