Global Revenue Cycle Management Market - 2021-2028

Global Revenue Cycle Management Market - 2021-2028

Market Overview

The global revenue cycle management market size was worth US$ XX million in 2020 and is estimated to reach US$ XX million by 2028, growing at a CAGR of XX % during the forecast period (2021-2028).

A revenue cycle management refers to solutions that support various hospitals and medical facilities to increase their revenue by addressing billing mistakes and helping with efficient billing, documentation, and claim management.

Market Dynamics

The global revenue cycle management market growth is driven by the increase in government initiatives to boost the adoption of RCM solutions, increasing revenue loss due to billing errors, and process improvements in healthcare organizations.

Increasing revenue loss due to billing errors is expected to drive the growth in the forecast period

Most hospitals are now dependent on third-party providers for denial management service, as they lack the expert knowledge and the time to manage the reimbursement process. The most common billing errors include failure to verify insurance, filing an incomplete claim, coding errors, lack of specificity, and missing filing deadlines. Many care providers are now addressing the challenge by working with third-party medical billing professionals, who are experts in the overall revenue cycle management.

Most of the healthcare providers in the region are deploying revenue cycle management systems that help in reducing the time taken for receiving payment after providing a service. The RCM that automates many activities previously done manually saves time. The healthcare providers are benefited, as they get insights on claims denial and prompt to add required medical information for claims processing. The increasing stringent regulations, more complicated coding systems, and evolving value-based reimbursement and payment models are the factors that are driving the market for RCM systems. Increasing the adoption of revenue management tools to minimize medical errors also boosts the market growth. Thus, owing to the factors mentioned above, it can be concluded that specialty revenue cycle management service providers can prevent revenue loss to hospitals due to billing errors. Thus, this factor is expected to drive the market studied over the forecast period.

High deployment cost of revenue cycle management solutions and the associated infrastructure are likely to hinder the market growth

The cost associated with maintaining revenue cycle management software is considerably high. Furthermore, IT support and maintenance services, which include modifying and upgrading software as per changing user requirements and maintaining an efficient IT infrastructure, represent a recurring expenditure. This accounts for a large share of the total cost of ownership. Also, post-sale custom interface development for device integration requires additional verification and validation to ensure solution accuracy and completeness. This further increases the total cost of ownership for healthcare providers. As a result of the high costs involved, small healthcare facilities, especially in emerging countries, are reluctant to replace their legacy systems with RCM solutions.

COVID-19 Impact Analysis

A profound impact on the revenue cycle management market has been observed. During the COVID-19 outbreak, reduced inpatient and outpatient volumes for elective care and the higher cost of care for every COVID-19 patient resulted in declining revenue. Medicaid beneficiaries have increased, but the Centers for Medicare & Medicaid Services (CMS) reimbursed Medicaid services at rates less than those for medicare or commercial insurance. Furthermore, the Centers for Medicare & Medicaid Services (CMS) announced temporary payment parity for virtual care visits, but many commercial payers reimburse virtual care services at lower rates. Hence, the COVID-19 is expected to significantly impact the growth of the studied market during the pandemic.

Segment Analysis

The claims and denial management segment are expected to hold the largest share in this market segment

Claims and denial management involve the reviews of the denial procedure. Solution providers of denial and appeal management do the root cause analysis for the insurer who denied the claim. This includes the review of patient documentation and resubmission of the claim.

Hospitals and medical care facilities, which do not have an expert team, often depend on third-party solution providers. These companies, who have a good understanding and experience of insurers' provider guidelines, revert to insurers with explanations and requests for payment. Sometimes, the denials may be reversed by a telephone conversation with the insurer, followed by an appeal in written form, focusing on why the claim cannot be denied. With more healthcare facilities under intense scrutiny and a rise in healthcare claims, a large amount of hospital revenue declined. The US Justice Department has recovered more than USD 2.6 billion from lawsuits involving healthcare fraud and false claims in 2019 in the United States, higher from USD 2.5 billion in 2018 and USD 2.1 billion in 2017.

Moreover, in November 2020, BKD CPAs & Advisors launched a new service aimed at helping clients identify and prevent insurance denials. Preventable insurance claim denials can cost an organization 3% or more of its net revenue annually. The increasing acceptance of companies that provide claims denial and appeal services has become more important to hospital facilities, thereby contributing to the market's growth studied over the forecast period.

Geographical Analysis

North America region holds the largest market share of global revenue cycle management market

North American healthcare revenue cycle management market dominated the global market and is estimated to show a similar trend during the forecast period. This growth is due to significant changes in regulations that have largely affected the finances, organization, and delivery of healthcare services.

Most healthcare providers deploy revenue cycle management (RCM) systems that reduce the time taken to receive payment after providing a service in the region. The RCM that automates many activities previously done manually saves time, which is a major factor for the market's growth. Moreover, a huge amount of patient data generation and increasing healthcare burden may lead to errors in medical billing and other processes. For example, according to an article published in 2020 in the American Journal of Medicine, around 80% of the medical billings carried out in the country contained at least one error, thus, increasing the demand for revenue cycle management.

To increase market share, market players adopt various strategies, such as acquisitions, collaborations, partnerships, and expansions. For example, in June 2020, Cerner Corporation announced the sale of its RCM outsourcing business, Cerner RevWorks, to R1 RCM Inc. This is expected to help in the integration of technology platforms of both companies and extend R1's RCM capabilities. Thus, these above factors are expected to drive the studied market during the forecast period.

Competitive Landscape

The global revenue cycle management market is moderately competitive with presence of local as well as global companies. Some of the key players which are contributing to the growth of the market include Athenahealth, McKesson Corporation, Allscripts Healthcare Solutions, R1 RCM Inc, eClinicalWorks, Constellation Software, Epic Systems Corporation, GeBBs Healthcare Solutions, Inc, Conifer Health Solutions, LLC and Infosys. The major players are adopting several growth strategies such as product launches, acquisitions, and collaborations, which are contributing to the growth of the market. For instance, In July 2021, Revenue cycle management (RCM) vendor Waystar announced its plans to acquire Patientco, in the latest deal between an RCM vendor and a patient payment company. The RCM vendor intends for the combination to boost the patient financial experience by offering users consumer-friendly options for paying medical bills.

Global Revenue Cycle Management Market – Key Companies to Watch

McKesson Corporation

Overview: McKesson Corporation is an American company distributing pharmaceuticals and providing health information technology, medical supplies, and care management tools. It is founded in 1833 with 76000 employees.

Product Portfolio: It includes TotalView which helps by delivering financial performance and productivity reports that allow specialty practices to spot trends and take action.

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• Visualize the composition of the revenue cycle management market segmentation by technology, application, end-user and region highlighting the key commercial assets and players.
• Identify commercial opportunities in revenue cycle management market by analyzing trends and co-development deals.
• Excel data sheet with thousands of data points of revenue cycle management market - level 4/5 segmentation.
• PDF report with the most relevant analysis cogently put together after exhaustive qualitative interviews and in-depth market study.
• Product mapping in excel for the key product of all major market players.

The global revenue cycle management market report would provide an access to an approx. 40+ market data table, 45+ figures and 180 pages.

Target Audience
• Service Providers/ Buyers
• Industry Investors/Investment Bankers
• Education & Research Institutes
• Research Professionals
• Emerging Companies
• Manufacturers

Market Segmentation

Global Revenue Cycle Management Market – By Deployment
• Cloud-based
• On-premise

Global Revenue Cycle Management Market – By Function
• Claims and Denial Management
• Medical Coding and Billing
• Electronic Health Record (EHR)
• Clinical Documentation Improvement (CDI)
• Insurance
• Other Functions

Global Revenue Cycle Management Market – By End-User
• Hospitals
• Diagnostic Laboratories
• Other End-Users

Global Revenue Cycle Management Market - By Region
• North America
• Europe
• Asia-Pacific
• Middle East & Africa
• South America