Revenue Cycle Management Market Analysis Report & Growth Outlook 2031

Coverage: Revenue Cycle Management Market covers analysis By Component (Solutions, Services), Deployment (On-Premise, Cloud), Organization Size (SMEs, Large Enterprises), Application (Claims & Denial Management, Medical Coding & Billing, Insurance, Others), End Use (Hospitals, Physician's Office, Others)

Publication Month : Apr 2024

  • Report Code : TIPRE00010467
  • Category : Healthcare IT
  • Status : Upcoming
  • No. of Pages : 150
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[Research Report] The revenue cycle management market is expected to grow from US$ 98.34 billion in 2022 to US$ 244.64 billion by 2030; it is estimated to grow at a CAGR of 12.1% from 2022 to 2030.

Analyst Perspective:

The rise in government initiatives to encourage the use of revenue cycle management solutions is one of the major factors fueling the growth of the revenue cycle management market. Also, the rise in revenue loss from billing errors and process enhancements in healthcare institutions is boosting the growth of the revenue cycle management market. Correct handling of medical claims is essential to healthcare providers' revenue streams. Healthcare facilities must continue to maintain a high-quality insurance billing and revenue cycle in order to improve their financial result. The majority of healthcare providers are losing money as a result of claim denials and their failure to submit or postpone the denied claim, which is putting increasing pressure on hospitals to cut expenses. This has created an opportunity for the market players to come up with advanced solutions for hospitals to cater to the above challenges of the revenue cycle. Furthermore, for the efficient management of the revenue cycle, various key players in the market are integrating artificial intelligence (AI) and machine learning (ML) technologies, which will further propel the growth of the revenue cycle management market.

Market Overview:

Healthcare facilities utilize revenue cycle management (RCM), a financial process that tracks patient care episodes from registration and appointment scheduling to the last payment of a balance, using medical billing software. To store and manage patient billing records, healthcare providers frequently invest in revenue cycle management systems. When a patient progresses through the treatment process, an efficient RCM system can connect with other health IT systems, such as electronic health records (EHR) and medical billing systems, to shorten the time between performing a service and getting paid. Healthcare companies can also save time by automating tasks that employees previously performed with the help of an RCM system. Administrative tasks include notifying patients of forthcoming appointments, reminding payers and patients of outstanding balances, and contacting insurers with specific inquiries if a claim is rejected. RCM systems can also help providers save money by providing them with information about the reasons behind refused claims. This gives providers better insight into why some claims have been refused, allowing them to address the matter and preventing them from having to resubmit the claim.

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Revenue Cycle Management Market: Strategic Insights

revenue-cycle-management-market
Market Size Value inUS$ 98.34 billion in 2022
Market Size Value byUS$ 244.64 billion by 2030
Growth rateCAGR of 12.1% from 2022 to 2030
Forecast Period2022-2030
Base Year2022
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Market Driver:

Integration of AI and ML Technologies is Creating an Opportunity for the Growth of the Revenue Cycle Management Market

AI and ML technologies continue to gain momentum and prove their potential in the development of revenue management systems. Many organizations still rely on manual error checks and reports for anomaly detection, making it difficult to identify the root cause, and becoming a time-consuming process. ML and AI help organizations proactively identify anomalous patterns in billing and revenue management solutions. Further, the model continuously improves over time due to regular updates, which results in accurate billing and automation of detecting anomalies. AI and ML can also accelerate root cause analysis, reducing investigation time and costs and providing faster resolution using revenue management systems. Therefore, the growing technological advancements in billing and revenue management are likely to fuel the revenue cycle management market growth during the forecast period.

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Segmental Analysis:

Based on components, the revenue cycle management market is segmented into solutions and services. The solutions segment held the largest share of the revenue cycle management market in 2022, whereas the service segment is estimated to register the highest CAGR in the revenue cycle management market during the forecast period. The RCM software is witnessing a rise in its adoption in the healthcare industry, particularly to avoid healthcare fraud and to decrease administrative costs. Furthermore, various key players in the market are continuously working on providing advanced solutions to improve revenue cycle management in hospitals, healthcare facilities, and others. Moreover, it is expected that due to the rise in the demand for cloud-based RCM and the increase in the demand for professional services, the service segment will grow with the highest CAGR in the revenue cycle management market.

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Regional Analysis:

The healthcare industry in North America is changing quickly, and digitalization is making it easier to install healthcare IT services like revenue cycle management (RCM) systems, which use synchronized management software solutions to organize and streamline activities in healthcare businesses. Also, the growing focus of the healthcare sector on enhancing patient care while also taking advantage of the financial benefits and effectiveness of these cutting-edge, innovative RCM solutions provided by various market players in the region is fueling the growth of the market. In addition, the healthcare sector in the US is expanding and changing quickly due to several factors, including rising healthcare costs, an increase in the number of reputable healthcare facilities, rising healthcare IT spending, improving healthcare IT infrastructure, and a growing emphasis on the patient-provider relationship. Per the U.S. Centers for Medicare & Medicaid Services, National Health Expenditure (NHE) grew 2.7% to US$ 4.3 trillion in 2021 (US$ 12,914 per person) and accounted for 18.3% of GDP. Also, medicare spending grew 8.4% to US$ 900.8 billion in 2021, or 21% of total NHE. Medicaid spending grew 9.2% to US$ 734.0 billion in 2021, or 17% of total NHE. With such a rise in healthcare spending in the US, medical service providers are facing complex challenges in billing and precise payment, further raising the need for more advanced RCM systems.

Furthermore, various market players in the region are continuously working on providing advanced solutions. For instance, in 2023, the Healthcare Financial Management Association (HFMA) announced a strategic alliance with FinThrive, Inc., a healthcare revenue cycle management software-as-a-service (SaaS) provider, to co-launch a peer-reviewed, five-stage Revenue Cycle Management Technology Adoption Model (RCMTAM) designed to help health systems leverage industry benchmarks to assess their current state of RCM technology maturity and build best-practice plans to optimize revenue cycle outcomes. Thus, all the above factors are fueling the revenue cycle management market growth in North America.

Key Player Analysis:

Athenahealth Inc., Experian Information Solutions Inc., GE Healthcare, McKesson Corporation, NXGN Management LLC, Optum Inc., Oracle Corporation, R1 RCM Inc., The SSI Group, and Veradigm LLC are among the key revenue cycle management market players. These revenue cycle management market players are focused on continuous product development and innovation.

Recent Developments:

 

Inorganic and organic strategies such as mergers and acquisitions are highly adopted by companies in the revenue cycle management market. A few recent revenue cycle management market developments are listed below: 

  • In October 2023, Omega Healthcare announced the launch of its Omega Digital Platform (ODP), designed to help healthcare organizations reduce administrative burdens while improving financial performance. The ODP leverages advanced proprietary technologies to streamline workflows and improve financial performance. It utilizes deep domain and technology expertise in robotic process automation (RPA), AI & ML, bots, and natural language processing (NLP), which enables solutions to drive greater efficiency and accuracy.
  • In June 2021, EXL, a leading operations management and analytics company, announced the launch of new Integrated Revenue Management Solutions from its EXL Health division. EXL Health has partnered with REVELOHEALTH, a provider of solutions dedicated to converting healthcare data into actionable information. EXL Health and REVELOHEALTH have combined their knowledge and expertise to provide new solutions that deliver a comprehensive, data-driven payment processing and revenue analytics capability. This new capability is structured to help providers optimize revenue cycle management, operating objectives, and compliance.
  • In June 2021, Vee Technologies, a leading consulting and professional services organization, announced the launch of the Sona Suite of products and its flagship RCM workflow tool, Sona PROMISE. The RCM solution was designed to enhance operational workflows and enable business intelligence capabilities and is capable of being a standalone tool for managing hospitals, specialty practices, medical clinics, ambulatory surgery centers, and others. The solution was designed to simplify business operations and offer elevated business analytics for increased revenue and growth potential.
  • In January 2020, R1 RCM Inc, a leading technology-enabled revenue cycle management (RCM) service provider for the healthcare sector, launched a new physician revenue cycle management solution, R1 Professional, for large independent practices and hospital-owned medical groups. The new solution is backed by a purpose-built technology platform, automation at scale, a digital patient financial experience aligned with consumer expectations, and proven performance improvement capabilities that empower financial visibility across large healthcare organizations.
Report Coverage
Report Coverage

Revenue forecast, Company Analysis, Industry landscape, Growth factors, and Trends

Segment Covered
Segment Covered

Component, Deployment, Organization Size, Application, End Use

Regional Scope
Regional Scope

North America, Europe, Asia Pacific, Middle East & Africa, South & Central America

Country Scope
Country Scope

This text is related
to country scope.

The List of Companies

1. Allscripts Healthcare Solutions, Inc.
2. Athenahealth, Inc.
3. Cerner Corporation
4. Eclinicalworks, LLC
5. Epic Systems Corporation
6. Experian PLC
7. GE Healthcare
8. Gebbs Healthcare Solutions
9. Mckesson Corporation
10. Quest Diagnostics Incorporated

The Insight Partners performs research in 4 major stages: Data Collection & Secondary Research, Primary Research, Data Analysis and Data Triangulation & Final Review.

  1. Data Collection and Secondary Research:

As a market research and consulting firm operating from a decade, we have published many reports and advised several clients across the globe. First step for any study will start with an assessment of currently available data and insights from existing reports. Further, historical and current market information is collected from Investor Presentations, Annual Reports, SEC Filings, etc., and other information related to company’s performance and market positioning are gathered from Paid Databases (Factiva, Hoovers, and Reuters) and various other publications available in public domain.

Several associations trade associates, technical forums, institutes, societies and organizations are accessed to gain technical as well as market related insights through their publications such as research papers, blogs and press releases related to the studies are referred to get cues about the market. Further, white papers, journals, magazines, and other news articles published in the last 3 years are scrutinized and analyzed to understand the current market trends.

  1. Primary Research:

The primarily interview analysis comprise of data obtained from industry participants interview and answers to survey questions gathered by in-house primary team.

For primary research, interviews are conducted with industry experts/CEOs/Marketing Managers/Sales Managers/VPs/Subject Matter Experts from both demand and supply side to get a 360-degree view of the market. The primary team conducts several interviews based on the complexity of the markets to understand the various market trends and dynamics which makes research more credible and precise.

A typical research interview fulfils the following functions:

  • Provides first-hand information on the market size, market trends, growth trends, competitive landscape, and outlook
  • Validates and strengthens in-house secondary research findings
  • Develops the analysis team’s expertise and market understanding

Primary research involves email interactions and telephone interviews for each market, category, segment, and sub-segment across geographies. The participants who typically take part in such a process include, but are not limited to:

  • Industry participants: VPs, business development managers, market intelligence managers and national sales managers
  • Outside experts: Valuation experts, research analysts and key opinion leaders specializing in the electronics and semiconductor industry.

Below is the breakup of our primary respondents by company, designation, and region:

Research Methodology

Once we receive the confirmation from primary research sources or primary respondents, we finalize the base year market estimation and forecast the data as per the macroeconomic and microeconomic factors assessed during data collection.

  1. Data Analysis:

Once data is validated through both secondary as well as primary respondents, we finalize the market estimations by hypothesis formulation and factor analysis at regional and country level.

  • 3.1 Macro-Economic Factor Analysis:

We analyse macroeconomic indicators such the gross domestic product (GDP), increase in the demand for goods and services across industries, technological advancement, regional economic growth, governmental policies, the influence of COVID-19, PEST analysis, and other aspects. This analysis aids in setting benchmarks for various nations/regions and approximating market splits. Additionally, the general trend of the aforementioned components aid in determining the market's development possibilities.

  • 3.2 Country Level Data:

Various factors that are especially aligned to the country are taken into account to determine the market size for a certain area and country, including the presence of vendors, such as headquarters and offices, the country's GDP, demand patterns, and industry growth. To comprehend the market dynamics for the nation, a number of growth variables, inhibitors, application areas, and current market trends are researched. The aforementioned elements aid in determining the country's overall market's growth potential.

  • 3.3 Company Profile:

The “Table of Contents” is formulated by listing and analyzing more than 25 - 30 companies operating in the market ecosystem across geographies. However, we profile only 10 companies as a standard practice in our syndicate reports. These 10 companies comprise leading, emerging, and regional players. Nonetheless, our analysis is not restricted to the 10 listed companies, we also analyze other companies present in the market to develop a holistic view and understand the prevailing trends. The “Company Profiles” section in the report covers key facts, business description, products & services, financial information, SWOT analysis, and key developments. The financial information presented is extracted from the annual reports and official documents of the publicly listed companies. Upon collecting the information for the sections of respective companies, we verify them via various primary sources and then compile the data in respective company profiles. The company level information helps us in deriving the base number as well as in forecasting the market size.

  • 3.4 Developing Base Number:

Aggregation of sales statistics (2020-2022) and macro-economic factor, and other secondary and primary research insights are utilized to arrive at base number and related market shares for 2022. The data gaps are identified in this step and relevant market data is analyzed, collected from paid primary interviews or databases. On finalizing the base year market size, forecasts are developed on the basis of macro-economic, industry and market growth factors and company level analysis.

  1. Data Triangulation and Final Review:

The market findings and base year market size calculations are validated from supply as well as demand side. Demand side validations are based on macro-economic factor analysis and benchmarks for respective regions and countries. In case of supply side validations, revenues of major companies are estimated (in case not available) based on industry benchmark, approximate number of employees, product portfolio, and primary interviews revenues are gathered. Further revenue from target product/service segment is assessed to avoid overshooting of market statistics. In case of heavy deviations between supply and demand side values, all thes steps are repeated to achieve synchronization.

We follow an iterative model, wherein we share our research findings with Subject Matter Experts (SME’s) and Key Opinion Leaders (KOLs) until consensus view of the market is not formulated – this model negates any drastic deviation in the opinions of experts. Only validated and universally acceptable research findings are quoted in our reports.

We have important check points that we use to validate our research findings – which we call – data triangulation, where we validate the information, we generate from secondary sources with primary interviews and then we re-validate with our internal data bases and Subject matter experts. This comprehensive model enables us to deliver high quality, reliable data in shortest possible time.

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