According to the latest report from Crystal Market Research, the Healthcare Revenue Cycle Management Market that was worth USD 35.25 billion in 2014 is expected to reach approximately USD 89.66 billion by the year 2023. Revenue cycle management involves patient registration, insurance eligibility verification, medical coding, claims processing and payments & AR management. During insurance verification and pre-authorization, the physician’s office staff has to work with payers and determine any out-of-pocket costs for the patient. The process of RCM enables healthcare facilities to optimize revenues through claims processing. Primarily, there are four prominent elements of RCM – patients, healthcare provider, billing company, and insurance payers. According to a Dimensional Insight and HIMSS Analytics survey, almost 69% of healthcare organizations use more than one vendor solution for revenue cycle management.

Healthcare Revenue Cycle

Key factors that are expected to boost the development of this RCM market include increment in expenditure for healthcare, expanding complications in medical coding for reimbursement of bills, reduction in medical reimbursements by private and government bodies, and rising rate of claim rejections.

Other key findings of this report include:

  • Owing to the expanding switch in the healthcare industry from volume-based installment to value-based frameworks, the integrated healthcare RCM market estimate was estimated at over USD 34 billion, capturing more than 85% of income share in 2015.
  • Cloud-based RCM solution is the biggest market shareholder and because of expanding interest for enhanced consumer platforms at moderate expenses, it is expected to encounter significant development over the forecast period. Cloud-based arrangements are generally more affordable in comparison with on-premise systems, and enable organizations to avoid IT equipment and support IT staff costs.
  • With rapid updates in programming, this healthcare RCM service held over 63% industry share in 2015 and is predicted to grow at a considerable CAGR over the forecast period. Improvement of big data analytics along with healthcare IT has substantially affected the usage of electronic medical records and e-prescribing systems, among others.
  • End users of this market include physicians as well as medical billing companies. Reliable RCM solutions help physicians streamline billing procedures and enhance submission of claims and expand accumulations.
  • Region wise, owing to stringent administrative regulations and existence of leading industry players, the U.S. healthcare RCM market is set to grow tremendously over the forecast period.
    The leading players in this market are athena health, Experian, McKesson Corporation, Allscripts, Siemens Healthineers, Quest Diagnostics, CareCloud, GE Healthcare and Cerner.