Revenue cycle management or RCM for any medical specialty involves many services ranging from patient scheduling and patient registration, to insurance authorization and verification service, medical coding, claims submission, charge capture, and payment collections.
According to the latest report from Global Market Insights Inc., the healthcare revenue cycle management market (HRCM) size is anticipated to surpass USD 489 billion by 2032. Driven by cumulative healthcare spending, the market is predicted to grow at over 12.5% CAGR from 2023 to 2032.
Continuous technical advancements in HRCM solutions is a major factor that promotes this market growth. Other growth drivers include
- Novel developments in the field
- Increasing healthcare expenditure in developed as well as developing economies
- Growing demand for health insurance in North America
- High preference for big data analytics, and
- Progress in the healthcare industry
Factors that can restrain the market growth are –
- Frequent changes in healthcare regulatory compliance
- Lack of trained professionals
In addition, burgeoning healthcare expenditure in developed and emerging economies is forecast to augment product adoption. Healthcare costs have increased in developed countries such as the U.S. and Germany, due to the rising frequency of various chronic diseases and cost of treatment.
COVID-19 Impact
The COVID-19 pandemic has impacted the market growth due to low hospital outpatient elective care numbers, unpredictable claim volumes, and high healthcare costs per patient. However, the healthcare sector has gradually recovered due to an increase in government efforts to promote revenue cycle management solution adoption to prevent revenue losses.
Healthcare Revenue Cycle Management Market (HRCM) Segmentation
The market is segmented on the basis of Product, Function, Deployment, End-use, and Region.
By Product, the market is divided into Integrated and Standalone segments. The market from Standalone segment is poised to grow at a CAGR of 11.5% by 2032. Providers prefer standalone software, mainly because it offers more comprehensive reporting capabilities and advanced features. These systems can streamline the process flow with longer lifecycles and customizable features, which is foreseen to stimulate segment progress.
By Function, the market is segmented into Claims & Denial Management, Medical Coding & Billing, Eligibility Verification, and Payment Remittance. The Claims and Denial Management segment has accounted over USD 40 million in 2022. Surging awareness about reimbursement is predicted to boost this segment.
By Deployment, the market is divided into On-premise and Cloud-based. On-premise segment held over 24% share of the market in 2022. Ongoing technological advancements, better data control & accessibility are expected to spur this segment development during the forecast period. The Cloud-based segment is set to reach more than USD 378.5 billion by the end of 2032 as a result of prominent innovation in cloud-based solutions by key players operating in the market.
End users of this market are – Hospitals, Physician Offices, Diagnostic Labs & Ambulatory Surgical Centers. The demand for HRCM systems for revenue management in diagnostic laboratories and ambulatory surgical centers is set to remain high in the coming years, due to high prominence in disease detection and cost-effectiveness. The physician office segment is speculated to progress at over 14% CAGR between 2023 and 2032, due to the widespread utilization of billing and coding HRCM software for managing patient data.
Region wise, the market is divided into North America (U.S., Canada), Europe (Germany, UK, France, Spain, Italy, Russia), Asia Pacific (China, India, Japan, Australia, South Korea), Latin America (Brazil, Mexico, Argentina), Middle East and Africa (South Africa, Saudi Arabia, UAE). Owing to an increasing demand for smoother financial management across healthcare facilities in the region, Europe market valuation is slated to hit USD 130.5 billion by 2032.
Some of the key players profiled in the report are AGS Health Inc., Change Healthcare, Formativ Health, Dell Technologies, R1 RCM, Inc., Experian Information Solutions, Inc., Allscripts Healthcare, LLC, Athenahealth, Cerner Corporation, McKesson Corporation, CareCloud, Inc., Conifer Health Solutions, LLC., Change Healthcare, SSI group Formativ Health, Dell Technologies, Cognizant, Optum (The Advisory Board Company), and Medical Information Technology, Inc (Meditech).
It is important for practices to handle their RCM processes efficiently to improve the bottom line. Outsourcing complex RCM tasks to experienced medical billing companies could prove beneficial, as they provide expert support to get the correct reimbursement.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.