According to a recent report from Research and Markets, the mid-revenue cycle management/clinical documentation improvement market that was valued at USD 3.1 billion in 2018 is expected to reach USD 4.5 billion by 2023, growing at a CAGR of 7.9%. With the introduction of value-based reimbursement, it is reported that providers now increasingly use mid-revenue cycle management solutions mainly to reduce costs in the face of ever-increasing healthcare spending. Mid-revenue cycle management (RCM) includes all the processes done between patient access and the business office – clinical documentation, medical coding, charge capture, pre-bill reviews, and other claim preparation processes. Medical billing outsourcing services also include managing revenue cycle that helps streamline revenue flow for any medical specialty.

According to the report, the healthcare providers segment is expected to grow at the highest rate during the forecast period. Growth in these mid-RCM solutions market can be linked to the increased demand for these services from healthcare providers for improving data accuracy in clinical documentation, maximizing hospital revenues by minimizing coding errors and shortening the claims reimbursement cycle. Other key factors that support the growth in the demand for these solutions are

  • revenue losses due to medical billing and coding errors
  • declining reimbursement rates, and
  • the need to reduce the rising healthcare costs

However, IT infrastructural constraints in developing countries, a scarcity of skilled IT professionals, and the risks associated with HCIT solutions in terms of data security & privacy may restrain the growth of this market to a certain extent.

Other key highlights of this report:

  • The Solutions segment accounted for the largest share of the market. These revenue cycle solutions can eliminate the duplication of the administrative work of entering selected codes into each record and improve the overall mid-revenue cycle process by reducing the potential for data documentation, charge capture, and coding errors.
  • Geographically, APAC is expected to witness the highest growth during the forecast period. Factors that support the growth of the mid RCM solutions market in this region include the improving healthcare infrastructure and the rising healthcare insurance coverage and medical tourism.
  • Key players in this market are 3M Company (US), Optum (US), Nuance (US), M*Modal (US), nThrive (US), Dolbey Systems (US), Streamline Health (US), Vitalware (US), Chartwise (US), Craneware (US), Epic Systems (US), Cerner (US), eZDI Inc. (US), Iodine Software (US), Flash Code (US), and TruCode (US).

This market report also provides in-depth assessment of growth strategies and products of leading players in this mid-revenue cycle management and clinical documentation improvement market.

Medical coding errors in claims and documents are of great concern, as it can create major consequences for hospitals as well as patients. Coding errors is an ongoing challenge, especially in a fast-paced emergency department (ED). A recent case of such an error reported in WFTV9abc, is that of a Marion County woman, whose husband’s claims for 50 minutes at the ER for four tiny stitches for a minor injury turned into a $5,000 bill. The issue was that instead of billing using a level one emergency code, this patient’s record was billed for a level three emergency. After clarification, the $5,000 amount dropped to $800. Remember that accurate medical coding services impact any practices’ revenue cycle performance to a great extent. Consider the services provided by AAPC-certified and experienced coding professionals to avoid any such coding errors, or consider partnering with an HIPAA-compliant medical billing and coding company.

Read our blog on common medical coding errors.