Revenue Cycle Management Industry Overview
The global revenue cycle management market size was valued at USD 243.1 billion in 2021 and is projected to expand at a compound annual growth rate (CAGR) of 11.6% from 2022 to 2030.
The rapidly growing era of digitalization of healthcare is driving the demand for advanced RCM solutions. The growing number of multiple data siloes and unorganized workflows in healthcare settings is paving a path for market development and growth. RCM is a combination of third-party payers, payment models, guidelines, and codes. A practice’s existence depends upon obtaining the right assets. As precise payment for medical services becomes increasingly complex, it increases the value of obtaining an efficient RCM solution.
Gather more insights about the market drivers, restrains and growth of the Global Revenue Cycle Management Market
According to the CAQH Index report in 2018, there was an increase of 18% between 2017 and 2018 in the overall size of healthcare businesses across the U.S. Physical transactions declined by 6%. Health systems are currently making headway in executing electronic processing for claims, coding, and reimbursements. Increasing healthcare expenditures are forcing industry participants-including providers and players-to adjust by accepting factors such as value-centric reimbursement structures, growth in risk sharing, and executing cost limits. These changes, along with other market dynamics, present considerable hurdles to health and hospital system revenue cycles.
Growing demand for workflow optimization in healthcare organizations coupled with innovative synchronized management software systems is expected to propel market growth. Increasing support from government bodies and federal agencies in form of favorable regulatory reforms is driving growth. The market for revenue cycle management is witnessing regular technological advancements and the industry is constantly evolving. Various healthcare providers and payers are rapidly adopting these innovative and upgraded RCM solutions. For instance, R1 RCM Inc launched R1 Professional in January 2020, an advanced RCM solution that is being widely used by large hospital-owned medical groups and other groups involved in independent practices.
R1 Professional revenue cycle management solution would enable healthcare facilities and other stakeholders to implement a standardized RCM strategy of reimbursement and operations model. Innovations and advancements in the RCM solutions have played a key role in improving provider-patient relations and include the implementation of ICD-10 for classifying, coding, and reporting data on disease diagnosis and treatment procedures, which directly helps healthcare systems enhance care delivery. Healthcare facilities are outsourcing revenue cycle management software solutions owing to the multiple advantages associated such as easy availability of trained and skilled professionals, compliance and adherence to required regulations, enhanced efficiency, and cost-effectiveness.
Due to the numerous benefits, available healthcare facilities are readily outsourcing RCM solutions and services. According to a Med USA article published in 2020, approximately two-thirds of healthcare organizations outsource their revenue cycle management solutions and services. The growing adoption rates are anticipated to propel market growth over the forthcoming years. One of the major challenges faced in adopting and implementing revenue cycle management software solutions is the lack of proper reimbursement regulations with respect to insurance and other formalities. The existing reimbursement policy gaps between public and private insurers are restraining the growth of the market for revenue cycle management.
According to a Healthcare Financial Management Association (HFMA) article, the average timeline of reimbursement of payment by public insurers such as Medicare was approximately 28 days whereas private insurers’ timeline was twice than that. The adoption and growth of RCM solutions is hindered due to such delays and discrepancies in reimbursement. However, to tackle these challenges government bodies are undertaking initiatives to improve management of reimbursement coverages through revenue cycle management solutions. In addition, several government organizations across the world are undertaking initiatives to facilitate health data exchange and improve efficiency of healthcare systems.
The ongoing Covid-19 pandemic had an unprecedented and unexpected impact on majority of the healthcare sectors and brought in significant transformations to the normal functioning of healthcare systems. Healthcare providers and healthcare payers struggled through several challenges impacting their revenue earnings and inpatient volume. Medical billing complexity and rising healthcare costs created a drastic rise in demand for outsourcing revenue cycle management solutions across the globe. The surge in demand for advanced and innovative RCM solutions drove key participants to developed value-added features such as payer connect, remote coding services, reporting, analytics, and audit and compliance to improve revenue generation and productivity.
Browse through Grand View Research's Healthcare IT Industry Research Reports.
- U.S. Revenue Cycle Management Market - The U.S. revenue cycle management market size was valued at USD 126.1 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 10.3% from 2022 to 2030. The rapidly transforming healthcare system and adoption of digitalization are paving a path for implementing healthcare IT services such as revenue cycle management (RCM) systems to organize and streamline workflows of healthcare organizations using synchronized management software solutions.
- Healthcare IT Market - The global healthcare IT market size was valued at USD 135.6 billion in 2021 and is projected to exhibit a CAGR of 29.3% in the forecast period. The growing trend of digitalization in healthcare, rising demand for preventive care solutions, the emergence of various entrepreneurship ventures, and growing partnerships & funding are propelling the market growth.
Revenue Cycle Management Market Segmentation
Grand View Research, Inc. has segmented the global revenue cycle management market on the basis of product, type, delivery, end-user, physician specialty, sourcing, function and region:
Revenue Cycle Management Product Type Outlook (Revenue, USD Million, 2016 - 2030)
- Software
- Services
Revenue Cycle Management Type Outlook (Revenue, USD Million, 2016 - 2030)
- Integrated
- Standalone
Revenue Cycle Management Delivery Mode Type Outlook (Revenue, USD Million, 2016 - 2030)
- On-Premises
- Web-Based
- Cloud-Based
Revenue Cycle Management End-Use Outlook (Revenue, USD Million, 2016 - 2030)
- Physician Back Offices
- Hospitals
- Diagnostic Laboratories
- Others
Revenue Cycle Management Physician Specialty Outlook (Revenue, USD Million, 2016 - 2030)
- Oncology
- Cardiology
- Anesthesia
- Radiology
- Pathology
- Pain Management
- Emergency Service
- Others
Revenue Cycle Management Sourcing Outlook (Revenue, USD Million, 2016 - 2030)
- In-house
- External RCM Apps/ Software
- Outsourced RCM Services
Revenue Cycle Management Function Outlook (Revenue, USD Million, 2016 - 2030)
- Product Development
- Member Engagement
- Network Management
- Care Management
- Claims Management
- Risk and Compliances
Revenue Cycle Management Regional Outlook (Revenue, USD Million, 2016 - 2030)
- North America
- Europe
- Asia Pacific
- South America
- Middle East & Africa
Market Share Insights
- January 2020: R1 RCM, Inc. entered into a strategic partnership with Rush University System for Health (RUSH) to achieve revenue cycle performance excellence and boost innovation in healthcare.
Key Companies profiled:
Some prominent players in the global revenue cycle management market include
- The SSI Group, Inc.
- AllScripts Healthcare, LLC
- Experian Health
- R1 RCM Inc
- McKesson Corporation
- athenahealth, Inc.
- Epic Systems Corporation
- NXGN Management, LLC
- CareCloud Corporation
- Quest Diagnostics, Inc.
- Cerner Corporation
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