U.S. Medical Billing Outsourcing Market Size, Share & COVID-19 Impact Analysis, By Service (Front End, Middle End, and Back End), By End-user (Hospitals, Physician’s Office, and Others), and Country Forecast, 2023-2030

The U.S. medical billing outsourcing market size was worth USD 6.77 billion in 2022 and is projected to grow at a CAGR of 11.5% during the forecast period.

Medical billing outsourcing is the practice of delegating the task of processing and managing healthcare-related financial transactions, including billing, coding, and claims submission, to a third-party service provider. This allows the healthcare industry to focus on patient care while ensuring accurate and efficient handling of administrative and financial aspects of their practice.

The upsurge in patient admissions in healthcare settings, coupled with the increased cost of healthcare, has led to continuous advancements in healthcare-related financial transactions, propelling the growth of the market. 

For instance, according to the 2021 AHA Annual Survey, the total number of admissions in hospitals was 34,011,386 in the U.S. Such a large number of admissions is expected to increase the demand for medical billing.

In 2020, the world experienced an outbreak of COVID-19, which increased the number of patient visits to healthcare facilities for the diagnosis and treatment of COVID-19 and other emergency treatments. This resulted in the positive impact of the COVID-19 pandemic on the U.S. market in 2020.

U.S. Medical Billing Outsourcing Market Trends

Integration of Artificial Intelligence and Machine Learning in Medical Billing Outsourcing

The integration of cutting-edge technologies is transforming traditional billing processes into easier and more efficient processes for healthcare facilities, such as hospitals, clinics, and ambulatory surgical centers. The integration of artificial intelligence and machine learning is increasingly being employed to enhance accuracy, speed, and efficiency in coding, claims processing, and billing workflows.

Furthermore, the adoption of advanced software solutions reduces manual errors, increases patient experience with faster service, and streamlines complex billing procedures, ensuring compliance with evolving healthcare regulations, thereby increasing the demand for advanced software in the market.  

U.S. Medical Billing Outsourcing Market Growth Factors

Increasing Patient Burden to Boost Demand for Medical Billing Outsourcing

The increasing burden on healthcare providers to manage a growing volume of patient data, billing complexities, and regulatory requirements has led to a surge in demand for medical billing outsourcing practices in the country. The increased patient loads have boosted the focus of healthcare facilities to provide strategic solutions to handle billing processes, coding, and claims submission efficiently.

• For instance, in January 2020, according to a report published by The Commonwealth Fund, adults in the U.S. had the highest obesity burden - about 40.0% of the total population.

Such a high burden of diseases has increased the patient burden on healthcare facilities. Furthermore, benefits associated with outsourcing these billing practices include streamlined operations, reduced errors, reduced repetitive work and improved patient experience with faster service, which is expected to drive the demand for medical billing outsourcing services during the forecast period.

In the U.S., there was an increase in the number of Medicare-certified ambulatory surgical centers. The country witnessed a growth of 0.2% as compared to the previous year, 2021.

RESTRAINING FACTORS

Concerns Associated with Data Privacy and Breaches to Hinder Market Growth

Concerns associated with data privacy and breaches pose a significant challenge to the growth of the market. The healthcare facilities, such as ambulatory surgical centers, clinics, and hospitals, increasingly rely on external service providers for billing processes and the handling of sensitive patient information. However, data breaches or privacy concerns can affect patients and healthcare providers, leading to hampering the adoption of medical billing outsourcing solutions.

• For instance, in August 2022, Practice Resources (PRL), a healthcare billing company, suffered from data breach issues and exposed the data of more than 942,000 patients from 27 hospitals and physician's offices.

Such data privacy issues associated with these outsourcing services are restricting the U.S. medical billing outsourcing market growth.

U.S. Medical Billing Outsourcing Market Segmentation Analysis

By Service Analysis

Based on service, the market is segregated into front end, middle end, and back end.

The front end segment dominated the market in 2022. The segmental growth is due to the growing demand for verification of insurance eligibility, managing patient schedules, and pre-authorization among healthcare facilities.

The middle end segment is expected to have the highest growth rate during the forecast period. Market players focus on various strategies to expand middle-end services for easy and errorless medical billing, which is expected to increase segmental growth during the forecast period.

By End-user Analysis

Based on end-user, the market is segregated into hospitals, physician’s office, and others.

The hospitals segment held the largest share in 2022. The complexity of hospital billing processes, extensive regulatory requirements, and the need for specialized expertise in handling diverse and intricate healthcare reimbursement systems are expected to grow the demand for outsourcing billing services.

The others segment includes surgical centers, radiology centers, and pain management centers. It is anticipated to expand at a higher CAGR over the forecast period, owing to higher adoption of medical billing outsourcing services in healthcare facilities.

List of Key Companies in U.S. Medical Billing Outsourcing Market

In terms of the competitive landscape, the market records the presence of key industry players, such as R1 RCM Inc., CareCloud Inc., Veradigm LLC, and Experian Information Solutions Inc., which have a significant U.S. medical billing outsourcing market share. R1 RCM Inc. is one of the prominent companies in the market due to its strong presence in the country and the diversified portfolio of services it provides.

In the market, there are other key players with a considerable market share, including Billing Paradise, 3Gen Consulting, eClinicalWorks and other companies. These market players are continuously focusing on partnerships, collaborations, and expansion of their presence in the market. Additionally, the surge in the introduction of novel and advanced services in healthcare facilities, such as hospitals, ASCs, and clinics, is expected to boost their presence in the market.

LIST OF KEY COMPANIES PROFILED:

• CareCloud, Inc. (U.S.)


• R1 RCM, Inc. (U.S.)


• Experian Information Solutions, Inc. (U.S.)


• Veradigm LLC (U.S.)


• BillingParadise (U.S.)


• 3Gen Consulting (U.S.)


• eClinicalWorks (U.S.)

KEY INDUSTRY DEVELOPMENTS:

• December 2023: eAssist Dental Solutions, a provider of dental billing and patient billing services for dental offices, launched its new AI-powered software. This upgrade in its technology aids the company in solving its clients' dental insurance billing problems.


• July 2023: 3Gen Consulting, a provider of customized outsourcing solutions, streamlined the Revenue Cycle Management (RCM) of a Texas-based physician with the help of their medical billing process. Implementation of this innovative technology solution significantly improved physician's financial performance and operational efficiency.


• August 2022: RevCycle Partners was selected as Optometric Management Group’s (OMG) outsourcing partner for insurance billing. This outsourcing was aimed at building and creating efficiencies in their operations.

REPORT COVERAGE

The report provides a detailed analysis of the market. It focuses on key aspects, such as technological advancements in the market. Besides this, the report provides information related to key industry developments, such as mergers and acquisitions and regional expansions in the market. In addition, the impact of COVID-19 and the industry overview during the pandemic are covered in the report.

Report Scope & Segmentation