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Revenue Cycle Management Market Size, Share and Industry Analysis By Structure (In-house Outsource) By Function (Claims & Denial Management, Medical Coding & Billing, Clinical Documentation Improvement (CDI), Insurance, Others) By Type (Software, Services) and Regional Forecast, 2019 - 2026

Region : Global | Published Date: Oct, 2019 | Report ID: FBI100275| Status : Published

 

KEY INDUSTRY INSIGHTS

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The global revenue cycle management market size was valued at USD 86,811.4 Million in 2018 and is projected to reach USD 216,990.6 Million by 2026, exhibiting a CAGR of 12.4% in the forecast period (2019-2026)


Today’s health systems are facing drastic challenges such as increasing complexity, rising treatment costs, and growing patient consumerism, among others. These market dynamics are placing enormous stress on large hospitals and clinics, driving them to transform into revenue cycle management (RCM) operations. Revenue cycle management is defined as a process that hospital designs and implements to maximize both - the amount of patient revenue and speed of patient revenue collection. It is becoming extremely difficult for the RCM providers today to introduce efficiencies into their systems. Hence, Revenue cycle management is in a state of rapid transition globally promoted by a shift towards minimizing complexity, need for systematic revenue management and increasing patient pool.


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"Shift towards revenue cycle management outsourcing, to tremendously drive the global market growth"


Revenue cycle management by hospitals and clinics are managed by revenue cycle management software solutions provided by revenue cycle management (RCM) software providers. Increasing patient admissions in the hospitals and the complexity of revenue cycle management procedures are forcing the hospitals to outsource the revenue cycle management process.


The outsource segment in the global revenue cycle management is expected to witness a higher CAGR during the forecast period. This shift from in-house revenue cycle management to outsourcing is anticipated to tremendously drive the RCM market growth. Additionally, developing market expansion, technological advances and rising labor costs are further expected to drive the demand for revenue cycle management during the forecast period. Due to cost and man-power constraints, healthcare providers are now outsourcing RCM. Offshoring RCM can bring in significant value to a provider by reducing cost and improving collection.


Market Segmentation


Based on the structure, the revenue cycle management market segments include in-house and outsource. The in-house segment dominated the global RCM market in 2018. The outsourcing segment is anticipated to witness a higher CAGR owing to the shift of hospitals from in-house RCM to outsource RCM. Based on function, the global market segments include claims & denial management, medical coding & billing, clinical documentation improvement (CDI), insurance and others.


Claims and denial management dominated the global market in 2018 and is expected to dominate throughout the forecast period (2019-2026). Based on type, the market segments include software and services. The services segment is set to witness a higher CAGR owing to adoption and need of RCM services for systematic management of the revenue generated by the hospitals and healthcare organizations.


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Regional Analysis


"The increasing patient population in Asia Pacific, to fuel the revenue cycle management market growth"


Presence of major players, the trend of outsourcing, and higher insurance coverage is anticipated to contribute to the higher market potential of North America. Currently, North America dominates the market in terms of revenue and is expected to dominate during the forecast period. The market in Europe accounts for a significant growth owing to the adoption of revenue cycle management, rising outsourcing trend and increasing services of revenue cycle management provided by the companies.


North America Revenue Cycle Management (RCM) Market Size, 2018

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Moreover, Asia Pacific is expected to register a significantly higher CAGR during the forecast period owing to the increasing patient population, higher penetration of revenue cycle management in the regions and rising revenue cycle management service start-ups. Countries such as China and India registered a higher CAGR owing to huge market potential and improved adoption of RCM services and software. The regions of Latin America and Middle East & Africa are also anticipated to reach significant revenue by 2026, owing to penetration of revenue cycle management players and emergence of software & services companies in the regions.


Key Market Players


"R R1 RCM Inc. to Lead the Global Market Backed by the Production of Technologically Advanced Service"


R1 RCM Inc. is the leading player among others in providing revenue cycle services and physician advisory services to healthcare providers. R1 RCM provides end-to-end revenue cycle management service that focuses on efficiency, production, and budget needs within an organization.


The R1 RCM looks into patient access, denial management, medical coding & billing, and patient pay/pre-collect. This technology-enabled efficient service helps the healthcare organizations to maintain and achieve their revenue goals. Other prominent players operating in the market are GeBBS Healthcare Solutions, Cerner, Allscripts Healthcare, LLC, Conifer Health Solutions, LLC., Epic Systems Corporation, eClinicalWorks, GENERAL ELECTRIC, athenahealth, Inc., McKesson Corporation and others.


List of Companies Profiled



  • R1 RCM Inc.

  • GeBBS Healthcare Solutions

  • Cerner

  • Allscripts Healthcare, LLC

  • Conifer Health Solutions, LLC.

  • Epic Systems Corporation

  • eClinicalWorks

  • GENERAL ELECTRIC

  • athenahealth, Inc.

  • McKesson Corporation

  • Others


Report Coverage 


Revenue cycle management has become the utmost need of the hour for healthcare organizations to effectively manage the return of investment through treatment delivery. Revenue cycle management offers advanced software and technologically developed services to healthcare organizations. The complexity of the process has forced the hospitals to outsource the revenue cycle management process. This, in turn, is expected to drive the revenue cycle management industry in the forecast period owing to adoption of the process and development of software.


The report provides qualitative and quantitative insights on the revenue cycle management industry trends and detailed analysis of market size and growth rate for all possible segments in the market. The market segment includes structure, function, type, and geography. Based on structure, the revenue cycle management market segments include in-house and outsource.


In terms of function, the global market segments include claims & denial management, medical coding & billing, clinical documentation improvement (CDI), insurance and others. Based on type, the global revenue cycle management market segments include software and services. Geographically, the market is segmented into five major regions, which are North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa. The regions are further categorized into countries.


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Along with this, the report analysis includes the revenue cycle management market dynamics and competitive landscape. Various key insights provided in the report are the statistical overview of hospital admissions - For key countries, 2018, Key start-ups with their funding overview, new product launch, technological advancements, regulatory scenario for key countries, recent industry developments such as mergers & acquisitions, and others.


Segmentation


























 Attributes


 Details

 By Structure




  • In-house

  • Outsource



 By Function




  • Claims & Denial Management

  • Medical Coding & Billing

  • Clinical Documentation Improvement (CDI)

  • Insurance

  • Others



 By Type




  • Software

  • Services



 By Geography




  • North America (the USA and Canada)

  • Europe (UK, Germany, France, Italy, Spain, Scandinavia, and Rest of Europe)

  • Asia Pacific (Japan, China, India, Australia, Southeast Asia, and Rest of Asia Pacific)

  • Latin America (Brazil, Mexico and Rest of Latin America)

  • Middle East & Africa (South Africa, GCC and Rest of the Middle East & Africa)



 


Key Industry Developments



  • In June 2019, Homecare Homebase, LLC. announced the launch of revenue cycle management (RCM) service to eliminate the burden associated with revenue generation.

  • In March 2019, Apprio, Inc. launched revenue cycle management division APPRIOHEALTH. The business will deliver services and advanced technology solutions for healthcare organizations revenue cycle management (RCM) needs.

  • In February 2018, eClinicalWorks launched cloud-based platform for revenue cycle management (RCM).


Frequently Asked Questions

Fortune Business Insights says that revenue cycle management is projected to reach USD 216,990.6 Million by 2026.

In 2018, the RCM market was valued at USD 86,811.4 Million.

Revenue cycle management market is projected to grow rapidly at a CAGR of 12.4% during the forecast period.

In-house product segment is leading the global revenue cycle management market

An increasing shift towards revenue cycle management outsourcing is expected to drive the global RCM market.

R1 RCM Inc., GeBBS Healthcare Solutions, and Cerner are the top players in the revenue cycle management market.

North America is expected to hold the highest market share in the market.

The trends observed in the revenue cycle management market are shift towards value-based care, use of artificial intelligence in medical billing, and emergence of revenue cycle management outsourcing.

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