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Revenue Cycle Management (RCM) Market Size, Share & COVID-19 Impact Analysis, By Structure (In-house and Outsource), Type (Software and Service), Functions (Claims & Denial Management, Medical Coding & Billing, Clinical Documentation Improvement (CDI), Insurance, and Others), End User (Hospitals, Physicians Office, and Others) and Regional Forecast, 2020-2027

Region : Global | Format: PDF | Report ID: FBI100275

 

KEY MARKET INSIGHTS

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The global revenue cycle management (RCM) market size was valued at USD 96.27 billion in 2019 and is projected to reach USD 258.16 billion by 2027, exhibiting a CAGR of 13.0% during the forecast period.

COVID-19 Cover

This report covers COVID-19 impact analysis on Revenue Cycle Management Market

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Today’s healthcare systems are facing major challenges such as increasing complexity, rising treatment costs, and growing patient consumerism, among others. These market dynamics are posing enormous stress on large hospitals and clinics, thereby, driving them to transform into RCM operations. RCM is defined as a process that a hospital designs and implements to maximize both the patient revenue and speed of its collection. It is becoming extremely difficult for the RCM providers today to introduce efficient solutions into their systems. Hence, revenue cycle management is in a state of rapid transition promoted globally by the shift towards systematic revenue management


Rising Prevalence of Coronavirus to Pose a Serious Threat to Market


Despite the disruptions in the RCM market due to the novel coronavirus pandemic, healthcare providers will continue to incur expenses. The healthcare organizations are undergoing financial difficulties owing to the shift in patient volume and hindrance in the normal revenue cycle management process. There has been a rapid inflow of patients in the emergency departments of healthcare facilities, and many countries have witnessed a near-collapse of their healthcare systems, owing to the huge number of inpatients. Although the number of patients diagnosed with other disorders have decreased, there has been a % tremendous rise in the patient pool for COVID-19 infections. This has propelled the RCM staff to focus on claims management for the insured patients. Efforts in updating medical coding & billing and reimbursement policies will lead to higher adoption of RCM solutions by hospitals, physicians, and others. Due to the rise in patient inflow, hospitals are likely to adopt RCM services and software to ensure timely revenue collection. Therefore, the overall impact of covid-19 on this global market is expected to be for a short-term.


LATEST TRENDS


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AI Derived Approach to Surge RCM Potential


AI (Artificial Intelligence) has now been addressing the biggest pain points of the RCM industry. Incorporation of this technology is optimizing clinical outcomes and automating processes is leading to improved revenue generation and collection. According to the recent survey of the Healthcare Financial Management Association (HFMA) revealed that, 75% of the healthcare leaders are focusing on implementing AI strategy in RCM. Also, 43% of them are focusing on automating RCM functions to reduce cost. By automating data-driven task which initially required manual operation coupled with reduction in administrative waste can help in streamlining the RCM process efficiently. Moreover, according to Optum’s data, 97% of the RCM industrialist trust AI for administrative and clinical operations. Therefore, the aforementioned factors shows that AI successfully holds a promising position in improving the dearth points of RCM.


DRIVING FACTORS


Regulatory Mandates for Adoption of EHR/EMR to Assist Market Growth


Introduction of Electronic Health Records (EHRs) revolutionized the healthcare organizations in terms of collecting, analyzing, and reporting patient data.  However, according to the survey of HIMSS Analytics, 31% providers still have manual claims denial management process. Therefore, the adoption of EHR/EMR have been made mandatory by the IT industry owing to stringent regulations.


The healthcare providers have eventually forced RCM vendors to deploy revenue cycle management operations to their systems. RCM offers a wide range of IT products including automated patient collection systems, advanced predictive analytics, and business intelligence tools. Additionally, some healthcare providers deny adopting RCM solutions that do not integrate with EHR operations. Therefore, the demand for integrated RCM/EHR solutions is propelling the global market. According to the KLAS survey, 59% of the organizations opted for a RCM replacement as they preferred integrated RCM/EHR solution.


Shift towards Outsourcing Services to Tremendously Drive the Global Market


Revenue management of hospitals and clinics are managed by RCM software/solutions provided by vendors. Increasing number of patient admissions in hospitals and the complexity of RCM procedures are forcing the hospitals to outsource end-to-end operations to service providers. The outsource segment in the global market is expected to showcase a high CAGR during the projected period. This shift from in-house revenue cycle management to outsourcing is anticipated to tremendously drive the global market sales. Additionally, technological advancements are further expected to drive the demand for software/services 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 the cost and improving collection.


RESTRAINING FACTORS


Risks Associated with Healthcare IT Solutions to have Negative Impact


RCM systems are a unified solution to manage the financial aspects of healthcare organizations. In EHR-incorporated revenue cycle management systems, the RCM system processes the claims for payments while the EHR assist in managing the patient’s clinical data. However, various organizations such as small hospitals and physician’s office lack the required interface infrastructure for RCM owing to budget constraints. Such ambiguity pertaining to IT infrastructure due to budget limitations might confine the global RCM market growth. Hence, the aforementioned factors might restrict the market growth up to a limited extent.


SEGMENTATION


By Structure


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Increasing Adoption of RCM Solutions to Help In-house Segment Emerge Dominant


Based on structure, the market is segmented into in-house and outsource. The in-house segment holds a major Revenue Cycle Management Market share to the higher adoption of RCM solutions by the hospitals due to increasing number of patient admissions. According to the American Hospital Association (AHA) survey, more than 36 million admissions were recorded in 2019. Also, the developing hospital infrastructure and health insurance policies in the emerging nations is also propelling the increased demand for RCM solutions. For instance, America’s Health Insurance Plans (AHIP) implemented RCM solutions to lower patient out-of-pocket cost to streamline the financial encounter.


Outsource segment is anticipated to witness a faster growth because of the shifting trend of in-house to outsourcing RCM services in major countries such as the U.S, the U.K., India, etc. According to the McKinsey research on ‘Hospital Revenue Cycle Operations’, it is expected that RCM outsourcing will surge tremendously over the coming years such that around 40% of providers will consider end-to-end outsourcing.


By Type


Introduction of Technologically Advanced Software to Hold Highest Market Share


Based on type, the market is segmented into software and service. The software segment dominates the market owing to the launch of advanced solutions to help improve RCM management at hospitals, physician’s facilities, and others. Additionally, in the light of COVID-19 pandemic, several companies have received lower revenues which has encouraged them to consult financial advisors in order to have effective measures. For instance, in May 2020, Objective Capital Partners announced that it served as a financial advisor to RCM Technologies. The company advised RCM technologies to adopt shareholders right plan, which is intended to protect and control the RCM of the company. Furthermore, the service segment is anticipated to emerge as the fastest growing category during the forecast period. The increasing trend of the segment is attributable to the growing demand for RCM services such as outsourcing, medical coding and billing services, and others.


By Functions


Launch of Advanced RCM Solutions to help Claims & Denial Management Service Segment to Hold Major Shares


On the basis of functions, the market is segmented into claims & denial management, medical coding & billing, clinical documentation improvement, insurance, and others. Claims & denial management segment will hold the dominant position owing to the launch of advanced RCM solutions that combines all the functions in one system. Moreover, increased revenue due to effective claims management by adoption of solutions/services for claims and denial management is likely to contribute to the leading position. For instance, NTT Data Inc. has an advanced denial management platform that uses machine learning and intelligent automation to effectively perform the claims denial management process. Medical coding & billing segment holds the second position followed by the clinical documentation improvement segment. High growth rate of this segment is accountable to the increasing demand for medical coding and billing services owing to the complexities associated with financial management of the end users.


By End User


Consolidation of Hospitals with RCM Vendors to Drive Segmental Growth


Based on end user, the market is categorized into hospitals, physician office, and others. The hospital segment dominated the market in 2019 in terms of market value and share. The dominance of this segment is attributable to the rising patient admissions thus generating higher revenue of the hospitals. In order to effectively manage revenue collection process, hospitals are adopting RCM solutions, thereby contributing to the growth of the segment during the analysis period. Physician segment is likely to grow at a faster rate owing to gradual increase in the number of physician offices willing to adopt RCM solutions.


REGIONAL INSIGHTS


North America Revenue Cycle Management Market Size, 2019 (USD Billion)

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The market in North America stood at USD 52.01 billion in 2019. This region accounted for a 54.0% share in the global market owing to the presence of leading major players. This, coupled with the higher usage of RCM software/service in U.S. will help augment the growth opportunities of the regional market Moreover, the launch of innovative solutions and centers is also contributing to the growth of the market in the North American region. For example, in January 2020, a leading player R1 RCM launched R1 Professional platform with an aim to expand its geographical reach. Also, the company, in collaboration with Intermountain Healthcare, launched an innovation center to carry RCM technology innovations. The U.S accounted for the highest revenue in the North America RCM market. Growth in Canada is attributable to the technological advancements pertaining to the RCM solutions for better management of the healthcare, clinical, and financial system.


Europe accounted for the second position in terms of value in the global market. The provision of opportunities for start-ups to develop effective financial technology is propelling the adoption and launch of RCM in the region. For instance, Chelsea and Westminster Hospital NHS Foundation Trust have opened new doors for the start-ups to come up with innovative financial management solutions. This is likely to boost the European market in the coming years.


Asia Pacific is expected to emerge as the fastest growing region during the forecast period owing to increasing awareness among the hospitals about the advantages of RCM service, coupled with their rising adoption rate is responsible for the higher growth of the region. Furthermore, Latin America and the Middle East & Africa are likely to witness a considerably slower growth owing to gradual penetration of advanced RCM solutions.


KEY INDUSTRY PLAYERS


Product Innovation and Delivering End-to-end Service to Clients to help Players Gain Top Position


Cerner Corporation is the leading player in providing revenue cycle services and physician advisory services to healthcare providers. This company provides end-to-end revenue cycle management service that focuses on efficiency, production, and budget needs within an organization. It also looks into patient access, denial management, medical coding & billing, and patient pay/pre-collect. This technology-enabled efficient service helps healthcare organizations maintain and achieve their revenue goals. Other prominent players operating in the market are GeBBS Healthcare Solutions, Epic Systems Corporation, Allscripts Healthcare, LLC, Conifer Health Solutions, LLC, R1 RCM Inc., eClinicalWorks, GENERAL ELECTRIC, Athenahealth, McKesson Corporation and others.


LIST OF KEY PLAYERS PROFILED:



  • Allscripts Healthcare, LLC (Illinois, U.S.)

  • Cerner Corporation (Missouri, U.S.)

  • Conifer Health Solutions, LLC (Texas, U.S)

  • Epic Systems Corporation (Wisconsin, U.S)

  • GeBBS Healthcare Solutions (California, U.S)

  • McKesson Corporation (Texas, U.S)

  • Medical Information Technology Inc (MEDITECH) (Massachusetts, U.S)

  • MEDHOST (Tennessee, U.S)

  • eClinicalWorks (Massachusetts, U.S)

  • Others


KEY INDUSTRY DEVELOPMENTS:



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

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


REPORT COVERAGE


An Infographic Representation of Revenue Cycle Management Market

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The revenue cycle management market research report provides a detailed analysis and focuses on crucial aspects such as leading companies, application, disposable types, and distribution channels. Also, the report offers insights into market, current trends, and highlights the vital industry analysis and developments. In addition to the factors mentioned above, the report encompasses various factors that have contributed to the growth of the market over recent years.


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Report Scope & Segmentation














































 ATTTIBUTE



  DETAILS



Study Period



  2016-2027



Base Year



  2019



Forecast Period



  2020-2027



Historical Period



  2016-2018



Unit



  Value (USD billion)



Segmentation



By Structure



  • In-house

  • Outsource



By Type



  • Service

  • Software



By Functions



  • Claims & Denial Management

  • Medical Coding & Billing

  • Clinical Documentation Improvement (CDI)

  • Insurance

  • Others



By End User



  • Hospitals

  • Physician’s Office

  • Others



By Geography



  • North America (U.S. and Canada)

  • Europe (U.K., 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 Middle East & Africa)



Frequently Asked Questions

Fortune Business Insights says that the global Revenue Cycle Management market size was USD 96.27 billion in 2019 and is projected to reach USD 258.16 billion by 2027.

In 2019, the market value stood at USD 96.27 billion.

Growing at a CAGR of 13.0%, the market will exhibit a steady growth during the forecast period (2020-2027).

The software category is expected to be leading the type segment in this market during the forecast period.

The growing shift towards outsourcing services will drive the market growth.

Cerner Corporation, epic Systems Corporation, and MEDITECH are some of the leading players in the global market.

North America dominated the global market in 2019.

Increasing complexities in the revenue management process coupled with advanced healthcare IT solutions is expected to drive the adoption of software/services.

Revenue Cycle Management Market Size, Share and Global Industry Trend Forecast till 2026
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