Revenue Cycle Management (RCM) Market Analysis US - Size and Forecast 2024-2028

US Revenue Cycle Management Market Size 2024-2028 

The US revenue cycle management (RCM) market size is forecast to increase by USD 14.52 billion at a CAGR of 10.81% between 2023 and 2028. The market is experiencing significant growth due to the increasing need to minimize revenue leakages in healthcare systems. This trend is driven by the adoption of value-based reimbursement models, which require accurate and timely processing of insurance coverage details, patient registration, intake, charge capture, medical procedure coding, and diagnosis codes. Interoperability issues associated with RCM solutions pose a challenge, as healthcare providers seek seamless integration between various systems to ensure clean claims and efficient denial management. Prior authorization processes also add complexity to RCM, necessitating effective solutions to streamline and automate these workflows. Overall, the market is witnessing a shift towards advanced RCM solutions that address these challenges and improve operational efficiency and financial performance in healthcare organizations.

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The Revenue Cycle Management (RCM) market in the healthcare industry plays a crucial role in the financial operations of healthcare organizations. RCM involves managing the entire process of collecting patient payments and insurance reimbursements for medical services provided. This includes appointment scheduling, patient registration, intake, charge capture, and medical coding. Patients' account balances are updated based on their appointment attendance, account information, insurance coverage details, and medical procedure codes. Insurance payments are processed based on contractual adjustments, denial management, prior authorization, and clean claims. RCM also includes managing write-offs for uncollectible accounts and handling compliance issues, fraud, waste, and other revenue cycle challenges.

Furthermore, surgical procedures and ancillary services add complexity to the revenue cycle process, requiring accurate and timely documentation and coding to ensure proper reimbursement. The revenue cycle goal is to maximize revenue while minimizing costs and ensuring compliance with regulatory requirements. Effective RCM relies on efficient appointment scheduling, accurate patient name and contact information, and timely processing of insurance payments and contractual adjustments. The use of technology and automation can streamline RCM processes, reducing errors and improving cash flow for healthcare organizations.

Market Segmentation

The market research report provides comprehensive data, with forecasts and estimates in "USD Billion" for the period 2024-2028, as well as historical data from 2018-2022 for the following segments.

• Product
  • Software
  • Services
• End-user
  • Hospitals
  • Physicians
  • Medical labs

By Product Insights

The software segment is estimated to witness significant growth during the forecast period. The US revenue cycle management (RCM) market encompasses software solutions that automate and optimize various aspects of RCM processes for healthcare providers. One significant segment of this market is software solutions, which include Electronic Health Records (EHR) systems. These systems integrate patient medical records, clinical documentation, and billing information into a unified platform. EHRs facilitate efficient revenue cycle management through advanced features such as coding, claims processing, and billing. By centralizing patient information, EHRs enable healthcare organizations to manage patient payments, address claim denials, and maintain accurate contact information with ease, ensuring regulatory compliance and enhancing patient satisfaction during appointment scheduling and beyond.

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The software segment was valued at USD 8.63 million in 2018 and showed a gradual increase during the forecast period.

Our market researchers analyzed the data with 2023 as the base year, along with the key drivers, trends, and challenges. A holistic analysis of drivers will help companies refine their marketing strategies to gain a competitive advantage.

US Revenue Cycle Management (RCM) Market Driver

The growing need to reduce revenue leakages in healthcare systems is the key driver of the market. In the dynamic healthcare landscape, revenue cycle management (RCM) has emerged as a critical function for organizations to optimize financial operations and mitigate revenue leakages. Inefficiencies in internal processes and payment systems can result in significant revenue loss for healthcare service providers, impacting their competitiveness in the market. These leakages can stem from three primary sources: process leaks, payer leaks, and patient leaks. Process leaks occur due to the manual recording of transactions between healthcare providers and patients, leading to inaccuracies and delays. Manual systems are more time-consuming and resource-intensive compared to electronic systems, where charge capture and billing processes are automated.

Furthermore, the charge capture process, which involves tracking the services provided by healthcare organizations for reimbursement, can be prone to errors and delays when done manually. Moreover, payer leaks result from complex insurance contracts and claims processing, leading to underpayments or denied claims. Patient leaks occur when patients fail to pay their account balances or do not show up for appointments, resulting in uncollected revenue. Effective RCM strategies can help healthcare organizations minimize these leakages and improve their financial performance.

Revenue Cycle Management (RCM) Market in US Trends

The growing adoption of value-based reimbursement model is the upcoming trend in the market. Healthcare organizations are shifting their financial operations from traditional fee-for-service reimbursement models to value-based reimbursement models in medical services. Value-based Revenue Cycle Management (RCM) is a payment methodology that prioritizes quality healthcare at a reasonable cost over volume-based RCM. This approach ensures that healthcare providers are remunerated based on the quality of patient care delivered.

Furthermore, the advantages of value-based RCM are numerous, including improved patient care, reduced healthcare costs, increased customer satisfaction, and customer retention. The global adoption of value-based RCM models is on the rise due to the implementation of such programs and legislation by various governments. In this model, the focus is on managing patient appointments, account balances, insurance payments, contractual adjustments, and write-offs in a manner that maximizes revenue while ensuring compliance with regulatory requirements.

US Revenue Cycle Management (RCM) Market Challenge

Interoperability issues associated with RCM solutions is a key challenge affecting the market growth. The Revenue Cycle Management (RCM) market in the US is experiencing challenges due to interoperability issues in RCM software. Interoperability enables authorized healthcare professionals to access comprehensive patient information from different Electronic Health Records (EHR) systems, enhancing the efficiency of financial operations and medical services.

However, the increasing complexity of interoperability in RCM solutions has resulted in a rise in denials, leading to decreased revenue generation and operational inefficiency for healthcare organizations. The root cause of these interoperability issues is the use of disparate IT systems by healthcare providers, each processing information differently, thereby reducing their compatibility. This results in delayed or lost insurance payments, contractual adjustments, and write-offs, ultimately affecting the financial health of healthcare organizations. Addressing these interoperability challenges through standardized data exchange formats and protocols is crucial for the growth of the RCM market in the US.

Exclusive Customer Landscape

The market forecasting report includes the adoption lifecycle of the market, covering from the innovator's stage to the laggard's stage. It focuses on adoption rates in different regions based on penetration. Furthermore, the report also includes key purchase criteria and drivers of price sensitivity to help companies evaluate and develop their market growth analysis strategies.

 Customer Landscape

Key Companies & Market Insights

Companies are implementing various strategies, such as strategic alliances, partnerships, mergers and acquisitions, geographical expansion, and product/service launches, to enhance their presence in the market.

Acclara Solutions LLC: The company offers revenue cycle management solutions such as Patient Access, Revenue Integrity and Coding, Business Office, and Community Provider Solution.

The market research and growth report includes detailed analyses of the competitive landscape of the market and information about key companies, including:

• Acclara Solutions LLC
• athenahealth Inc.
• CareCloud Inc.
• Change Healthcare Inc.
• Cognizant Technology Solutions Corp.
• eClinicalWorks LLC
• Epic Systems Corp.
• Experian Plc
• International Business Machines Corp.
• Koch Industries Inc.
• McKesson Corp.
• Medical Information Technology Inc.
• Oncospark Inc.
• Oracle Corp.
• OSP
• Planet DDS
• R1 RCM Inc.
• Sage Group Plc
• The SSI Group LLC
• TruBridge, Inc.
• Veradigm LLC

Qualitative and quantitative analysis of companies has been conducted to help clients understand the wider business environment as well as the strengths and weaknesses of key market players. Data is qualitatively analyzed to categorize companies as pure play, category-focused, industry-focused, and diversified; it is quantitatively analyzed to categorize companies as dominant, leading, strong, tentative, and weak.

Research Analyst Overview

The market in the healthcare industry plays a crucial role in the financial operations of healthcare organizations. RCM involves managing patient accounts from appointment scheduling to insurance payments and collections. It includes patient registration, intake, charge capture, coding, and billing records. The process encompasses medical services such as surgical procedures, ancillary services, and diagnostic tests. RCM aims to ensure accurate and timely processing of patient accounts, minimizing claim denials, and maximizing revenue. It involves managing patient demographic data, insurance coverage details, and account balances. RCM also includes contractual adjustments, write-offs, and handling of patient payments.

Furthermore, RCM services providers help healthcare providers manage regulatory requirements, patient satisfaction, and compliance standards. They use technology such as RCM software, patient portals, and customer service to streamline processes and improve clean claim rates. RCM also includes fraud, waste, and abuse prevention, prior authorization, denial management, and coding. The ultimate goal is to optimize revenue while maintaining patient safety, quality of care, and documentation.

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What are the Key Data Covered in this Market Research Report?

• CAGR of the market during the forecast period
• Detailed information on factors that will drive the market growth and forecasting between 2024 and 2028
• Precise estimation of the size of the market  and its contribution of the market in focus to the parent market
• Accurate predictions about upcoming market growth and trends and changes in consumer behaviour
• Growth of the market across US
• Thorough analysis of the market's competitive landscape and detailed information about companies
• Comprehensive analysis of factors that will challenge the growth of market companies

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