Key Market Overview:
Revenue Cycle Management Market size was worth USD 45.7 Billion in 2022, accounting for a CAGR of 9.7% during the forecast period (2023-2030), and the market is projected to be worth USD 98.2 Billion by 2030.
Revenue Cycle Management (RCM) is the process of managing financial transactions and related processes in healthcare organizations. RCM starts from the patient’s appointment scheduling to verifying their insurance, to collecting payments for services rendered, and eventually posting payments to the organization’s accounting system. The goal of RCM is to optimize revenue and streamline administrative functions, thus ensuring financial stability and success for the healthcare provider. RCM is crucial in maintaining financial health for healthcare providers. The revenue cycle management process ensures proper billing and coding practices are followed, claim denials are reduced, and collections are maximized. By utilizing RCM, healthcare providers minimize financial losses, reduce payment delays, and increase revenue.
For instance, more than 66% of healthcare facilities are using automation tools for their revenue cycle and more than 60% of the organizations collaborate with revenue cycle management providers to manage their procedures of medical billing. The increasing adoption of revenue cycle management in the healthcare industry is boosting the growth of the market.
The revenue cycle management (RCM) market has seen significant growth in recent years due to the following factors. The increasing demand for healthcare services, has led to a higher volume of patient visits and a greater need for efficient RCM processes. Healthcare providers are required to optimize revenue, reduce costs, and ensure financial stability, and RCM solutions help them achieve these goals by streamlining administrative functions and improving the accuracy and speed of billing and claims management. Another factor driving the growth of the RCM market is the widespread adoption of electronic health records (EHRs). EHRs have made it easier for healthcare providers to manage patient data, track claims, and automate billing processes. This has led to increased efficiency in RCM, as well as improved accuracy and faster reimbursement times. Providers who have implemented EHRs have seen significant improvements in their revenue cycle management processes, as well as overall cost savings.
The high implementation and maintenance costs associated with revenue cycle management solutions, particularly for small and medium-sized healthcare providers with limited financial resources is a significant restraining factors. Additionally, these solutions are complex and require substantial training to use effectively, hampering the adoption. Another important restraint is the requirement to manage sensitive patient data in RCM solutions, which leads to security and privacy concerns for healthcare providers. These concerns limit the market growth of revenue cycle management solutions, particularly for providers that prioritize data security and privacy. Therefore, the above-mentioned factors are restraining the market growth.
The implementation of artificial intelligence (AI) is becoming increasingly prevalent in the revenue cycle management (RCM) market, as providers seek to leverage technology to optimize financial performance and operational efficiency. AI is used in several aspects of the revenue cycle, including claims processing, denial management, and payment collections. One of the key benefits of using AI in revenue cycle management is the ability to automate many of the time-consuming and repetitive tasks associated with revenue cycle management. As a result, creating ample opportunities for the market.
For instance, in September 2022, AGS Health launched the AGS AI Platform, an innovative solution that integrates AI and automation with human-in-the-loop services to enhance revenue cycle performance for US healthcare providers.
Revenue Cycle Management Report Coverage:
|Report Attributes||Report Details|
|Market Size in 2030 (USD Billion)||98.2 Billion|
|By Product||Integrated and Standalone|
|By Component||Software (Web Based, Cloud Based, and On-Premise) and Services (Mid-Revenue Cycle Outsourcing Services and Back-End Revenue Cycle Outsourcing Services)|
|By Application||Medical Coding and Billing, Claims and Denial Management, Clinical Documentation Improvement (CDI) Electronic Health Record (EHR), Insurance, and Others|
|By End-use||Hospitals, Diagnostics Centres, Pharmacies, and Others|
|By Region||North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa|
|Key Players||Allscripts Healthcare, LLC, The SSI Group, LLC, Experian Information Solutions, Inc., McKesson Corporation, R1 RCM Inc., Epic Systems Corporation, NXGN Management, LLC, CareCloud Corporation (CareCloud), Quest Diagnostics Incorporated, Cerner Corporation (Oracle Corporation), and athenahealth, Inc.|
Based on the product, the revenue cycle management market is categorized into integrated and standalone. The integrated revenue cycle management segment holds the largest market share in the year 2022. This is due to their ability to provide end-to-end solutions that optimize the entire revenue cycle process. This offers a complete suite of services, including coding, billing, claims management, and patient engagement tools. However, the standalone segment is anticipated to witness the fastest CAGR over the forecast period. This is due to the increasing demand for specific revenue cycle management services, such as medical coding and billing, as well as the rising adoption of cloud-based RCM solutions. Standalone solutions are also becoming more attractive to smaller healthcare providers who do not require a complete suite of services but need to optimize specific areas of their revenue cycle process.
Based on components, the revenue cycle management market is bifurcated into software and services. The software segment holds the largest market share in the year 2022. This is due to the increasing demand for software solutions that automate and optimizes the revenue cycle process, including billing and claims management software, patient engagement tools, and analytics and reporting tools. This improves the efficiency of revenue cycle operations in healthcare organizations. However, the services segment is anticipated to witness the fastest CAGR over the forecast period. This is due to the increasing complexity of the revenue cycle process and the need for expert guidance and support in managing it.
Based on applications, the market is categorized into medical coding and billing, claims and denial management, clinical documentation improvement (CDI), electronic health records (EHR), insurance, and others. The medical coding and billing segment holds the largest market share in the year 2022. As a medical coding and billing are essential components of the revenue cycle management process. Medical coding is the process of translating healthcare procedures and diagnoses into codes that submit to insurance companies for reimbursement. Revenue cycle management software helps to automate the coding process and ensure accurate and timely billing. However, clinical documentation improvement (CDI) is projected to witness the fastest CAGR over the forecast period as accurate and complete clinical documentation is crucial for proper coding and billing. In addition to this, CDI software can help healthcare providers improve the accuracy and completeness of their clinical documentation, in turn, proliferating segment growth.
The end-user segment is classified into hospitals, diagnostics centers, pharmacies, and others. The hospital segment holds the largest market share in the year 2022 since hospitals have complex revenue cycle management processes and deal with a large volume of claims and payments. Revenue cycle management software helps hospitals to streamline their billing and payment processes, reduce claim denials, and improve revenue collection. However, the diagnostic centers are anticipated to witness the fastest CAGR over the forecast period as these centers typically perform a large number of diagnostic tests and procedures and rely on accurate and efficient billing and payment processes to ensure timely payment for their services.
Based on region, the revenue cycle management market is categorized into North America, Europe, Asia Pacific, Latin America, and the Middle East & Africa. North America holds the largest market share in the year 2022. This is due to the presence of renowned hospitals and well-established healthcare facilities, along with a rising need to minimize healthcare costs and favorable regulations. This presents lucrative growth for the market in the region. However, the Asia Pacific region is anticipated to witness the fastest CAGR over the forecast period. This is attributed to several factors, including favorable government initiatives and support, a growing demand to improve the quality of care delivery, increasing digital literacy, rising adoption of healthcare IT solutions, advancing healthcare infrastructure, and increased healthcare IT spending.
Revenue Cycle Management Market Competitive Landscape:
The market is highly competitive, with a large number of players operating at the global and regional levels. The players compete on various parameters such as price, quality, innovation, and customer service. They are constantly investing in research and development to improve their products and expand their market share. Mergers, acquisitions, and partnerships are also common strategies employed by companies to enhance their market position and expand their product portfolio. Key players in the market include-
- Allscripts Healthcare, LLC
- The SSI Group, LLC
- Experian Information Solutions, Inc.
- McKesson Corporation
- R1 RCM Inc.
- Epic Systems Corporation
- NXGN Management, LLC
- CareCloud Corporation (CareCloud)
- Quest Diagnostics Incorporated
- Cerner Corporation (Oracle Corporation)
- athenahealth, Inc
- In October 2021, R1RCM, Inc. and American Physician Partners signed a contract extension for R1’s revenue cycle management services partnership until 2031. The purpose of the partnership extension is to continue to expand and enhance revenue cycle management services specifically for emergency medicine. This partnership is intended to support the long-term growth and success of both organizations in the healthcare industry.
- In July 2020, athenahealth, Inc. made an announcement that it will rename Centricity Business to athenaIDX. The rebranding is part of the operational integration between Virence Health and athenahealth and is aimed at aligning the enterprise Revenue Cycle Management (RCM) solution with the company’s product portfolio. The rebranding also leverages the strength of the IDX and athenahealth brands. This strategic move is intended to enhance the company’s positioning in the market and reinforce its commitment to providing innovative and comprehensive RCM solutions to its clients.
- In June 2020, Cerner Corporation announced that it had sold its Revenue Cycle Management (RCM) outsourcing business, Cerner RevWorks, to R1 RCM Inc. The sale is anticipated to facilitate the integration of technology platforms between both companies and expand R1’s RCM capabilities. This strategic move will enable R1 RCM to enhance its market position in the healthcare industry by offering a broader range of RCM solutions to its clients. The acquisition is also expected to benefit Cerner Corporation by allowing the company to focus on its core business operations while providing its clients with access to R1 RCM’s advanced RCM technologies and services.
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