The administration of financial transactions resulting from medical encounters between a patient and a provider, facility, and/or supplier is known as revenue cycle management (RCM). Billing, collections, payer contracting, provider enrollment, coding, data analytics, management, and compliance are examples of these transactions.

Market Dynamics

Technology and payment trends are reshaping the global revenue cycle management market

Pricing pressures and rising claims processing workloads will continue to plague industries. With limited funding to hire more people, the RCM team will be forced to rely more on technology to replace highly manual processes and to make better use of available data and analytics. The team's effectiveness and efficiency can be improved by leveraging digital tools and automating activities. In finance, for example, it is estimated that activities that currently consume approximately 43 percent of employees' time (e.g., mortgage application processing, financial data verification, and market trend analysis) could be automated. Furthermore, some of the more intriguing (and currently available) advances include software that can predict clinical codes based on clinical documentation, voice recognition software to reduce reliance on manual data entry, machine learning to automate bill scrubbing and modifier usage and software that can automate simple appeals with remittance data. Because capacity can be created more easily by leveraging digital tools and automating activities, many providers are turning to advanced analytics to improve decision making and resource management.

Process improvement, customer engagement, and measurement and analytics acts as strong pillars of the global revenue cycle management market

The establishment of shared service departments allows for the standardization of best-in-class processes for key revenue cycle functions. As a result of increased specialization and reduced handoffs and miscommunication, efficiency is increased. Furthermore, it boosts productivity while lowering costs, resulting in a more transparent and consistent patient experience. Implementing strategically balanced improvements across these domains can improve revenue cycle integration, resulting in improved service quality and financial performance. The revenue cycle function has the most interactions with patients – possibly more than any other function in a health care organization. Revenue cycle operations have a significant impact on patient experience and, as a result, customer engagement from the first time a patient calls to schedule an appointment to the time the patient's last bill is paid.

Favorable regulatory compliance bolsters the growth of global revenue cycle management market

The RCM is heavily influenced by government regulations. HIPAA, or the Healthcare Insurance Portability and Accountability Act, has some of this effect. One of the most complex and broad areas of government regulations relating to RCM is how it affects patient collections, specifically how medical debt can be collected. A number of these changes have been spearheaded by the Consumer Financial Protection Bureau (CFPB). Furthermore, the Healthcare Financial Management Association (HFMA) and the Association of Credit and Collection Professionals (ACA International) published a joint report on best practices for medical billing and found the following steps to be beneficial, all of which can be integrated into the RCM cycle to simplify patient billing and collections.

Market Segmentation

The global revenue cycle management market is segmented based on product, type, delivery mode, and end-user. By product, the market is bifurcated into software and services. By type, the market is classified as integrated and standalone. By delivery mode, the market is segmented as on-premise, web-based, and cloud based. Further, by end-user, the market is segmented as physician offices, hospitals, diagnostic laboratories, and others.

By product, the software segment is expected to dominate the revenue cycle management market. The increased amount of data in recent years as a result of digitalization of processes and streamlining for better patient care has resulted in the adoption of solutions, so healthcare analytical software solutions are gaining traction. Based on type, the integrated segment is expected to dominate the global revenue cycle management market. The growth can be attributed to a variety of changes, including a preference for volume-based payments over value-based payments, which is one of the major factors contributing to market growth. By delivery mode, the web-based segment is expected to dominate the global revenue cycle management market. The growing adoption of web-based solutions is expected to drive overall market growth in the coming years. The physician back-office segment will dominate the global revenue cycle management market in terms of end-user. The increasing focus on various healthcare infrastructure and organizations toward the implementation of these systems, as well as the growing number of physicians, drive the global revenue cycle management market.

Regional Overview

North America will continue to dominate the global revenue cycle management market in the coming years. The global revenue cycle management market is growing as a result of government initiatives to increase the adoption of RCM solutions and enhancements in healthcare organizations. Furthermore, rising demand for cloud-based RCM solutions, as well as increased consolidation among vendors offering end-to-end solutions, are propelling the global revenue cycle management market forward. Furthermore, it has been observed that there are lucrative opportunities for the revenue cycle management market in the provinces of North America. One of the major market drivers is the development of an IT framework for the healthcare industry. Because of favorable regulations, the presence of several large hospitals and health systems, the growing geriatric population, and the increasing need to reduce healthcare costs in the country, the United States represents lucrative opportunities in North America.

Europe, on the other hand, is the second largest RCM market. Government initiatives in this region for eHealth, as well as the need to improve overall efficiency in healthcare organizations, are propelling European market growth. Aside from that, the RCM markets in Asia and the Rest of the World are expanding. Factors such as increased government eHealth initiatives, rising medical tourism, and growing demand for quality healthcare are propelling the RCM market in these regions.

Competitive Landscape

The prominent players of the global revenue cycle management market are The SSI Group, Inc., Allscripts Healthcare, LLC, Experian Information Solutions, Inc., McKesson Corporation, Athenahealth, Epic Systems Corporation, NXGN Management, LLC., CareCloud Corporation, Quest Diagnostics, R1 RCM Inc., and among others 

Market Segmentation

Market By Product

Software
Services

Market By Type

Integrated
Standalone

Market By Delivery Mode

On-premise
Web-based
Cloud based

Market By End-use

Physician Offices
Hospitals
Diagnostic Laboratories
Others

Market By Geography

North America
•    U.S.
•    Canada

Europe
•    U.K.
•    Germany
•    France
•    Spain
•    Rest of Europe

Asia-Pacific
•    China
•    Japan
•    India
•    Australia
•    South Korea
•    Rest of Asia-Pacific

Latin America
•    Brazil 
•    Mexico
•    Rest of Latin America

Middle East & Africa
•    GCC
•    South Africa
•    Rest of Middle East & Africa