Assessment of the US Revenue Cycle Management Market, Forecast to 2024

The Next Generation RCM is Prioritizing Consumer Centricity

This study primarily strives to:

• Analyze the market forces affecting the utilization of next-generation Revenue Cycle Management (RCM) IT and service solutions among US hospitals and physician practices.
• Evaluate the latest regulatory objectives that mandate episodic financial risk management initiatives.
• Highlight the best practices in the areas of how RCM IT and service solutions are procured, deployed, and optimized.
• Assess the outlook of outsourced or shared service-based RCM operating models.
• Identify 5 major growth opportunities related to RCM.
• Estimate the revenue potential of the total US RCM market (software applications and services), and include breakdowns by hospitals and physician practices, from 2019 to 2024.
• Shortlist vendors that propose best in class RCM IT and service solutions for hospitals and physician practices.

Market Overview:

• CMS’ tough stand on the final rule of Quality Payment Program (QPP), that increased reporting requirements for Merit-based Incentive Payment System (MIPS) participants in 2020 and 2021, will establish the value-based payment program as the predominant revenue model for all payers and providers in the next few years. Hence, the focus on RCM IT and service solutions that enable financial risk and quality management at an enterprise level will be intensified. This will also lead larger health systems consolidating their overall spend on core RCM IT solutions to a fewer number of incumbent or prominent market participants.
• Patients’ direct contribution to total provider revenue is increasing rapidly, allowing payers and providers to invest on self-service tools that improve patients’ overall financial experience by helping them schedule appointments, verify benefit eligibility, estimate financial responsibility, and facilitate secured payment online, from anywhere.
• More patients are also deferring payment on their healthcare bills resulting in cash flow issues and solvency concerns for providers. Hence, back-end RCM processes continue to be important. RCM service providers that specialize on medical billing, bad debt collection and complex contract management (e.g., Worker’s Compensation Framework) will be working more closely with both payers (to provide input on sustainable premiums) and providers (to manage A/R).
• The RCM outsourcing market is likely to sustain its strong momentum; however, business models remain inconsistent and contingent on the strength of providers’ incumbent clinical documentation, coding, claims pre-authorization and denial management capabilities.
• The RCM vendor market is going to be expanded to niche and third-party RCM service providers that render IT automation consumer centricity, EMR interoperability, and RCM performance reporting functions.
• In the foreseeable future, progressive technologies (Natural Language Processing (NLP), voice assistants, Machine Learning (ML), chatbots) will become essential components of all advanced RCM portfolios that are used to reduce physician burden, improve coders’ productivity, reduce denials, and manage financial risk.