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Revenue Cycle Management Market - Growth, Trends, COVID-19 Impact, and Forecasts (2023-2028)

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  • 110 Pages
  • April 2023
  • Region: Global
  • Mordor Intelligence
  • ID: 4622507
The revenue cycle management market was valued at USD 9,196.63 million in the base year and is poised to grow at a CAGR of 12.26% over the forecast period.

A profound impact on the revenue cycle management market was observed. During the COVID-19 pandemic, reduced inpatient and outpatient volumes for elective care and the higher cost of care for every COVID-19 patient resulted in declining revenue. Healthcare providers and healthcare payers struggled through several challenges impacting their revenue earnings and inpatient volume. Medical billing complexity and rising healthcare costs created a drastic rise in demand for outsourcing revenue cycle management solutions across the globe. Moreover, the Centers for Medicare & Medicaid Services (CMS) announced temporary payment parity for virtual care visits, but many commercial payers reimbursed virtual care services at lower rates. Thus, COVID-19 is expected to have a significant impact on the growth of the studied market during the pandemic. However, uplifting the lockdown, stabilizing cases of COVID-19 in 2021, and introducing of advanced software to manage revenue is expected to bring the market growth to the pre-pandemic level.

The growth of the RCM market is attributed to the increase in government initiatives to boost the adoption of RCM solutions, increasing revenue loss due to billing errors, and process improvements in healthcare organizations.

Revenue for healthcare providers depends on the accurate processing of medical claims. For improving the financial outcome, a healthcare organization needs to maintain a quality revenue cycle and insurance billing. The revenue cycle management team comprises accounts receivable (A/R) management and denial management. With mounting pressure on hospitals to reduce costs, most care providers are losing revenue due to claim denials and their failure to submit or delay the denied claim. This has allowed specialty firms that provide revenue cycle management services.

The most common billing errors include failure to verify insurance, filing an incomplete claim, coding errors, lack of specificity, and missing filing deadlines. Many of the care providers are now addressing the challenge by working with third-party medical billing professionals, who are experts in overall revenue cycle management.

Moreover, in July 2021, Revenue cycle management (RCM) vendor Waystar announced its plans to acquire Patientco, in the latest deal between an RCM vendor and a patient payment company. The RCM vendor intends for the combination to boost the patient's financial experience by offering users consumer-friendly options for paying medical bills. Similarly, in July 2020, athenahealth, Inc. announced that Centricity Business will be renamed athenaIDX. Through the operational integration between Virence Health and athenahealth, this rebrand aligns the enterprise Revenue Cycle Management (RCM) solution with the company’s product portfolio and leverages the strength of the IDX and athenahealth brands.

RCM systems are becoming increasingly popular as the healthcare industry is moving toward digitization. A lot of government initiatives, such as encouraging physicians to adopt electronic health records, investing in training healthcare information technology workers, and establishing regional extension centers to provide technical and other advice, are triggering the RCM market’s growth. For instance, in March 2021, the European Commission adopted a recommendation for a European electronic health record exchange format to unlock the flow of health data across borders. This policy helps European citizens to securely access and exchange their health data wherever they are in Europe.

Thus, owing to the factors mentioned above, it can be concluded that the revenue loss to hospitals due to billing errors can be prevented by specialty revenue cycle management service providers. However, high pricing and maintenance of RCM solutions, and lack of roper IT infrastructure is expected to hinder the growth of the market over the forecast period.

Revenue Cycle Management Market Trends

Claims and Denial Management Segment is Expected to Grow Fastest Over the Forecast Period

Claims and denial management involve the reviews of the denial procedure. Solution providers of denial and appeal management do the root cause analysis for the claim being denied by the insurer. This involves the review of patient documentation and resubmission of the claim.

Hospitals and medical care facilities, which do not have an expert team, often depend on third-party solution providers. These companies, who have a good understanding and experience of insurer’s provider guidelines, revert to insurers with explanations and requests for payment. Sometimes, the denials may be reversed by a telephone conversation with the insurer, followed by an appeal in written form, with a focus on why the claim cannot be denied.

With more healthcare facilities, under intense scrutiny and a rise in the number of healthcare claims, a large amount of hospital revenue is being declined. As per the US Justice Department, data updated in January 2021, of the more than USD 2.2 billion in settlements and judgments recovered by the Department of Justice this past fiscal year, over USD 1.8 billion relates to matters that involved the healthcare industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. The amounts included in the USD 1.8 billion reflect only federal losses, and, in many of these cases, the department was instrumental in recovering additional tens of millions of dollars for state Medicaid programs.

Furthermore, In November 2020, BKD CPAs & Advisors launched a new service aimed at helping clients identify and prevent insurance denials in the United States. Preventable insurance claim denials can cost an organization 3% or more of its net revenue, annually. With the increasing acceptance of companies that provide claims denial and appeal services, they have become more important to hospital facilities, thereby, contributing to the growth of the market studied over the forecast period.

North America holds the Largest Market Share of the Revenue Cycle Management Market Currently and is Believed to Follow the Same Trend over the Forecast Period

The North American healthcare revenue cycle management market dominated the global market and is estimated to show a similar trend during the forecast period. This growth is due to factors like significant changes in regulations that have largely affected the finances, organization, and delivery of healthcare services.

Most healthcare providers are deploying revenue cycle management (RCM) systems that reduce the time taken for receiving payment after providing a service in the region. The RCM that automates many activities previously done manually is saving time, which is a major factor in the growth of the market. Furthermore, a large amount of patient data generation and increasing healthcare burden may lead to errors in medical billing and other processes. For instance, according to an article published in 2020 in the American Journal of Medicine, around 80% of the medical billings carried out in the country contained at least one error, thus, increasing the demand for revenue cycle management.

The market players adopt various strategies, such as acquisitions, collaborations, partnerships, and expansions, to increase market share. For instance, in September 2022, AGS Health, announced the launch of the AGS AI Platform, a connected solution that blends artificial intelligence (AI) and automation with award-winning human-in-the-loop services and expert support to maximize revenue cycle performance in the US. Moreover, in June 2020, Cerner Corporation announced the sale of its RCM outsourcing business, Cerner RevWorks, to R1 RCM Inc. This is expected to help in the integration of technology platforms of both companies and extend R1’s RCM capabilities. Thus, these factors mentioned above are expected to drive the studied market during the forecast period.

Revenue Cycle Management Market Competitor Analysis

The revenue cycle management market is moderately competitive and consists of several major players, including Allscripts Healthcare Solutions, Inc., Athenahealth, Cerner Corporation, etc. The companies are implementing certain strategic initiatives, such as mergers, new product launches, acquisitions, and partnerships that help them in strengthening their market position.

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Table of Contents

1.1 Study Assumptions and Market Definition
1.2 Scope of the Study
4.1 Market Overview
4.2 Market Drivers
4.2.1 Government Initiatives to Boost the Adoption of RCM Solutions
4.2.2 Increasing Revenue Loss Due to Billing Errors
4.2.3 Process Improvements in Healthcare Organizations
4.3 Market Restraints
4.3.1 High Pricing and Maintenance of RCM Solutions
4.3.2 Lack of Proper IT Infrastructure
4.4 Porter's Five Forces Analysis
4.4.1 Threat of New Entrants
4.4.2 Bargaining Power of Buyers/Consumers
4.4.3 Bargaining Power of Suppliers
4.4.4 Threat of Substitute Products
4.4.5 Intensity of Competitive Rivalry
5 MARKET SEGMENTATION (Market Size by Value - USD Million)
5.1 By Deployment
5.1.1 Cloud-based
5.1.2 On-premise
5.2 By Function
5.2.1 Claims and Denial Management
5.2.2 Medical Coding and Billing
5.2.3 Electronic Health Record (EHR)
5.2.4 Clinical Documentation Improvement (CDI)
5.2.5 Insurance
5.2.6 Other Functions
5.3 By End User
5.3.1 Hospitals
5.3.2 Laboratories
5.3.3 Other End Users
5.4 Geography
5.4.1 North America United States Canada Mexico
5.4.2 Europe Germany United Kingdom France Italy Spain Rest of Europe
5.4.3 Asia-Pacific China Japan India Australia South Korea Rest of Asia-Pacific
5.4.4 Middle East and Africa GCC South Africa Rest of Middle East and Africa
5.4.5 South America Brazil Argentina Rest of South America
6.1 Company Profiles
6.1.1 Allscripts Healthcare Solutions, Inc.
6.1.2 athenahealth, Inc.
6.1.3 R1 RCM Inc.
6.1.4 Conifer Health Solutions, LLC
6.1.5 Constellation Software Inc.
6.1.6 eClinicalWorks
6.1.7 Epic Systems Corporation
6.1.8 GeBBs Healthcare Solutions, Inc.
6.1.9 Mckesson Corporation
6.1.10 Infosys Limited
6.1.11 Cerner Corporation
6.1.12 Oracle
6.1.13 Accenture

Companies Mentioned (Partial List)

A selection of companies mentioned in this report includes, but is not limited to:

  • Allscripts Healthcare Solutions, Inc.
  • athenahealth, Inc.
  • R1 RCM Inc.
  • Conifer Health Solutions, LLC
  • Constellation Software Inc.
  • eClinicalWorks
  • Epic Systems Corporation
  • GeBBs Healthcare Solutions, Inc.
  • Mckesson Corporation
  • Infosys Limited
  • Cerner Corporation
  • Oracle
  • Accenture