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

  • Report

  • 105 Pages
  • January 2020
  • Region: United States
  • Frost & Sullivan
  • ID: 4989000

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.

Table of Contents

1. Executive Summary
  • Key Findings - Market Financials
  • Key Findings - Major Market Forces
  • Scope and Segmentation
  • Key Questions this Study will Answer
  • Market Engineering Measurements
  • CEO’s Perspective
  • Key Companies to Watch
  • Executive Summary - 3 Big Predictions

2. Market Overview
  • Market Background - The Mature RCM Market is Preparing for an Upgrade
  • Market Background - Patients’ Concern for Their Increasing Financial Liability is Real
  • Market Background - Regulatory Agencies are Favoring Modernization of RCM

3. Introduction to Next Generation RCM
  • Market Definition and Vendor Map
  • End-user and Product Segmentation of RCM

4. Hospital RCM Market Analysis
  • Market Overview
  • Top Growth Opportunities
  • Key Success Factors

5. Physician Practice RCM Market Analysis
  • Market Overview
  • Top Growth Opportunities
  • Key Success Factors

6. Outsourced RCM Services Market
  • Introduction to Outsourced RCM Services - Assessment of Market Forces
  • Outlook for Outsourced RCM Services - A Wide Array of Business Models are at Play
  • Assessment of Best Practices - Outsourced RCM Services

7. Forecasts and Trends - Total RCM Market
  • Market Engineering Measurements
  • Forecast Methodology and Assumptions
  • Revenue Forecast
  • Percent Revenue Forecast by End-user Segment
  • Revenue Forecast by End-user Segment
  • Revenue Forecast Discussion

8. Growth Opportunity Assessment
  • 5 Major Growth Opportunities
  • Strategic Imperatives for Success and Growth

9. Hospital RCM Segment Analysis
  • Market Engineering Measurements
  • Revenue Forecast
  • Revenue Forecast Discussion
  • Revenue Forecast by Offering
  • Revenue Forecast by Offering Discussion

10. Physician Practice RCM Segment Analysis
  • Market Engineering Measurements
  • Revenue Forecast
  • Revenue Forecast Discussion
  • Revenue Forecast by Offering
  • Revenue Forecast Discussion - Software and Service Applications

11. Penetration Analysis - Total RCM Market
  • Penetration Analysis - Hospitals
  • Penetration Analysis - Physician Practices

12. Competitive Market Structure
  • Competitive Environment

13. Vendor Landscape Assessment - Total RCM Market
  • Vendor Examples by RCM Applications and Services

14. Key Companies to Watch
  • Vendor Segmentation - Software Application Providers
  • Vendor Segmentation - Service Providers

15. Future Perspectives
  • 3 Big Predictions
  • Legal Disclaimer

16. Appendix
  • Abbreviation List
  • Vendor Segmentation Capability Definitions
  • List of Exhibits

Companies Mentioned

A selection of companies mentioned in this report includes:

  • Allscripts
  • athenahealth
  • Change Healthcare
  • Greeway Health
  • Optum
  • Parallon