Revenue Integrity in Healthcare: Solutions Driving Payment Performance

Revenue cycle issues manifest in the claims process of submission, appeal, and remittance, but causes are found much earlier in clinical workflows. Rather than think of these as disparate issues, they should all be considered under a broader category of revenue integrity.

This latest report reveals a market in flux as new technologies are applied to old problems, increasingly complicated by contracts that include performance and reporting requirements.

These activities are essential for healthcare enterprises of all sizes, scopes, and specialties. They are needed whether the organization is primarily concerned with fee-for-service (FFS) reimbursement or value-based care (VBC).

The ongoing COVID-19 public health emergency has made the need for automation and reduced administrative costs even clearer. With appointment volumes dropping, provider organizations are faced with the need for reliable, accurate payments for their care activities more than ever. These solutions are equally valuable for traditional provider care and for modern virtual care solutions like telehealth.

The report reviews the current state of the market, the maturity of solutions, and the strengths and weaknesses of each solution type. While the current market is valued at more than $20 billion, projections within the report show growth should approach $35 billion in the next five years. The report shows which segments of this market can expect annual growth rates exceeding 10% and which will slow to under 2.5%.

Each type of solution (EHR, Platform, Best of Breed) is evaluated based on how they address the needs of provider enterprises. In addition to the categorical analyses, this report includes 13 profiles of major and promising vendors. Each profile includes an assessment of the vendor's strengths and challenges, detailed descriptions and evaluations of the product capabilities and market execution, and rankings across 24 categories.