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US RCM Growth Opportunities

  • Report

  • 55 Pages
  • March 2022
  • Region: United States
  • Frost & Sullivan
  • ID: 5578734

Internal Challenges due to COVID-19 Accelerated the Shift to Revenue Cycle Management (RCM) Outsourcing

This research service provides an overview of the US revenue cycle management, revenue forecast, and competitive analysis of various legacy and modular RCM solutions. This study explores RCM applications across front-end, middle, and back-end processes and the end-users are hospitals and ambulatory physician practices. In addition, it offers detailed insight into the RCM outsourcing market in the US.

RCM refers to the several administrative and clinical functions for capturing, managing, and collecting patient service revenue. The RCM process starts with admission (patient access) and continues to accounts receivable (payment and collections). Several RCM solutions (for example, IT applications and services) help healthcare providers perform different functions.

The top three strategic imperatives impacting RCM are:

  • Internal Challenges: Healthcare organizations are looking for improved efficiency, faster reimbursement, and profitability by reducing billing errors, lowering cost, and optimizing collection during COVID-19. Pent-up demand for elected surgeries, due from the last two years, is further requiring providers to bolster the productivity of their incumbent RCM solutions.
  • Transformative Mega Trends: COVID-19 pandemic has led to a surge of patients with long-term symptoms that vary from traditional chronic conditions with new comorbidities to the unprecedented prevalence of rare diseases. As a result, robust clinical risk management has become imperative to new-age RCM, leading vendors to transform their RCM platforms’ underlying clinical logic, financial template, and codes.
  • Customer Value Chain Compression: Providers use and prefer a mix of in-house and outsourced RCM to meet their organizational needs. Vendors for this outsourcing appear to be very fragmented based on expertise in specific areas of need across front-end, middle, and back-end processes.

Table of Contents

1. Strategic Imperatives
  • Why Is It Increasingly Difficult to Grow?
  • The Strategic Imperative 8™
  • The Impact of the Top Three Strategic Imperatives on US RCM
  • Growth Opportunities Fuel the Growth Pipeline Engine™
2. Growth Opportunity Analysis, US RCM
  • Scope of Analysis
  • End-user and Product Segmentation of RCM
  • Summary RCM Process Pathway
  • Current State of the US RCM
  • Current State of US RCM - Level of Satisfaction for Incumbent RCM Processes
  • Current State of US Hospital RCM - Level of Satisfaction for Outsourced RCM Processes
  • Current State of US Physician Practices RCM - Level of Satisfaction for Outsourced RCM Processes
  • Impact of COVID-19 on the Shift to RCM Outsourcing
  • COVID-19’s Impact on RCM & Outsourcing - Discussion
  • Key Growth Metrics for US RCM
  • Growth Drivers for US RCM
  • Growth Restraints for US RCM
  • Forecast Assumptions, US RCM Market
  • Revenue Forecast, RCM
  • Revenue Forecast by Applications, RCM
  • Revenue Forecast Analysis, US RCM
  • Pricing Trends and Forecast Analysis, US RCM
  • Competitive Environment, US RCM Market
  • Competitive Overview
3. Growth Opportunity Analysis, Hospital RCM Market
  • Key Growth Metrics for Hospital RCM
  • Market Segmentation
  • Revenue Forecast by Application, Hospital RCM Software
  • Revenue Forecast by Application, Hospital RCM Services
  • Forecast Analysis, Hospital RCM
4. Growth Opportunity Analysis, Physician Practices RCM Market
  • Key Growth Metrics for Physician Practices RCM
  • Revenue Forecast, Physician Practices RCM
  • Revenue Forecast by Application, Physician Practices RCM Software
  • Revenue Forecast by Application, Physician Practices RCM Services
  • Forecast Analysis by End-user, Physician Practices RCM
5. Growth Opportunity Universe
  • Growth Opportunity 1 - Big Tech will help Legacy CDI Solution Providers Expand Scope from Disparate OPDs and ICUs to Enterprise-level Case Management
  • Growth Opportunity 2 - Overhaul of Front-end RCM Processes for Physician Practices will Improve End-user Satisfaction
  • Growth Opportunity 3 - Hospital RCM Back-end Processes are Ready for Outsourcing After COVID-19 to Improve Collection and Ratings
6. Next Steps
  • Your Next Steps
  • Why Now?
7. List of Exhibits