According to the Market Statsville Group (MSG), the global revenue cycle management market size is expected to grow around USD 132.63 billion by 2033, at a CAGR of 10.3% from 2023 to 2033. In revenue cycle management (RCM), medical billing software is used to track patient care episodes, ranging from registration and appointment scheduling to final payment. The increase in geriatric population and the growing incidence of chronic disorders will drive the market for the upcoming forecasting period. Lack of IT infrastructure, support, and good technology within the organization will be the major constraint for the growth of the RCM solutions market in underdeveloped and developing regions. The increasing outsourcing services in developing countries will create the opportunities for the new and the key player to capture the market for the upcoming period.
Revenue Cycle management encompasses various activities, such as patient registration, insurance coverage determination, coding, claims processing, payment management, and receivable management. The main components of revenue cycle management (RCM) are patients, health service providers, billing businesses, and insurance payers. Revenue cycle management (RCM) is made up of different types of payment structures, payers, different sets of codes and different sets of rules.
According to the Healthcare Financial Management Association (HFMA) revenue cycle includes all the clinical activity and administrative function that contribute to the capture, management, and collection of patient service revenue. However, the revenue cycle involves of charge capture, claim submission, coding and many more.
The outbreak of COVID-19 pandemic had negatively affected the global revenue cycle management market growth. Several market players, including CERNER CORPORATION and TH Medical, witnessed a significant decline in the revenue from their revenue cycle management services. Due to the growing demand for healthcare, growing patient volumes and IT solutions such as electronic health record (EHR), patient registry and platforms, to manage complex patient data has increased.
Government and market payers are continually changing policies about the COVID-19 treatment co-pays, patient responsibility amounts and their collection. Due to the addition of new codes and keeping up with evolving policies, there have been more appeals, more resubmissions of claims due to changes in patient responsibility, and reworked patient statements as a result.
In additional, the increasing trend for telemedicine service in the COVID-19 is resulting in a number of complications and problem while managing insurance coverage. Also, many codes were introduced for COVID-19 in patients. As a result, many challenges were encountered for maintaining new billing guidelines for COVID-19 patients and for revenue cycle management. And these where the several negative and positive point that was affected by COVID-19 pandemic around globally.
The growing number of chronic disorders, the rising demand for quality healthcare services and rapidly increasing geriatric population are the major factors that are responsible for increasing healthcare systems across the globe. According to the World Health Organization (WHO), the global number of people aged 60 plus are expected to increase from 900 million in 2015 to 2 billion by 2050. The centers for disease control (CDC) stated that chronic diseases such as cancer, diabetes, cardiovascular disease (CVD) and respiratory diseases cause approximately 70% to 75% of deaths in the US every year.
There has been an increase in healthcare-related expenditures in the recent year, and this trend is expected to grow during the forecast period. The combination of rising medical prices, growing insured populations, and an increase in advanced healthcare services is responsible for the healthcare spending growth rate. The rise in healthcare expenditures among countries such as Germany, France, Sweden, UK, and others in this region has also contributed to the growth of revenue cycle management in Europe.
Revenue cycle management (RCM) solutions are typically integrated with electronic health record (EHR) where the electronic health record EHR manages the patient’s data while the revenue cycle management (RCM) system processes the claims for payments for the patients. The success of RCM largely depends on the support and IT infrastructure within the organization. The software offered by RCM companies is to providers requirement to IT expertise and infrastructure to function properly within the organization. It is necessary to obtain the information of the patient from various departments as well as healthcare providers. Collecting these data from all these departments is used for sharp coding and correcting bill, claims denial management and establishing effective health data security. Most developing markets is lacking in the requirement of interoperability infrastructure to implement RCM solutions due to budgetary constraints.
Outsourcing is a popular strategy that the healthcare organizations is used to control the rising costs of services. An external contractor manages business, clinical, financial, or hospitality services for a healthcare organization. It is common for healthcare leaders to consider outsourcing the revenue cycle management process in order to reduce spending and focus on value-based care. The cost of outsourcing the billing operations is less expensive than doing the billing in-house operation. A reliable revenue cycle management (RCM) partner can manage day to day revenue cycle management (RCM) activities like reimbursements, billing, patient check-in/check-out and registrations. This helps the healthcare facilities to shift their burden from their staff to their outsourcing partners. Revenue cycle management (RCM) outsourcing improves cash flow of the organization. With the help of RCM outsourcing partners, through which a organization can handle a huge amount of billing through software and hardware solutions. With outsourcing process, end users have access to expert coders, CDI experts, financial experts, and A/R specialists, reducing the risk of error.
The study categorizes the revenue cycle management market based on type, product and services, deployment mode, component, and end user at the regional and global levels.
By Type Outlook (Sales, USD Million, 2017-2033)
By Component Outlook (Sales, USD Million, 2017-2033)
By deployment mode there are 2 type of segment present in the market on-premises solutions, cloud-based solutions. Among of these cloud-based solutions is anticipated to register the highest market growth over the forthcoming years using their higher flexibility and increased cost-effectiveness to end-users. Cloud deployed solutions have made medical data-sharing easy and more secure. Telehealth applications can be created and protected with this software, which automates backend processes. As well as avoiding additional server maintenance costs, cloud-based solutions help healthcare institutions manage electronic medical records, patient portals, big data analytics, and mobile applications. A number of cloud-based products have been developed in order to improve resource procurement, enhance infrastructure reliability, and improve operations.
Asia Pacific is to register the fastest growth rate over the forthcoming years in revenue cycle management market. A growing number of favorable government initiatives and support, an increase in the need to improve the quality of healthcare delivery, an increase in digital literacy, an increase in adoption of healthcare IT solutions, a growing health infrastructure, an increase in healthcare IT spending, and an increase in unmet healthcare needs in emerging nations. Furthermore, the Asia Pacific market offers low manufacturing costs and a cost-effective workforce, which makes doing business easier.
On the other hand, North America dominated the market for revenue cycle management and accounted for the largest revenue share in 2022. Because of the expanding number of physician offices in the United States, there has been a considerable increase in demand for healthcare IT solutions such as revenue cycle management systems to improve efficiency and service delivery in recent years. Legislative changes, such as the ICD-10 in 2015, have resulted in a digital transformation of healthcare systems.
Major players in the global revenue cycle management market are:
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