Revenue Cycle Management Market Size, Share & Trends Analysis Report By Product (Software, Services), By Type (Integrated, Standalone), By Delivery Mode, By End Use, By Region, And Segment Forecasts, 2022 - 2030

Report Overview

The global revenue cycle management market size was valued at USD 243.1 billion in 2021 and is projected to expand at a compound annual growth rate (CAGR) of 11.6% from 2022 to 2030. The rapidly growing era of digitalization of healthcare is driving the demand for advanced RCM solutions. The growing number of multiple data siloes and unorganized workflows in healthcare settings is paving a path for market development and growth. RCM is a combination of third-party payers, payment models, guidelines, and codes. A practice’s existence depends upon obtaining the right assets. As precise payment for medical services becomes increasingly complex, it increases the value of obtaining an efficient RCM solution.

According to the CAQH Index report in 2018, there was an increase of 18% between 2017 and 2018 in the overall size of healthcare businesses across the U.S. Physical transactions declined by 6%. Health systems are currently making headway in executing electronic processing for claims, coding, and reimbursements. Increasing healthcare expenditures are forcing industry participants-including providers and players-to adjust by accepting factors such as value-centric reimbursement structures, growth in risk sharing, and executing cost limits. These changes, along with other market dynamics, present considerable hurdles to health and hospital system revenue cycles.

Growing demand for workflow optimization in healthcare organizations coupled with innovative synchronized management software systems is expected to propel market growth. Increasing support from government bodies and federal agencies in form of favorable regulatory reforms is driving growth. The market for revenue cycle management is witnessing regular technological advancements and the industry is constantly evolving. Various healthcare providers and payers are rapidly adopting these innovative and upgraded RCM solutions. For instance, R1 RCM Inc launched R1 Professional in January 2020, an advanced RCM solution that is being widely used by large hospital-owned medical groups and other groups involved in independent practices.

R1 Professional revenue cycle management solution would enable healthcare facilities and other stakeholders to implement a standardized RCM strategy of reimbursement and operations model. Innovations and advancements in the RCM solutions have played a key role in improving provider-patient relations and include the implementation of ICD-10 for classifying, coding, and reporting data on disease diagnosis and treatment procedures, which directly helps healthcare systems enhance care delivery. Healthcare facilities are outsourcing revenue cycle management software solutions owing to the multiple advantages associated such as easy availability of trained and skilled professionals, compliance and adherence to required regulations, enhanced efficiency, and cost-effectiveness.

Due to the numerous benefits, available healthcare facilities are readily outsourcing RCM solutions and services. According to a Med USA article published in 2020, approximately two-thirds of healthcare organizations outsource their revenue cycle management solutions and services. The growing adoption rates are anticipated to propel market growth over the forthcoming years. One of the major challenges faced in adopting and implementing revenue cycle management software solutions is the lack of proper reimbursement regulations with respect to insurance and other formalities. The existing reimbursement policy gaps between public and private insurers are restraining the growth of the market for revenue cycle management.

According to a Healthcare Financial Management Association (HFMA) article, the average timeline of reimbursement of payment by public insurers such as Medicare was approximately 28 days whereas private insurers’ timeline was twice than that. The adoption and growth of RCM solutions is hindered due to such delays and discrepancies in reimbursement. However, to tackle these challenges government bodies are undertaking initiatives to improve management of reimbursement coverages through revenue cycle management solutions. In addition, several government organizations across the world are undertaking initiatives to facilitate health data exchange and improve efficiency of healthcare systems.

COVID19 revenue cycle management market impact: an increase of 18.4% market growth between 2019 and 2020

The ongoing Covid-19 pandemic had an unprecedented and unexpected impact on majority of the healthcare sectors and brought in significant transformations to the normal functioning of healthcare systems. 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. The surge in demand for advanced and innovative RCM solutions drove key participants to developed value-added features such as payer connect, remote coding services, reporting, analytics, and audit and compliance to improve revenue generation and productivity. 

Product Insights

The software segment dominated the revenue cycle management market and accounted for the largest revenue share of 66.4% in 2021. Growing data siloes and the increasing amount of data generated from multiple healthcare functions are driving the need for process digitalization and streamlining workflows for enhanced efficiencies and improved patient care. The growing amount of unorganized data requires consolidation which is supporting the growing need for RCM software solutions. Multiple data silos reduce the ability to accurately analyze data and increase the risk of data losses.

An RCM software tool will help to manage a large amount of data and the procedure for evaluating data and designing valuable mitigation tasks will be easy. This would allow the staff to immediately document and review the performance and to effectively take decisions pertaining to the course selection process. According to Health Catalyst data estimates, 90% of healthcare organizations use these software solutions to enhance quality and improve revenue cycle management. On the other hand, the services segment is anticipated to register the fastest growth rate over the forthcoming years owing to the growing trend of outsourcing these services to healthcare facilities.

There has been an increase in outsourcing of services as many healthcare services mandatorily require resources and skillsets for implementation of revenue cycle management solutions. Either the entire process is outsourced, or a part of it in the form of a long-term contract. RCM services make sure healthcare procedures achieve an optimum return on their investment. A variety of RCM services are being offered by companies, such as patient management solutions, medical billing, medical coding, and others. Key participants are undertaking various strategic initiatives to boost the adoption of RCM services.

Type Insights

The integrated type segment dominated the market for revenue cycle management and accounted for the largest revenue share of 69.8% in 2021 owing to the growing preference for volume-based payments over value-based payments. Integrated solutions offer a streamlined and synchronized format for various financial activities via a single platform resulting in a standardized data collection and analysis process. Integrated revenue cycle management provides a number of benefits, from growing collections to planning alternative payment and reimbursement methodologies. According to the survey of Black Book Market Research, technologies that fully incorporate revenue cycle management, practice management, and Electronic Health Record (EHR) systems are the path of the future.

Successful integration schemes allow healthcare workers to improve productivity, decrease costs, increase collections, and increase net operating margins. The integrated type of services is anticipated to register the fastest growth over the forthcoming years owing to the growing demand for enhancing healthcare systems’ efficiency, increasing healthcare facilities, and growing healthcare costs. Moreover, the growing need to minimize or eliminate human errors and accelerate administrative functions is anticipated to boost the growth of an integrated type of service.

Delivery Mode Insights

The web-based delivery mode segment dominated the market for revenue cycle managementand accounted for the largest revenue share of 53.0% in 2021 owing to the growing implementation of web-based solutions. Web-based delivered solutions do not require additional hardware or storage and can be installed off-site and controlled by a third party, which is boosting the adoption of web-based solutions over on-premise delivered solutions. Benefits associated with web-based delivered solutions are affordability and rapid deployment.

On the other hand, the cloud-deployed segment is anticipated to register the fastest growth rate over the forthcoming years owing to higher flexibility and increased cost-effectiveness to end-users. Cloud deployed solutions have rendered medical data-sharing easy and secure. It automates backend processes and enables the creation and protection of telehealth apps.Also, cloud-deployed solutions help healthcare institutes to deal with electronic medical records, patient portals, big data analytics, and mobile applications to avoid additional costs for maintaining servers. Cloud-based products have been developed to improve resource procurement, enhance infrastructure dependability, and strengthen operations.

End-use Insights

The physician back-office segment dominated the market for revenue cycle managementand accounted for the largest revenue share of 38.0% in 2021. According to the Association for Service Management International, practice management systems are used more in physician offices in the U.S. These systems are routinely used by physicians and their staff, such as nurses, consultants, and office managers to assist in the smooth functioning of their units. A rising focus on increasing the number of physicians and healthcare facilities across the region is expected to drive the market for revenue cycle management. Private physician offices undergo numerous economic challenges such as physician reimbursement, increasing operating expenses, and patient content. Private physician offices are outsourcing RCM solutions and services to align with medical and financial needs.

On the other hand, the hospital’s segment is anticipated to register the fastest growth rate over the forthcoming years owing to the rising number of protocols and guidelines introduced by regulatory bodies with respect to patient safety. The growing demand for streamlining hospitals’ workflows and enhancing productivity and efficiency is driving the adoption of RCM solutions in hospitals. Hospitals commonly use an integrated type of RCM system bringing patients and providers collectively into a single platform. Through this platform, providers, payers, and patients are updated on medications billed to a patient and enable the maintenance of a complete database of patient purchase history.

Regional Insights

North America dominated the market for revenue cycle management and accounted for the largest revenue share of 56.2% in 2021. The large revenue share of the market is due to the growing presence of physician’s offices in the U.S. Regulatory reforms such as amendments in ICD-10 in 2015 have led to a digital transformation in healthcare systems and there has been a significant surge in demand for healthcare IT solutions such as revenue cycle management systems to enhance efficiency and improve care delivery. Moreover, the presence of large renowned hospitals and well-established healthcare facilities, increasing need to minimize healthcare costs, and favorable regulations are posing lucrative growth opportunities for the market in the region.

On the other hand, in Asia Pacific, the market for revenue cycle management is anticipated to register the fastest growth rate over the forthcoming years owing to growing favorable government initiatives and support, growing demand to improve care delivery quality, increasing digital literacy, growing adoption of healthcare IT solutions, advancing healthcare infrastructure, rising healthcare IT spending, and rising unmet healthcare needs of emerging economies. Furthermore, the Asia Pacific market offers low manufacturing costs and the availability of a cost-effective workforce which increases the ease of doing business.

Key Companies & Market Share Insights

The key participants in the market for revenue cycle management are devising various strategic initiatives to expand their business footprint and gain a competitive edge in the market. Key players are focusing on strategic initiatives such as mergers and acquisitions, technological collaborations, partnerships, funding and investments, and innovative product developments and launches to expand their expertise and product portfolio. For instance, in January 2020, R1 RCM, Inc. entered into a strategic partnership with Rush University System for Health (RUSH) to achieve revenue cycle performance excellence and boost innovation in healthcare. Some of the prominent players in the revenue cycle management market include:

• The SSI Group, Inc.

• AllScripts Healthcare, LLC

• Experian Health

• R1 RCM Inc

• McKesson Corporation

• athenahealth, Inc.

• Epic Systems Corporation

• NXGN Management, LLC

• CareCloud Corporation

• Quest Diagnostics, Inc.

• Cerner Corporation

Revenue Cycle Management Market Report Scope

Segments Covered in the Report

This report forecasts revenue growth at global, regional, and country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2016 to 2030. For the purpose of this study, Grand View Research, Inc. has segmented the global revenue cycle management market report on the basis of product, type, delivery, end-user, physician specialty, sourcing, function and region:

• Product Type Outlook (Revenue, USD Million, 2016 - 2030)

  • Software

  • Services

• Type Outlook (Revenue, USD Million, 2016 - 2030)

  • Integrated

  • Standalone

• Delivery Mode Type Outlook (Revenue, USD Million, 2016 - 2030)

  • On-Premises

  • Web-Based

  • Cloud-Based

• End-Use Outlook (Revenue, USD Million, 2016 - 2030)

  • Physician Back Offices

  • Hospitals

  • Diagnostic Laboratories

  • Others

• Physician Specialty Outlook (Revenue, USD Million, 2016 - 2030)

  • Oncology

  • Cardiology

  • Anesthesia

  • Radiology

  • Pathology

  • Pain Management

  • Emergency Service

  • Others

• Sourcing Outlook (Revenue, USD Million, 2016 - 2030)

  • In-house

  • External RCM Apps/ Software

  • Outsourced RCM Services

• Function Outlook (Revenue, USD Million, 2016 - 2030)

  • Product Development

  • Member Engagement

  • Network Management

  • Care Management

  • Claims Management

  • Risk and Compliances

• Regional Outlook (Revenue, USD Million, 2016 - 2030)

  • North America

    • U.S.

    • Canada

  • Europe

    • UK

    • Germany

    • Spain

    • France

    • Italy

  • Asia Pacific

    • China

    • Japan

    • India

    • Australia

    • Singapore

    • South Korea

  • South America

    • Brazil

    • Mexico

    • Argentina

  • Middle East and Africa

    • Saudi Arabia

    • UAE

    • South Africa