U.S. Revenue Cycle Management Market Size By Sourcing (In-House, External Apps/Software), By Delivery Mode (On-Premise, Cloud-Based), By End User (Healthcare Providers, Healthcare Payers) And Forecast

U.S. Revenue Cycle Management Market Size And Forecast

U.S. Revenue Cycle Management Market size was valued at USD 112.5 Billion in 2022 and is projected to reach USD 230.55 Billion by 2030, growing at a CAGR of 10.4% from 2023 to 2030.

The rapidly flourishing healthcare industry along with rising demand for billing transparency as well as fair and timely reimbursement is expected to drive the market demand over the forecast period. Other factors aging population, chronic illness diagnosis, tight labor market, and rising drug and supply costs are expected to fuel the market growth of the country over the period. The U.S. Revenue Cycle Management Market report provides a holistic evaluation of the market. The report offers a comprehensive analysis of key segments, trends, drivers, restraints, competitive landscape, and factors that are playing a substantial role in the market.

U.S. Revenue Cycle Management Market Definition

Revenue Cycle Management (RCM) is generally defined as a method in which healthcare facilities manage the entire billing cycle of the patient ranging from eligibility to final payment. The three main components of RCM include revenue generation, capture, and collection. Gaps and inefficiency reduction along with reimbursement maximization can effectively contribute towards an increase in revenue generation. As the healthcare industry is quality-driven, the revenue cycle entirely depends on the precise and complete documentation of patient information, right from registration to clinical documentation. Even a single gap in data can greatly influence revenue streams.

The U.S. healthcare industry is continuously developing and implementing new, novel, and innovative technological solutions. Hence revenue cycle managers in healthcare establishments need to recognize opportunities that can enhance patient fulfillment efficiency, productivity, as well as financial and operational outcomes of the establishments. Some of the major factors that enhance effectiveness include enhanced profit collection rates, development and execution of superior care practices, higher patient satisfaction, and improved account receivable outstanding timeline. Lack of skills for the development and implementation of the RCM Process is one of the greatest factors restraining the market growth. Other factors such as augmented costs, adequate resource allotment, and management as well as insurance claims management are also expected to hinder the market growth.

U.S. Revenue Cycle Management Market Overview

Healthcare establishments are engaged in implementing digital techniques and processes for claims management, reimbursement, and code which in turn is propelling customers to make room for execution cost limits, risk-sharing, as well as centralized reimbursement structures. Furthermore, healthcare establishments are aiming towards implementing workflow optimization solutions, which, are likely to augment the market growth. Also, favorable government policies and regulations are expected to contribute toward market demand.

Using a well-designed, developed, and implemented RCM system abbreviates the billing and collection cycles by precisely registering, appointing, scheduling, and processing payments. Furthermore, it combines administrative data (including patient’s identity, insurance plan, etc.) with other care facilities received by patients. In addition, it also contributes towards lowering the number of denied claims and enables digital online payments, thus aiding time management. Some of the functions of RCM include storing and managing patient billing information, integrating of EHR and billing systems, and lower administrative expenses.

Market Attractiveness

The image of market attractiveness provided would further help to get information about the region that is majorly leading in the U.S. Revenue Cycle Management Market. We cover the major impacting factors that are responsible for driving the industry growth in the given region.

Porter’s Five Forces

The image provided would further help to get information about Porter’s five forces framework providing a blueprint for understanding the behavior of competitors and a player’s strategic positioning in the respective industry. Porter’s five forces model can be used to assess the competitive landscape in the U.S. Revenue Cycle Management Market, gauge the attractiveness of a certain sector, and assess investment possibilities.

U.S. Revenue Cycle Management MarketSegmentation Analysis

The U.S. Revenue Cycle Management Market is Segmented on the basis of Sourcing, Delivery Mode, and End User.

U.S. Revenue Cycle Management Market, By Sourcing

• In-House
• External Apps/Software
• Outsourcing Services

Based on Sourcing, the market is segmented into In-House, External Apps/Software, and Outsourcing Services. The in-House segment is anticipated to hold the largest market share in 2021. Whereas outsourcing services is expected to witness the highest CAGR over the forecast period. Outsourcing refers to hiring an external third-party company to perform the revenue cycle management process including billing, coding, and other non-provider-related tasks.

U.S. Revenue Cycle Management Market, By Delivery Mode

• On-Premise
• Cloud-Based

Based on Delivery Mode, the market is segmented into On-Premise and Cloud-Based. The cloud-based segment is anticipated to register a higher growth rate owing to widespread benefits such as ease of installation, low maintenance cost, greater security, and higher quality control. Waystar, Kareo, and Athena collector are some of the cloud-based software for RCM.

U.S. Revenue Cycle Management Market, By End User

• Healthcare Providers
• Healthcare Payers

Based on End User, the market is segmented into Healthcare Providers and Healthcare Payers. Healthcare Providers accounted for the largest market share in 2021. The segment includes hospitals, diagnostic centers, nursing homes, and ambulatory surgical centers among others. The adoption of RCM by healthcare providers enables optimized workflow, and improved efficiency, and helps to streamline processes which ultimately contributes towards load reduction.

Key Players

The “U.S. Revenue Cycle Management Market” study report will provide valuable insight with an emphasis on the market including some of the major players are Optum, R1 RCM Inc, Change Healthcare, 3M, The SSI Group, Inc., Allscripts Healthcare, LLC, Cerner Corporation, McKesson Corporation, Epic Systems Corporation, Eclinicalworks, MEDIREVV, NXGN Management, LLC, OSP Labs, and Experian PLC.

These players are investing heavily in research and development activities in order to upscale their technologies and enhance product features that are application specific. Furthermore, the companies are undertaking strategic alliances to gain a strong foothold in the market and enhance its geographic reach. Product differentiations, pricing, and robustness are some of the prominent factors taken into consideration by companies to sustain the market competition.

Key Developments

• In 2021, Vanderbilt announced that it has entered into a collaborative agreement with McKesson to provide a specialty pharmacy consulting suite for the latter’s client.

Ace Matrix Analysis

The Ace Matrix provided in the report would help to understand how the major key players involved in this industry are performing as we provide a ranking for these companies based on various factors such as service features & innovations, scalability, innovation of services, industry coverage, industry reach, and growth roadmap. Based on these factors, we rank the companies into four categories as Active, Cutting Edge, Emerging, and Innovators.

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Reasons to Purchase this Report

• Qualitative and quantitative analysis of the market based on segmentation involving both economic as well as non-economic factors• Provision of market value (USD Billion) data for each segment and sub-segment• Indicates the region and segment that is expected to witness the fastest growth as well as to dominate the market• Analysis by geography highlighting the consumption of the product/service in the region as well as indicating the factors that are affecting the market within each region• Competitive landscape which incorporates the market ranking of the major players, along with new service/product launches, partnerships, business expansions, and acquisitions in the past five years of companies profiled• Extensive company profiles comprising of company overview, company insights, product benchmarking, and SWOT analysis for the major market players• The current as well as the future market outlook of the industry with respect to recent developments which involve growth opportunities and drivers as well as challenges and restraints of both emerging as well as developed regions• Includes in-depth analysis of the market of various perspectives through Porter’s five forces analysis• Provides insight into the market through Value Chain• Market dynamics scenario, along with growth opportunities of the market in the years to come• 6-month post-sales analyst support

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