Revenue cycle management (RCM) is a process that involves capture, management, and collection of patient services payments. RCM is collaboration of administrative as well clinical functions to manage revenue of a health care provider, physician, or a hospital. Several software modules are used to function the revenue cycle management at physician offices, hospitals, laboratories, and other health care facilities. The role of RCM starts when a patient makes an appointment with a consultant, wherein the administrators at hospitals or health care facility provider feeds in patient information in RCM and checks the insurance and other financial eligibilities. The process of RCM ends with collection of payments from patient or from his private/government insurer. RCM helps health care providers to manage critical functions such as tracking the claims made to insurer, manage the claim denials and queries, and reduce billing errors. Revenue cycle management comprises synchronized flow of clinical and administrative functions to shorten the revenue generation cycle for health care providers and maintain requisite cash flows.
The global revenue cycle management market is expected to witness strong growth over a period of time due to many factors. Increasing complexity in medical coding for bill reimbursements in countries such as the U.S. is anticipated to drive the revenue cycle management market, as these modules are meant to reduce billing errors by health care providers. Additionally, reduction in health care reimbursements by government and private bodies and rising rate of claim denials will induce large number of health care providers to adopt RCM practices. However, limited investments in the health care IT sector and high cost of RCM software and services are expected to restrain the revenue cycle management market.
The global revenue cycle management market has been classified based on offering type, deployment, solution type, and end-user. In terms of offering type, the market has been categorized into services and software. The hardware and other components for revenue cycle management are owned and operated by the health care provider. The services segment held a major market share, as large number of small and medium scale health care providers opt for service providers to avoid costs related to hardware, component, and staff recruitments and training.
Based on deployment, the revenue cycle management market has been segmented into web-based, cloud-based, and on-premises. The web and cloud-based revenue cycle management solutions are witnessing strong growth as these can be easily integrated into other health care IT system solutions. Remote accessibility and high demand for outsourced RCM services are the factors expected to boost the segment.
In terms of solution type, the revenue cycle management market has been segmented into integrated RCM solutions and standalone RCM solutions. Integrated RCM solutions are widely used and are likely to witness strong growth as these provide the flexibility to access other health care solutions such as electronic health records (EHR) and clinical data interface.
Different modules of revenue cycle management solutions are available based on the size of health care provider. Based on end-user, the revenue cycle management market has been segmented into hospitals, clinics (physicians), diagnostic centers, laboratories, and others. Several hospitals are adopting revenue cycle management solutions due to increasing pressure to maintain cash flows and to remain solvent. Ease of maintaining patient records and shortening the revenue generation cycle have induced physicians to opt for revenue cycle management solutions outsourced to service providers.
Revenue cycle management solutions implementation is rising across the globe owing to rising demand for maintaining cash flows and addressing the changing and complex reimbursements norms set by governments and private insurers. Geographically, the revenue cycle management market has been classified into North America, Europe, Asia Pacific, Middle East & Africa, and Latin America. North America leads the global revenue cycle management market driven by strong health care infrastructure and well-established health care IT industry. North America held the largest share of the global market, as most of the leading RCM solution providers are based in the region. Europe was the second most attractive market for revenue cycle management. This is due to rising health care expenditure and supportive government steps on health care reimbursements. Germany, France, Spain, Italy, and the U.K. are the major markets in Europe. Rise in health care infrastructure and emerging markets such as India and China are likely to drive the revenue cycle management market in Asia Pacific.
Factors such as increased government and private spending in health care, need for reduction in billing errors, and demand for shortening revenue generation cycle are expected to drive the global revenue cycle management market. However, high cost of RCM solutions, higher cost of implementation, and lower investment in health care IT are the major restraints of the revenue cycle management market.
Globally, the revenue cycle management market is dominated by McKesson Corporation, athenahealth, Inc., CareCloud Corporation, GE Healthcare, Allscripts Healthcare Solutions, Inc., Cerner Corporation, Siemens AG, Deloitte LLP, eClinicalWorks, LLC, SSI Group, Inc., iPatientCare, Inc., and Accretive Health, Inc.
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