Healthcare revenue cycle management helps healthcare providers maximize their reimbursement rates and reduce losses caused by medical billing errors. It involves managing all clinical and financial transactions related to patient services. Key functions of healthcare revenue cycle management include insurance verification, eligibility checks, claim processing, payments posting and collections. It provides hospitals and clinics an opportunity to enhance cash flow and focus on core clinical functions by streamlining their back-end operations.
The global healthcare sector is undergoing a major transformation led by factors like aging population, rise of chronic diseases, growing medical costs and payment reforms. Healthcare providers are under constant pressure to deliver quality care at lower costs while ensuring financial sustainability. Healthcare revenue cycle management addresses these challenges by improving billing processes, avoiding claim denials and recovering unpaid claims. The use of technology solutions like cloud-based platforms and artificial intelligence is enhancing visibility into workflows and automating repetitive manual tasks. This is helping organizations boost staff productivity and optimize billing processes.
The global Healthcare Revenue Cycle Management Market is estimated to be valued at US$ 120 Billion in 2023 and is expected to exhibit a CAGR of 5.6% over the forecast period 2023 to 2030, as highlighted in a new report published by Coherent Market Insights.
Market key trends:
Focus on preventing revenue leakages: Healthcare providers are increasingly adopting predictive analytics tools that can identify billing errors and lost reimbursements in real-time. Solutions like artificial intelligence and robotic process automation for pre-payment audits are being leveraged to minimize undercharges and denied claims before billing. This is helping organizations improve cash flow by preventing revenue leakages. Streamlining workflows for faster payments: The shift towards value-based reimbursements is compelling healthcare systems to optimize their revenue cycle workflows. Players are offering integrated platforms and workflow automation capabilities to accelerate claim submission, adjudication and payments processing. This ensures timely reimbursement and lowers the days in Accounts Receivable (A/R).
Porter’s Analysis
Threat of new entrants: The threat of new entrants is moderate. High setup costs and regulatory barriers create entry barriers for new players.
Bargaining power of buyers: The bargaining power of buyers is high. Buyers have the option to choose from various players providing similar services.
Bargaining power of suppliers: The bargaining power of suppliers is moderate. Suppliers of healthcare revenue cycle management services have established themselves in the market.
Threat of new substitutes: The threat of substitutes is low as there are limited substitute products and services for healthcare revenue cycle management.
Competitive rivalry: The competitive rivalry is high due to presence of various global and regional players providing differentiated services.
Key Takeaways
The GLOBAL Healthcare Revenue Cycle Management Market SIZE is expected to witness high growth. The global Healthcare Revenue Cycle Management Market is estimated to be valued at US$ 120 Billion in 2023 and is expected to exhibit a CAGR of 5.6% over the forecast period 2023 to 2030.
Regional analysis: North America dominates the global healthcare revenue cycle management market due to established healthcare infrastructure and presence of key players. Asia Pacific is expected to witness fastest growth due to increasing healthcare expenditure and expanding medical tourism industry.
Key players: Key players operating in the Healthcare Revenue Cycle Management market are Cerner Corporation, Change Healthcare, Experian plc, Allscripts Healthcare Solutions Inc., Conifer Health Solutions, Eclinicalworks, Gebbs Healthcare Solutions, Epic Systems Corporation McKesson Corporation, and Cognizant Technology Solutions Corporation.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
