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  • To Be Published : Apr 2024
  • Code : CMI157
  • Formats :
      Excel and PDF
  • Industry : Healthcare IT

Revenue cycle management or RCM is a combination of revenue generation, payment, and claims processing. In layman’s terms, it is a healthcare system’s financial system. Its components include all clinical and administrative functions that consist of the management, collection, and capture of revenue gained from patient service. It is primarily the entire lifespan of a patient account in a healthcare organization. Revenue cycle management incorporates the use of specific technological tools to track claims throughout patient’s lifecycle, ensuring that the payments are collected without any hurdle, and claims are addressed successfully. RCM tools let healthcare providers do the billing and identify issues quickly, thereby allowing for the secure stream of revenue. A system that runs efficiently thwarts rejection of claims and preserves an efficient and transparent billing process. Revenue cycle management also includes everything from deciding on patient’s insurance adequacy and eligibility to regulating claims through ICD-10.

HRCM or healthcare revenue cycle management is an important architecture in a healthcare infrastructure. Healthcare organizations employ EHR or Electronic Health Records and computerized performance management to save costs related to the maintenance of their books. This is achieved by lessening the total number of claims denied and by facilitating individuals for adopting online payment platforms. The advent of superior automated elucidations has assisted front desk and clinical staffs, coders & billers, and providers to boost their performance levels in addition to saving time. With the growing business, patients are adopting more than a few payment gateways to make their payments against the services received at hospitals or clinics. Multiple advantages will propel the growth of healthcare revenue cycle management market in the near future.

Integrated solutions is likely to be the primary growth segment in the healthcare revenue cycle management market owing to improved operational competences and smooth economic and clinical structure with better management of treatments, outcomes and most importantly, costs related to these treatments.

Healthcare Revenue Cycle Management Market Taxonomy

On the basis of deployment, the global healthcare RCM market is classified into:

    • On-Premise
    • Cloud-Based
    • Web-Based
    • Others

On the basis of component, the global healthcare RCM market is classified into:

    • Software
    • Services

On the basis of product type, the global healthcare RCM market is classified into:

    • Standalone
    • Integrated
    • Others

On the basis of end user, the global healthcare RCM market is classified into:

    • Hospitals
    • Laboratories
    • Physicians
    • Others

Among deployment types, the cloud based solutions holds the majority share in the healthcare revenue cycle management market. The primary factor for the dominance of this segment is high rate of adoption of electronic medium for maintaining health records, thereby ensuring well-organized data mining, superior accessibility of the data and precise evaluation of the data corresponding to health information. This in turn will fuel the growth of the overall healthcare revenue cycle management market.

Rising incidences of hospitalizations will drive the overall healthcare revenue cycle management market

According to the American Hospital Association, the total number of registered hospitals in the U.S. was 5,564 in 2015. Moreover, it states that in 2015, the total number of admissions in these hospitals was 35,061,292, i.e. around 35 million patients. Increasing number of hospitalizations, in turn fuels growth of the global healthcare revenue cycle management systems market. Maintaining well organized records of patients is the need of the hour. Additionally, the emerging economies, especially countries such as China and India are likely to show significant growth prospects over the course of the forecast period. Increasing spends on healthcare, availability and accessibility of better healthcare facilities, increasing incidence of diseases and the rising importance of studying historical patient profile across the healthcare industry will augment the overall growth of the market. Government initiates and strict regulatory framework will shape the future of the global healthcare revenue cycle management market.

Major manufacturers in the market compete on the basis of price, and technology (ease of use). Some of the major players operating in the healthcare revenue cycle management market are GE Healthcare, Experian PLC., Eclinicalworks, LLC, Mckesson Corporation, Cerner Corporation, Gebbs Healthcare Solutions, Conifer Health Solutions, and LLC. Epic Systems Corporation, Quest Diagnostics Incorporated, All scripts Healthcare Solutions, Inc., and Athena health, Inc.

Key Developments

  1. Key companies in the market are involved in various business strategies such as collaboration and partnership, in order to provider novel products to in the global market. For instance, in January 2019, Change Healthcare and Experian Health, both working revenue cycle management market, entered into partnership to provide an identity management solution, which will answer patient duplication and identification challenges.
  2. Major companies in the market are focused on different business stratifies such as product and assets acquisition, in order to gain competitive edge in the global market. For instance, in July 2018, VERITAS Capital, a private equity investment company, acquired GE Healthcare’s Enterprise Financial Management (Revenue Cycle), Workforce Management, and Ambulatory Care Management for US$ 1.05 billion in cash.
  3. Key companies in the marker are focused on various business strategies such as merger and acquisition, in order to enhance the global market presence. For instance, in December 2018, ChrysCaptial, an Indian private equity firm, acquired GeBBS Healthcare Solutions, a provider of revenue cycle management.

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