US Revenue Cycle Management Market Analysis


  • Type: Service area
  • Published : December 2021
  • Region: North America
  • Country: US
  • Report ID : 4983

  • Format: PPT, PDF

US Revenue Cycle Management (RCM) Market : Segmented by Product, Procedure, Application and End users – Growth, Market Size, Future Prospects & Competitive Analysis, 2020 – 2028

SKU: 4983 Categories: ,

Report Description of the US Revenue Cycle Management (RCM) Market

Research Scope and Assumption

  • The report provides the market value for the base year 2020 and a yearly forecast up to 2028 in terms of revenue (USD billion)
  • The key industry dynamics, regulatory scenario, reimbursement scenario, major market trends, and drug markets are evaluated to understand their impacts on the demand for the forecast period. The growth rates were estimated using correlation, regression, and time-series analysis
  • We have used the combination of top-down and bottom-up approach for market sizing, analyzing key regional markets, dynamics, and trends for various solutions, services, and end uses
  • All market estimates and forecasts have been validated through primary interviews with the Key Industry Players (KIPs) and secondary analysis
  • Inflation has not been accounted for in order to estimate and forecast the market
  • Numbers may not add up due to rounding off

US Revenue Cycle Management (RCM) Market

Research Objective:

  • To analyze and forecast the market size of US Revenue Cycle Management Market
  • To classify and forecast US Revenue Cycle Management market based on application, drugs, project type, and application.
  • To identify drivers and challenges for US Revenue Cycle Management market
  • To examine competitive developments such as mergers and acquisitions, agreements, collaborations and partnerships, etc., in US Revenue Cycle Management market
  • To conduct pricing analysis for US Revenue Cycle Management market
  • To identify and analyze the profile of leading players operating in US Revenue Cycle Management market

Reason to Buy the Report:

  • Facilitate decision-making based on strong current and forecast data for Revenue Cycle Management (RCM) market
  • Develop strategies based on the latest regulatory framework
  • Strategically analyze micro-markets with respect to individual growth trends, future prospects, and their contribution to the market
  • Analyze competitive developments such as expansions, investments, mergers & acquisitions, new product developments, and research & developments in the Revenue Cycle Management (RCM) market
  • Analyze the opportunities in the market for stakeholders and draw a competitive landscape for market leaders
  • To strategically profile key players and comprehensively analyze their market shares and core competencies
  • We have technically sound team which do a deep dive research and also provide strategy based consulting analysis

US Revenue Cycle Management (RCM) Executive Summary

Revenue Cycle Management (RCM) refers to the process of identifying, collecting and managing the practice’s revenue from payers based on the services provided. A successful RCM process is essential for a healthcare practice to maintain financial viability and continue to provide quality care for their patients

The US RCM market offers attractive growth opportunities due to the existence of many major hospitals and health systems, favourable legislation, growing geriatric population, and the country’s increasing need to reduce costs in healthcare

Market Size and Key Findings

The US RCM size is at around USD 120.7 billion in 2020 and is projected to reach USD xx billion by 2028, exhibiting a CAGR of xx% during the forecast period

US as world’s third largest community, will be growing at faster pace of 11.42% during the forecasted period till 2028. The benefits etched to the revenue cycle management solutions such as secure, flexible, and cost-effective may bring expansive growth prospects for the revenue cycle management market. US has been identified as game changer and fastest growing economy in RCM. Also, the establishment of teams by federal agencies for regulatory reforms leads to the possibility of reclassification of various healthcare products within the medical industry. The healthcare industry can leverage the efficacy & economic value presented by third-party RCM service providers and focus more on a key purpose, which is patient care. The changing aspects of service outsourcing in healthcare RCM are largely driven by finances.

US Revenue Cycle Management (RCM) Market

Market Dynamics

Market Growth Drivers Analysis

  • The volume of electronic data produced in the healthcare industry, primarily due to rising patient volumes and the digitization of administrative, clinical, and financial information, has expanded to terabytes and petabytes. Other major factors contributing to this trend are the sheer diversity of data in healthcare
  • Rising prominence and usage of HCIT tools
  • Given how acquisitive large hospital systems have been in recent years with physician offices and independent practices, the outpatient care setting will continue to be a large market opportunity for RCM vendors
  • Large software companies that previously operated outside of healthcare are entering the space via RCM, as it gives access to provider networks, physician practices, data and analytics from insurance providers, such as claims, denial write-offs and underpayment, and provides a steady form of revenue for the acquirer

Market Restraints

The cost associated with maintaining revenue cycle management software is considerably high. Moreover, IT support and maintenance services, which include modifying and upgrading software as per changing user requirements and maintaining an efficient IT infrastructure, represent a recurring expenditure. This accounts for a large share of the total cost of ownership. Also, post-sale custom interface development for device integration requires additional verification and validation to ensure solution accuracy and completeness. This further increases the total cost of ownership for healthcare providers. As a result of the high costs involved, small healthcare facilities are reluctant to replace their legacy systems with RCM solutions

COVID-19 impact on “US Revenue Cycle Management (RCM)”

The Covid-19 pandemic has significantly affected almost all industries across the globe but specifically the healthcare sector. The healthcare providers in the country have reported a significant rise in patient volume, which has also impacted the healthcare costs and medical billing complexities. Due to this, there is a rise in outsourcing of Revenue cycle management (RCM) services in the US as providers need to engage in collaborations for outcome-based, service-level agreement-driven RCM services. This procedure is becoming popular despite the positive impact of the pandemic

Competitive Landscape

Key Players

The “Revenue Cycle Management in US” study report will provide valuable insights with an emphasis on the US market including some of the key market players such as The SSI Group, Inc., McKesson Corp., Allscripts Healthcare, LLC Athenahealth, Inc., Epic Systems Corp., NXGN Management, LLC, Oncospark Inc., eClinicalWorks

Our market analysis also entails a section solely dedicated to such major players wherein our analysts provide an insight to the financial statements of all the major players, along with its product benchmarking and revenue analysis. The competitive landscape section also includes key development strategies, market share, and market ranking analysis of the above-mentioned players

Notable Recent Deals

Some Acquisition and Partnership deals are:

  1. Nexteligent acquired Professional Revenue Management Services Addition expands Nexteligent’s National Capabilities for Medical Billing, Coding and Electronic Claims Processing for Clinics
  2. Health Catalyst acquired VitalWare Acquisition helps Health Catalyst’s ability to scale software on top of its cloud-base data, Operating System and further enhance analytics insights. Coronis Health RCM, LLC acquired Revenue Guard Claims Management Revenue Guard will be excellent addition to the management team and will lead EMS (Emergency Medical Services) vertical for Coronis Health
  3. Revint and Triage merges to become Cloudmed. The merger creates a unique, first-of-its-kind, single source enterprise platform that delivers Revenue Intelligence™ for a smarter, more predictive way for hospitals and health systems

Healthcare Policies and Regulatory Landscape

Policy Changes and Reimbursement Scenario

Competitive and transparent pricing of services, high quality clinical outcomes, and effective billing and collection process are becoming more important than ever. The front-end of the revenue cycle must be diligent with determining Medicaid eligibility and assist uninsured patients understand their coverage options with the insurance exchanges. One of the biggest challenges in revenue cycle management is the ever-changing healthcare regulations and complex reimbursement models introduced every few years. Practices must stay abreast of these changes and ensure that their staff understands them and performs their tasks in compliance with these regulations. Expertise in all aspects of the change may be hard to attain, especially for smaller practices

1. Report Description of the US Revenue Cycle Management (RCM)……………
1.1 Research Scope and Assumption
1.2 Objective of the Study
1.3 Research Methodology
1.4 Reason to Buy the Report
2. Revenue Cycle Management (RCM) Market Executive Summary………………………
2.1 Revenue Cycle Management (RCM) – Industry Snapshot & Key Buying Criteria, 2020-2028
2.2 Market Size, Growth Prospects and Key Findings
3. Market Dynamics of Revenue Cycle Management (RCM) Market……………………
3.1 Market Growth Drivers Analysis
3.1.1 Increasing volume of Electronic Data
3.1.2 Usage of HCIT Tools
3.1.3 Acquisitive large Hospital Systems
3.1.4 Access to Provider Networks
3.2 Market Restraints Analysis
3.2.1 High Maintenance Services
3.2.2 Increasing Total Cost of Ownership
3.3 Covid-19 Market Impact Analysis
4. US Revenue Cycle Management (RCM) Market Segmentation……………………………
4.1 By Delivery Analysis:
4.1.1 Web-Based Delivery
4.1.2 Cloud-Based Solutions
4.1.3 On Premise
4.2 By insights Analysis:
4.2.1 In-House Segment
4.2.2 Outsourcing Segment
4.2.3 External RCM Apps/Software
4.3 By Physician Analysis:
4.3.1 Oncology
4.3.2 Cardiology
4.3.3 Anaesthesia
4.3.4 Radiology
4.3.5 Pathology
4.3.6 Pain Management
4.3.7 Emergency Services
4.3.8 Others
4.4 By End-users Analysis:
4.4.1 Hospital’s Segment
4.4.2 Physician and Clinical Services Segment
4.5 RCM Market Share………………………………………
4.5.1 Market Analysis, Insights and Forecast – By Revenue
5. Revenue Cycle Management Market Share
5.1 Market Analysis, Insights and Forecast – By Revenue
6. Competitive Landscape…………………………………………………………………
6.1.1 Major Top Market Players
6.1.2 R&D Initiatives in Revenue Cycle Management (RCM) Market
6.2 Notable Recent Deals in Revenue Cycle Management (RCM) Market
6.2.1 Joint Ventures
6.2.2 Partnerships
6.2.3 Mergers & Acquisitions
6.2.4 Strategic Divestments
7. Key Company Profiles………………………………………………………………….
7.1 McKesson Corp Company overview
Product & Services, Strategies & Financials
7.2 Allscripts Healthcare Company overview
Product & Services, Strategies & Financials
7.3 Oncospark Inc Company overview
Product & Services, Strategies & Financials
7.4 eClinicalWorks company overview
Product & Services, Strategies & Financials
7.5 LLC Athenahealth Company overview
Product & Services, Strategies & Financials
7.6 McKesson Corp Company overview
Product & Services, Strategies & Financials
7.7 NXGN Management Company overview
Product & Services, Strategies & Financials
8. Healthcare Policies and Regulatory Landscape……………………………………
8.1 Policy changes and Reimbursement Scenario
8.2 Government Initiatives / Intervention Programs
9. Factors Driving Future Growth…………………………………………………………
9.1 New Trends and Development of Revenue Cycle Management (RCM) Market
9.2 Future Opportunities
10. Strategic Recommendations

US Revenue Cycle Management (RCM) Market Segmentation

By Delivery:

Products mentioned below are the pillars of US revenue cycle management (RCM) market which are widely used:

  • Web-based delivery
  • Cloud-based solutions
  • On premise

Sourcing insights

  • In-house segment
  • Outsourcing segment
  • External RCM apps/software

Based on sourcing, the in-house segment dominated the market with a revenue share of over 75% in 2020

Physician Specialty Insights

  • Oncology
  • Cardiology
  • Anaesthesia
  • Radiology
  • Pathology
  • Pain management
  • Emergency services
  • Others

From the above-mentioned Physician Specialty Insights, the others specialty segment dominated the overall market with a revenue share of over 70%. Increasing insurance coverage for a large number of applications is resulting in the demand for RCM solutions in the majority of specialties, which is one of the key factors for the large share of this segment.

End-user Insights

  • Hospital’s segment
  • Physician and clinical services segment

From the above-mentioned End-user insights, the hospitals segment dominated the US Revenue Cycle Management (RCM) market with a revenue share of 58.5%. Also, they are executing new technology and collaborating with vendors to steer the ever-changing reimbursement environment, which is likely to boost the segment growth

Research Methodology

Insights10 will provide you reports within 10 key parameters which are:

  1. Market overview
  2. Market growth drivers & restraints
  3. Epidemiology or disease type
  4. Market segmentation
  5. Market share
  6. Competitive landscape
  7. Key company profiles
  8. Healthcare policies & regulatory framework
  9. Reimbursement scenario
  10. Factors driving future growth

Based on our many years of experience, we believe that these are the parameters that are critical to decision making for business stakeholders. Our focused approach to develop reports focused on 10 key parameters, enabled us to arrive at the name “Insights10”.

Our analysis methodology involves three critical stages:

Stage I: Market Data Collection

Primary Interviews: We have developed a network of experts, freelancers and researchers across countries through which we engage with local experts to gather key data points and assumptions around each market. We also engage regularly with some of the best market research agencies such as Atheneum, GuidePoint, GLG, etc. to conduct surveys and interviews, and build intelligence. We have language translators as a part of our team, who between them can cover 30+ languages allowing us to extract better local insights.

Secondary Data Collection: We have developed strong expertise and experience in secondary data collection methods for developing unique data sets and research material. We gather data from multiple reliable sources to maintain the high level of accuracy and consistency. The market data is analysed and forecasted using appropriate statistical and coherent models. The report offers an overall analysis of the market size, growth, market share as well as segment-level analysis of the specific market. Our report includes precise, to the point information related to the overall market, competition, growth drivers, challenges, regulatory updates, and competition.

Data Sources: We have access to multiple highly reliable free and subscription data sources. We have many years of experience to understand which sources are more dependable for what and which to prefer for the reliable and latest information. The key sources of information include the following, but are not limited to:

  • Statistical Databases
  • Company Websites/Annual Reports
  • Trade Publications
  • Online Databases
  • Published Research Reports
  • Whitepapers
  • Press Releases of Key Market Players

Stage II: Market Data Analysis and Statistical Model

Market Trends: We generally look at macro parameter and micro indicators. The macro parameters includes changes in government policies, demand and supply of the market, government intervention programs and major market share. The micro indicators GDP growth, market size, market volume etc. We also understand nuances specific to each country like US, Canada, India, Germany, etc. and have worked across 60+ countries and hence no only understand global trends, but how these differ by country, how payment models, market structure, cultural parameters, etc. differ in each country.

Market Sizing and Analysis: Our expert data analytics team has created various market forecast models by employing the top-down approach i.e. start with large overall market and segment different areas and bottom-up approach i.e. start with population and epidemiology and roll up based on spend, etc., estimating the size of the market, and distributing among the geographic and/or product segments.

The top-down approach mainly used for new product forecasting and bottom-up approach is used for demand estimation of any product for different countries summed up to form total market. We are able to round off insights and build stronger forecasts because we always do both these methods and triangulate the final numbers.

The study on the market covers the analysis of the leading geographies such as North America, Europe, Asia-Pacific, and Africa for the period of 2020 to 2028. The qualitative analysis covers the industry landscape and trends, market opportunities, competitive landscape and policy and regulatory scenario and the quantitative analysis covers different market estimates and forecasts.

Data Triangulation & Validation:

Data triangulation of various sources and results of the research are carried out by benchmarking with reliable sources such as industry statistics, statistical databases and the company level averages etc.

We make sure to finalize the numbers in alignment to the market research. Firstly, our internal experts ensure thorough validation and checking to ensure the accurate and precise analysis and then validation is also done using multiple data analysis model.  Two level validation is done and entails finalization of report scope and to way of representation pattern.

Stage III: Interpretation and Presentation

Analysis & Interpretation: The information gathered is then analysed and synthesized. A second series of interviews are done if necessary to check and validate. The future opportunities are analysed by understanding product commercialization and many other factors. It also comprises the analysis of data discrepancies observed across various data sources. Information procured from secondary and primary results are then, interpreted by considering following parameters: (a partial list)

  • Establishing market drivers and trends
  • Analyzing regulatory landscape to understand future growth
  • Market Segment based analysis to obtain revenue / volume
  • Analyzing current needs and determining penetration to estimate market

Insights: Our reports deliver actionable insights backed with supporting facts and figures to assist you in achieving exemplary growth. Our in-depth analyses are interspersed with relevant insights and statistics to offer an executive-level view of a given market. The description helps in correlating many minor factors affecting the market and its impact to the different segments within the market.
Data curated from the analysis and interpretation are drawn to portray all in one consolidated report.

Presentation & Reporting: The market research report is presented in different forms such as charts by using a scientific approach for easy understanding. Historic, current and future analysis is provided for each market in terms of both value and volume. The size of the market is interpreted in the US Dollar value and the respective unit, based on the product, for volume consumptions.
The foreign exchange rates are calculated on the respective dates and for the respective regions covered in the study.

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