North America Healthcare Revenue Cycle Management Market size was valued at USD 23 billion in 2019 and is expected to witness 11% CAGR from 2019 to 2026.
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Growing healthcare expenditure in North America will positively influence the healthcare revenue cycle management market growth during the forecast period. Developed economies such as the U.S. and Canada are well aware regarding available treatment and diagnosis avenues of various diseases and usually have high healthcare expenditures. Increasing number of chronic diseases and genetic disorders will further elevate the healthcare expenditures. According to the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), every six in ten adults in the U.S. have a chronic disease, such as heart disease, cancer, or diabetes. Such scenario propels the demand for healthcare revenue cycle management in the foreseeable years.
Technological juggernaut in healthcare revenue cycle management software will bolster the market growth over the projected timeline. Clinics, hospitals, and healthcare organizations have shown increased adoption of technologically advanced software to improve revenue cycle management. The adoption of healthcare revenue cycle management software, over the past years, has also increased due to minimization of human errors. The standalone and integrated software also offers automation, saving ample time of the management. This will positively impact the market demand for healthcare revenue cycle management avenues over the forecast period.
North America Market Share, By Product
Integrated segment held USD 20 billion revenue size in 2019. By product, the other segment in North America healthcare revenue cycle management includes, standalone. Growing attention of market participants on designing and developing advanced integrated revenue cycle management solutions is bolstering the integrated segment growth. For instance, Streamline Health Solutions, provides a fully integrated system of revenue cycle management solutions including denials management, accounts receivable management, and business analytics.
North America Market Size, By Function
Claims & Denial Management segment is anticipated to progress at around 12% CAGR throughout the projected timeframe. By function, healthcare revenue cycle management industry is segmented into eligibility verification, medical coding & billing, payment remittance, and others. Growing demand for claims and denial management services in healthcare industry for resolution of denied claims, report follow-ups, claims status checks will propel the segmental share over the forecast timeframe.
North America Market Growth, By Deployment
By deployment, the healthcare revenue cycle management market is bifurcated into cloud-based and on-premise. The cloud-based segment will witness rapid growth at over 11.5% CAGR. The cloud-based software analyses revenue cycle data including accounts receivable, transactions, and charges. Additionally, cloud-based services are cost-efficient and provide ease of accessibility of data that help in providing better patient care.
North America Market Forecast, By End-use
By end-use, the healthcare revenue cycle management market is segmented into hospitals, physicians, diagnostics and ambulatory surgical centres, and others. The physicians segment will witness rapid growth at around 11% CAGR in 2026. Physicians are associated with various non-clinical issues including financial pressure accompanied with the revenue collection from patients along with administrative burden. This results in the need for revenue cycle management that will augment the segmental growth.
North America Market Value, By Country
U.S. healthcare revenue cycle management market accounted for USD 20 billion market size in 2019, owing to the increasing prevalence of chronic diseases such as diabetes, cancer and others. Additionally, insurance providing companies in the U.S. such as Medicaid and Medicare have implemented benefit programs for aging population that increases the revenue investments in healthcare policies. Favourable demographic trends along with rising prevalence of chronic conditions will further drive the U.S. healthcare revenue cycle management industry during the forecast timeline.
Competitive Market Share
Some of the prominent market participants in North America healthcare revenue cycle management market include R1 RCM, AGS Health, Allscripts Healthcare, Athenahealth, CareCloud Corporation (MTBC), Cerner Corporation, Conifer Health Solutions, Change Healthcare, Experian Information Solutions, Formativ Health, GeBBS Healthcare Solutions, Kareo, McKesson Corporation, Medical Information Technology, Advisory Board (OptumInsight), and SSI Group, among other market players. Market players are adopting business strategies such as product development and partnerships to bolster their industry footprint and expand their offerings. For instance, in January 2020, CareCloud announced that it has entered a strategic partnership with Luma Health, as part of the CareCloud Connect technology partner program. This partnership helped the company to integrate innovative technologies into its variety of tools to drive their business forward.
North America Healthcare Revenue Cycle Management Market Background
The concept of healthcare revenue cycle management (HRCM) can be traced back to its use in private and public health systems that have been facing declining margins and revenue pressures for years. HRCM is the financial process that utilizes medical billing software to track patient care events from registration and appointment arrangement to the final settlement of a balance. In earlier days, revenue management in medical facilities was used to be managed by accountants. This often resulted in mismanagement of financial resources and revenue data due to human error attributable to the complexity of the method. New HRCM methods enable efficient data management and automations in various steps of revenue cycle management minimizing the complexity and errors associated with the process. Furthermore, alteration in population demographics and rising risk of value-based reimbursement models is surging the need for better estimation and organization of revenue cycles, especially for high and at-risk patient population. Advanced HRCM streamlines financial performance paving the way for flawless payer-provider communications regarding financial risk, thereby fostering the market growth.