Market Trends of Global Revenue Cycle Management Industry
Claims and Denial Management Segment is Expected to Grow Fastest Over the Forecast Period
Claims and denial management involve the reviews of the denial procedure. Solution providers of denial and appeal management do the root cause analysis for the claim being denied by the insurer. This involves the review of patient documentation and resubmission of the claim.
Hospitals and medical care facilities, which do not have an expert team, often depend on third-party solution providers. These companies, who have a good understanding and experience of insurer's provider guidelines, revert to insurers with explanations and requests for payment. Sometimes, the denials may be reversed by a telephone conversation with the insurer, followed by an appeal in written form, with a focus on why the claim cannot be denied.
With more healthcare facilities, under intense scrutiny and a rise in the number of healthcare claims, a large amount of hospital revenue is being declined. As per the US Justice Department, data updated in January 2021, of the more than USD 2.2 billion in settlements and judgments recovered by the Department of Justice this past fiscal year, over USD 1.8 billion relates to matters that involved the healthcare industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. The amounts included in the USD 1.8 billion reflect only federal losses, and, in many of these cases, the department was instrumental in recovering additional tens of millions of dollars for state Medicaid programs.
Furthermore, In November 2020, BKD CPAs & Advisors launched a new service aimed at helping clients identify and prevent insurance denials in the United States. Preventable insurance claim denials can cost an organization 3% or more of its net revenue, annually. With the increasing acceptance of companies that provide claims denial and appeal services, they have become more important to hospital facilities, thereby, contributing to the growth of the market studied over the forecast period.
North America holds the Largest Market Share of the Revenue Cycle Management Market Currently and is Believed to Follow the Same Trend over the Forecast Period
The North American healthcare revenue cycle management market dominated the global market and is estimated to show a similar trend during the forecast period. This growth is due to factors like significant changes in regulations that have largely affected the finances, organization, and delivery of healthcare services.
Most healthcare providers are deploying revenue cycle management (RCM) systems that reduce the time taken for receiving payment after providing a service in the region. The RCM that automates many activities previously done manually is saving time, which is a major factor in the growth of the market. Furthermore, a large amount of patient data generation and increasing healthcare burden may lead to errors in medical billing and other processes. For instance, according to an article published in 2020 in the American Journal of Medicine, around 80% of the medical billings carried out in the country contained at least one error, thus, increasing the demand for revenue cycle management.
The market players adopt various strategies, such as acquisitions, collaborations, partnerships, and expansions, to increase market share. For instance, in September 2022, AGS Health, announced the launch of the AGS AI Platform, a connected solution that blends artificial intelligence (AI) and automation with award-winning human-in-the-loop services and expert support to maximize revenue cycle performance in the US. Moreover, in June 2020, Cerner Corporation announced the sale of its RCM outsourcing business, Cerner RevWorks, to R1 RCM Inc. This is expected to help in the integration of technology platforms of both companies and extend R1's RCM capabilities. Thus, these factors mentioned above are expected to drive the studied market during the forecast period.
