US RCM Growth Opportunities

Internal Challenges due to COVID-19 Accelerated the Shift to Revenue Cycle Management (RCM) Outsourcing

This research service provides an overview of the US revenue cycle management, revenue forecast, and competitive analysis of various legacy and modular RCM solutions. This study explores RCM applications across front-end, middle, and back-end processes and the end-users are hospitals and ambulatory physician practices. In addition, it offers detailed insight into the RCM outsourcing market in the US.

RCM refers to the several administrative and clinical functions for capturing, managing, and collecting patient service revenue. The RCM process starts with admission (patient access) and continues to accounts receivable (payment and collections). Several RCM solutions (for example, IT applications and services) help healthcare providers perform different functions.

The top three strategic imperatives impacting RCM are:

• Internal Challenges: Healthcare organizations are looking for improved efficiency, faster reimbursement, and profitability by reducing billing errors, lowering cost, and optimizing collection during COVID-19. Pent-up demand for elected surgeries, due from the last two years, is further requiring providers to bolster the productivity of their incumbent RCM solutions.
• Transformative Mega Trends: COVID-19 pandemic has led to a surge of patients with long-term symptoms that vary from traditional chronic conditions with new comorbidities to the unprecedented prevalence of rare diseases. As a result, robust clinical risk management has become imperative to new-age RCM, leading vendors to transform their RCM platforms’ underlying clinical logic, financial template, and codes.
• Customer Value Chain Compression: Providers use and prefer a mix of in-house and outsourced RCM to meet their organizational needs. Vendors for this outsourcing appear to be very fragmented based on expertise in specific areas of need across front-end, middle, and back-end processes.