The global healthcare claims management market size is expected to reach USD 136.67 billion by 2030. It is expected to expand at a CAGR of 23.4% from 2022 to 2030. The rising complexity of claims administration and the medical billing process is one of the most immediate concerns confronting health insurance companies and other private payers. The capacity to digitize every stage of the claims process, implying process improvement, from data entry to claims management and billing processing, holds enormous promise for increasing medical billing and claims management efficiency and accuracy. When done correctly, the end result may be cheaper expenses and a better customer experience. Thus, improvements to the overall healthcare organization’s process are expected to propel the industry growth.
Furthermore, the growing importance of denial management is expected to further boost the industrygrowth. According to a Kaiser Family Foundation recent analysis, around 17% of in-network claims were refused across HealthCare.gov issuers in 2019 and approximately 14% were denied in 2018. Specific issuer rates differed greatly from these averages. As a result, financial strategists who are truly focused on the transition from volume to value undervalue it. This is a mistake since dealing with rejections is as important now as it was decades ago.
The global COVID-19 pandemic has had a mixed impact on the overall market. Furthermore, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was designed in developed countries such as the U.S. to provide healthcare resources required to combat COVID-19. The CARES Act incorporated medical billing rules, which resulted in an increase in claim denials and their management. This will further boost the overall market for medical billing and healthcare claims management.
Despite the expected rise in the market, there have been rising concerns in terms of data privacy. For instance, modern technologies such as cloud, mobile, and next-generation databases are increasingly being used to manage, store, and retrieve such claims data as technology advances. These elements have conspired to form healthcare data security an ongoing concern for the overall healthcare industry. To guarantee that patients have the data protection they need and deserve, rules and regulations governing healthcare data are always evolving.
Due to the clear nascent nature of technology innovation in the medical billing and claims processing market, share is widely distributed across various competitors. This is bolstered by the fact that a large number of businesses have joined the market due to the minimum capital requirements for establishing and maintaining technological infrastructure. However, there has been a reduced risk of entry to some extent due to the complexity in the healthcare medical billing and claims processing market dynamics.
Larger, established players and well-known players have a credibility advantage, which reduces the threat of entry from smaller, less established players with minimal IT experience in healthcare. However, due to the expanding number of advanced solution providers, such as CareCloud, Inc. and AdvancedMD, who are increasingly focusing on lowering claim denial rates and improving the medical billing rates, the industryis set to experience a higher new entrant rate.
Furthermore, the growing importance of denial management is expected to further boost the industrygrowth. According to a Kaiser Family Foundation recent analysis, around 17% of in-network claims were refused across HealthCare.gov issuers in 2019 and approximately 14% were denied in 2018. Specific issuer rates differed greatly from these averages. As a result, financial strategists who are truly focused on the transition from volume to value undervalue it. This is a mistake since dealing with rejections is as important now as it was decades ago.
The global COVID-19 pandemic has had a mixed impact on the overall market. Furthermore, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was designed in developed countries such as the U.S. to provide healthcare resources required to combat COVID-19. The CARES Act incorporated medical billing rules, which resulted in an increase in claim denials and their management. This will further boost the overall market for medical billing and healthcare claims management.
Despite the expected rise in the market, there have been rising concerns in terms of data privacy. For instance, modern technologies such as cloud, mobile, and next-generation databases are increasingly being used to manage, store, and retrieve such claims data as technology advances. These elements have conspired to form healthcare data security an ongoing concern for the overall healthcare industry. To guarantee that patients have the data protection they need and deserve, rules and regulations governing healthcare data are always evolving.
Due to the clear nascent nature of technology innovation in the medical billing and claims processing market, share is widely distributed across various competitors. This is bolstered by the fact that a large number of businesses have joined the market due to the minimum capital requirements for establishing and maintaining technological infrastructure. However, there has been a reduced risk of entry to some extent due to the complexity in the healthcare medical billing and claims processing market dynamics.
Larger, established players and well-known players have a credibility advantage, which reduces the threat of entry from smaller, less established players with minimal IT experience in healthcare. However, due to the expanding number of advanced solution providers, such as CareCloud, Inc. and AdvancedMD, who are increasingly focusing on lowering claim denial rates and improving the medical billing rates, the industryis set to experience a higher new entrant rate.
Healthcare Claims Management Market Report Highlights
- Providers actively wanted methods to enhance their claim management and medical billing systems. As a result, one strategy is to create an integrated billing and claims processing system, which offers several advantages. As a result, integrated solutions accounted for a dominant revenue share of more than 70.0%
- By component, the software segment accounted for the largest revenue share of more than 65.0% in 2021. It is expected to maintain its dominance throughout the forecast period
- The healthcare industry has been revolutionized by overall digitization, which has improved patient treatment guidance systems and software technologies that have provided simple access to healthcare data through cost-effective automated billing and claims processing systems. Medical billing and claims processing software have several advantages, including more accurate bills, fewer administrative errors, fewer insurance claim denials, invoice tracking, and speedier payments, which boosts efficiency and accuracy even more
- The web-based and cloud-based deployment mode segments have a strong competitive presence in the market. They together accounted for more than 85.0% share of the overall revenue in 2021. Furthermore, regardless of the industry, overall cloud billing services assist organizations in saving money while still offering excellent customer service. According to a Flexera study from 2021, 93% of organizations are using cloud-based technology, with 73% seeking to optimize their present cloud utilization for cost savings. As a result, the cloud-based billing industry's overall growth is being supported by a growing need for cheaper capital and operating costs
- The healthcare providers end-use segment is anticipated to rise moderately over the forecast period, with growth aided by the adoption of rigorous regulatory rules in various countries, such as the U.S. Healthcare payers are expected to expand rapidly during the forecast period, supported by the implementation of stringent regulatory requirements, an in-house lack of experienced individuals for claims processing, and growing healthcare costs and related frauds
- North America accounted for the largest revenue share of over 35.0% in 2021 owing to an increase in patient load and healthcare coverage, adoption of EHRs and e-prescribing services, growing government spending, and improving healthcare infrastructure
- The Asia Pacific market is likely to witness the fastest growth over the forecast period mainly owing to a quick expansion of the healthcare business, government attempts to improve the quality of healthcare delivery systems, and the adoption of technological advancements such as healthcare IT systems
- Key players also contribute to the industrygrowth by entering partnerships, mergers and acquisitions, and launching new products. For instance, in October 2021, The SSI Group developed a strategic alliance with RCxRules to provide updated automated billing solutions for healthcare organizations' population health and revenue cycle operations, resulting in revenue growth as the strategic partnership grows
Table of Contents
Chapter 1 Research Methodology & Scope
Chapter 2 Executive Summary
Chapter 3 Healthcare Claims Management Market Variables, Trends & Scope
Chapter 4 Healthcare Claims Management Market: Covid-19 Impact
Chapter 5 Healthcare Claims Management Market: Product Estimates & Trend Analysis
Chapter 6 Healthcare Claims Management Market: Component Estimates & Trend Analysis
Chapter 7 Healthcare Claims Management Market: Solution Type Estimates & Trend Analysis
Chapter 8 Healthcare Claims Management Market: Deployment Mode Estimates & Trend Analysis
Chapter 9 Healthcare Claims Management Market: End-Use Estimates & Trend Analysis
Chapter 10 Healthcare Claims Management Market: Regional Estimates & Trend Analysis, By Product, Component, Solution Type, Deployment Mode, And End-Use
Chapter 11 Competitive Landscape
Chapter 12 Company Profile
List of Tables
List of Figures
Companies Mentioned
- Mckesson Corporation
- The SSI Group, Inc
- Quest Diagnostics
- Kareo
- Optum, Inc (A Subsidiary Of Unitedhealth Group)
- Conifer Health Solutions
- Carecloud
- Eclinicalworks
- IBM
- Cerner Corporation
Methodology
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Table Information
| Report Attribute | Details |
|---|---|
| No. of Pages | 150 |
| Published | July 2022 |
| Forecast Period | 2022 - 2030 |
| Estimated Market Value ( USD | $ 25.44 Billion |
| Forecasted Market Value ( USD | $ 136.67 Billion |
| Compound Annual Growth Rate | 23.4% |
| Regions Covered | Global |
| No. of Companies Mentioned | 10 |
