U.S. Revenue Cycle Management Industry Overview

The U.S. revenue cycle management market size was estimated at USD 155.59 billion in 2023 and is projected to grow at a CAGR of 10.18% from 2024 to 2030. The rapidly transforming healthcare system, including digitalization, has paved the path for implementing healthcare IT services such as Revenue Cycle Management (RCM) systems to organize and streamline healthcare organization workflows using synchronized management software solutions. RCM solutions are an integration of payment models, reimbursement guidelines, codes, and third-party payers. Medical services are facing complex challenges in billing and precise payment, which is anticipated to drive the demand for innovative RCM solutions. The availability of advanced innovative RCM solutions offered by renowned third-party service providers can help healthcare organizations leverage the economic value and efficacy of these RCM solutions while simultaneously focusing on improving patient care.

Gather more insights about the market drivers, restrains and growth of the U.S. Revenue Cycle Management Market

The outsourcing of RCM by U.S. players is growing due to its increasing popularity. The market is expected to grow significantly due to the complexity and labor-intensive nature of RCM processes, the scarcity of skilled healthcare professionals, the need for cost-effective solutions, and the challenges posed by stringent regulations, financial pressures, & staff shortages in the healthcare industry. As a result, healthcare providers are increasingly opting to outsource RCM tasks to specialized companies to streamline processes, reduce costs, improve accuracy, & focus on patient care over administrative tasks. This trend is expected to continue as providers seek efficient cash flow, cost savings, and enhanced value-based care delivery.

Moreover, market players are strengthening revenue cycle platforms by integrating Artificial Intelligence (AI), electronic health records systems, and data analytics, which contributes to reducing administrative burdens, streamlining workflows, & improving revenue capture. For instance, in September 2022, AGS Health, an RCM solutions provider, launched the AGS AI Platform. This solution blends AI and automation with human-in-the-loop services and experts to maximize revenue cycle performance. This platform can enhance visibility into the day-to-day performance and operations of the revenue cycle, including productivity reports, root cause analysis, intelligent worklists, executive reporting, & customizable dashboards. The growing adoption of telemedicine and homecare offering value-based care is expected to support market growth.

Recent Developments

• In July 2023, TELCOR, Inc. launched version 21.3 of TELCOR RCM. The update enabled the use of web APIs, Report Designer (expanded use), Executive Module, and other features to improve laboratory productivity & collections.

• In June 2022, R1 RCM, Inc. acquired Cloudmed, intending to offer a leading healthcare provider RCM platform and drive digital transformation through automation & AI.

• In February 2020, Waystar Health launched Hubble, an AI/RPA-integrated platform for revenue cycle process automation. This platform helped increase revenue capture using predictive analytics and advanced machine learning algorithms. These advanced addon integrations automatically recognize missing charges, coding variances, and DRG anomalies based on an organization’s past billing practice. The Hubble platform enables a seamless financial experience for patients and helps determine patients’ ability & likelihood to pay.

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U.S. Revenue Cycle Management Market Segmentation

Grand View Research has segmented the U.S. revenue cycle management market based on end-use, product type, component, delivery mode, physician specialty, sourcing, and function:

U.S. Revenue Cycle Management Product Type Outlook (Revenue, USD Billion, 2018 - 2030)
• Integrated System
• Standalone System

U.S. Revenue Cycle Management Component Outlook (Revenue, USD Billion, 2018 - 2030)
• Software Solution
• Services

U.S. Revenue Cycle Management Delivery Mode Outlook (Revenue, USD Billion, 2018 - 2030)
• On-Premise
• Web-Based
• Cloud-Based

U.S. Revenue Cycle Management Physician Specialty Outlook (Revenue, USD Billion, 2018 - 2030)
• Oncology
• Cardiology
• Anesthesia
• Radiology
• Pathology
• Pain Management
• Emergency Services
• Others

U.S. Revenue Cycle Management Sourcing Outlook (Revenue, USD Billion, 2018 - 2030)
• In-house
• External RCM Apps/Software
• Outsourced RCM Services

U.S. Revenue Cycle Management Function Outlook (Revenue, USD Billion, 2018 - 2030)
• Product Development
• Member Engagement
• Network Management
• Care Management
• Claim Management
• Risk and Compliances

U.S. Revenue Cycle Management End-use Outlook (Revenue, USD Billion, 2018 - 2030)
• Hospitals
• Physician & Clinical Services

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Key Companies profiled:
• athenahealth, Inc.
• Cerner Corporation
• eClinicalWorks
• Epic Systems Corporation
• McKesson Corporation
• NXGN Management, LLC
• Oncospark, Inc.
• R1 RCM, Inc.
• The SSI Group, Inc.
• Veradigm LLC (Allscripts Healthcare LLC)