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2023年至2028年医疗保健收益週期管理市场预测
市场调查报告书
商品编码
1410064

2023年至2028年医疗保健收益週期管理市场预测

Healthcare Revenue Cycle Management Market - Forecasts from 2023 to 2028
出版日期: | 出版商: Knowledge Sourcing Intelligence | 英文 149 Pages | 商品交期: 最快1-2个工作天内

价格
简介目录

医疗保健收益週期管理市场预计将从2021年的532.05亿美元成长到2028年的1,163.07亿美元，复合年增长率为11.82%。

医疗保健收益周期管理 (RCM) 是医疗保健营运的重要组成部分，重点关注患者照护的财务方面。 RCM 包括与病患服务收益业务、管理和征收相关的所有行政和临床业务。 RCM 在医疗保健组织中至关重要，因为它可确保正确申请、快速付款处理和收益。近年来，由于医疗报销系统日益复杂、监管变化和技术改进，医疗收益周期管理（RCM）市场规模不断扩大和变化。医疗保健成本上升、基于价值的护理模式的趋势以及对更快的财务处理的需求等趋势正在推动该行业的发展。此外，电子健康记录(EHR)、医疗编码系统和资料分析工具的使用正在改变收益週期管理格局。

医疗收益周期管理市场中医疗报销系统的复杂性不断增加

日益复杂的医疗报销体係是医疗保健企业面临的重大挑战。保险报销流程复杂且容易出错，因为它涉及相关人员、规则和编码要求。随着支付模式的发展和基于价值的护理的实施，报销系统变得越来越复杂。为了确保正确和及时的赔偿，医疗保健提供者必须穿越复杂的法律和法规。这种复杂性增加了管理负担，并增加了错误、延误和财务损失的风险。解决医疗报销系统日益复杂的问题需要新颖的解决方案和技术来加快业务并提高准确性和效率。

对简化财务流程的需求推动医疗保健收益周期管理市场的成长

在医疗保健产业，改善财务业务的愿望是一个基本驱动力。医疗保健公司正在寻找简化和优化其财务流程的方法，以提高效率并减少费用。这包括自动化财务活动、加速申请和索赔处理以及增强收益週期管理。透过简化的财务程序，医疗保健提供者可以减少管理工作、加快支付週期、消除错误并提高整体财务绩效。医疗保健产业对业务效率和财务永续性的关注正在推动对创新解决方案和技术的需求，从而为医疗保健组织提供无缝且有效的财务管理。

医疗收益周期管理市场采用电子健康记录(EHR)

电子健康记录(EHR) 的使用已成为医疗收益週期管理业务不可或缺的一部分。 EHR 透过数位化病患资讯来自动化文件和申请流程，使医疗保健专业人员能够更有效地处理和追踪财务资料。与 EHR 整合的收益週期管理系统可协助医疗保健组织优化编码、提高申请准确性并减少申请错误。 EHR 和 RCM 系统的整合透过简化工作流程、提高编码准确性以及实现高效的申请和支付程序来扩大市场。

北美是最大的医疗保健收益周期管理市场

北美在医疗收益周期管理市场中占据最大的市场占有率。这是由于该地区完善的医疗基础设施、高昂的医疗成本、先进的付款系统以及大型收益週期管理解决方案供应商的存在。此外，《健康保险互通性与课责法案》(HIPAA) 等严格的法律要求正在推动北美地区采用收益週期管理系统。该地区专注于开发高效的财务程序、优化报销和加强收益征收，将其定位为领先的医疗收益周期管理市场系统。

需要在医疗收益週期管理 (RCM) 市场中获取收益并提高申请准确性

准确及时的申请对于医疗机构确保适当的报销、财务稳定和优质的患者照护至关重要。申请不准确可能会导致申请、收入损失和合规问题。日益复杂的医疗保健报销系统、新的支付结构和监管限制使得准确的服务收取和申请变得困难。人们越来越需要能够自动编码和申请并利用人工智慧和机器学习等新技术来提高申请准确性的系统。提高收益收集和申请准确性有助于医疗保健组织最大限度地提高收益、减少拒绝并增强财务绩效，同时保持监管合规性。

主要进展

2023 年 3 月，Satori Healing, LLC 最近选择了 eClinicalWorks 和 heow，以提高病患满意度和收益週期管理 (RCM) 服务。 2022年9月，AGS Health宣布推出AGS AI平台，该平台利用人工智慧和自动化提供端到端的收益週期管理。基于人工智慧的平台使医疗保健组织能够提高日常业务和收益週期的绩效，包括生产力报告、智慧型工作清单和可自订的仪表板。

公司产品

  • 申请管理： eClinicalWorks 提供管理申请从提交到付款的整个过程的解决方案。这些系统会自动建立、清理和提交申请，减少错误并提高报销率。
  • 拒绝管理： RCM 解决方案提供拒绝管理工具来快速侦测和解决申请问题。透过简化流程，组织可以更快地重新提交申请并降低成本。
  • 编码和文件： McKesson 的 RCM 服务包括编码和文件支持，以确保准确且合规的编码实践。这提高了编码准确性，降低了审核风险，并确保适当的补偿。
  • 病患报表与收集：eClinicalWorks 可以建立和分发病患报表，从而公开、清楚地揭露财务责任。 eClinicalWorks 也提供催收管理解决方案，协助您简化和追踪催收程序。

目录

第一章简介

  • 市场概况
  • 市场定义
  • 调查范围
  • 市场区隔
  • 货币
  • 先决条件
  • 基准年和预测年时间表

第二章调查方法

  • 调查资料
  • 资讯来源
  • 研究设计

第三章执行摘要

  • 研究亮点

第四章市场动态

  • 市场驱动因素
  • 市场抑制因素
  • 波特五力分析
    • 供应商的议价能力
    • 买方议价能力
    • 新进入者的威胁
    • 替代品的威胁
    • 业内竞争对手之间的对抗关係
  • 产业价值链分析

第五章医疗保健收益周期管理市场：依产品类型

  • 介绍
  • 综合解决方案
  • 独立解决方案
  • 服务

第六章医疗收益周期管理市场：依功能

  • 介绍
  • 管理投诉和拒绝
  • 医疗编码和申请
  • 付款汇款
  • 验证保险资格
  • 其他的

第七章医疗收益周期管理市场：依发展分类

  • 介绍
  • 本地
  • 云端基础

第八章医疗收益周期管理市场：依最终用户分类

  • 介绍
  • 医院
  • 医生治疗
  • 诊断实验室
  • 门诊手术中心
  • 其他的

第九章医疗收益周期管理市场：按地区

  • 介绍
  • 北美洲
    • 美国
    • 加拿大
    • 墨西哥
  • 南美洲
    • 巴西
    • 阿根廷
    • 其他的
  • 欧洲
    • 英国
    • 德国
    • 法国
    • 义大利
    • 西班牙
    • 其他的
  • 中东/非洲
    • 沙乌地阿拉伯
    • 阿拉伯聯合大公国
    • 其他的
  • 亚太地区
    • 日本
    • 中国
    • 印度
    • 韩国
    • 印尼
    • 台湾
    • 其他的

第十章竞争环境及分析

  • 主要企业及策略分析
  • 新兴企业和市场盈利
  • 合併、收购、协议和合作
  • 供应商竞争力矩阵

第十一章 公司简介

  • CERNER CORPORATION
  • EPIC SYSTEMS CORPORATION
  • ALLSCRIPTS HEALTHCARE SOLUTIONS, INC.
  • ATHENAHEALTH, INC.（ACQUIRED BY VERITAS CAPITAL AND EVERGREEN COAST CAPITAL）
  • MCKESSON CORPORATION
  • QUEST DIAGNOSTICS INCORPORATED
  • GE HEALTHCARE
  • EXPERIAN INFORMATION SOLUTIONS, INC.
  • CHANGE HEALTHCARE
  • WAYSTAR（FORMERLY KNOWN AS ZIRMED）
简介目录
Product Code: KSI061615737

The healthcare revenue cycle management market is expected to grow at a CAGR of 11.82% from US$53.205 billion in 2021 to US$116.307 billion in 2028.

The healthcare revenue cycle management (RCM) is an important part of the healthcare business that focuses on the financial aspects of patient care. It includes all administrative and clinical operations linked to patient service revenue capture, management, and collection. RCM is critical in healthcare organizations because it ensures correct invoicing, fast payment processing, and revenue creation. Because of the rising complexity of healthcare reimbursement systems, regulatory changes, and technology improvements, the healthcare revenue cycle management (RCM) market size has seen substantial expansion and transition in recent years. Factors such as growing healthcare costs, a trend toward value-based care models, and the demand for faster financial procedures are driving the industry. Furthermore, the use of electronic health records (EHRs), medical coding systems, and data analytics tools has transformed the revenue cycle management environment.

Increasing Complexity of Healthcare Reimbursement Systems in the Healthcare Revenue Cycle Management Market.

The growing complexity of healthcare reimbursement systems is a substantial challenge to the healthcare business. Reimbursement processes are complicated and prone to mistakes since they include several parties, rules, and coding requirements. Reimbursement systems have gotten increasingly more complex as payment models have evolved and value-based treatment has been implemented. To guarantee correct and timely compensation, healthcare providers must traverse a maze of laws and regulations. The intricacy increases the administrative load and raises the danger of errors, delays, and financial losses. To address the growing complexity of healthcare reimbursement systems, novel solutions, and technology are required to expedite operations and improve accuracy and efficiency.

Demand for Streamlined Financial Processes Drives the Healthcare Revenue Cycle Management Market Growth

In the healthcare business, the desire for improved financial operations is a fundamental driver. Healthcare organizations are looking for methods to streamline and optimize their financial processes to increase efficiency and cut expenses. This involves automating financial activities, expediting invoicing and claims processes, and enhancing revenue cycle management. Healthcare providers may decrease administrative hassles, accelerate payment cycles, eliminate mistakes, and improve overall financial performance by using simplified financial procedures. The industry's focus on operational efficiency and financial sustainability is driving the demand for innovative solutions and technology that enable seamless and effective financial management in healthcare organizations.

Adoption of Electronic Health Records (EHRs) in Healthcare Revenue Cycle Management Market.

The use of Electronic Health Records (EHRs) has become an essential component of the healthcare revenue cycle management business. EHRs automate documentation and billing procedures by digitizing patient information, allowing healthcare practitioners to handle and track financial data more effectively. EHR-integrated revenue cycle management systems assist healthcare organizations in optimizing coding, improving claim accuracy, and reducing billing mistakes. Integration of EHRs with RCM systems simplifies workflows, improves coding accuracy, and enables efficient billing and payment procedures, resulting in a market increase.

North America has the Biggest Market in the Healthcare Revenue Cycle Management Market.

North America has the largest market share in the healthcare revenue cycle management market. Several reasons contribute to this, including the region's well-established healthcare infrastructure, high healthcare expenditure, sophisticated payment systems, and the presence of significant revenue cycle management solution suppliers. Furthermore, strict legal requirements, such as the Health Insurance Portability and Accountability Act (HIPAA), promote revenue cycle management system adoption in North America. The region's emphasis on developing efficient financial procedures, optimizing reimbursement, and enhancing revenue collection positions it as the main healthcare revenue cycle management market system.

Need for Improved Revenue Capture and Billing Accuracy in Healthcare Revenue Cycle Management (RCM) Market.

For healthcare organizations to secure adequate reimbursement, financial stability, and high-quality patient care, accurate and timely billing is critical. Incorrect billing can result in claim denials, income loss, and compliance problems. The growing complexity of healthcare reimbursement systems, new payment structures, and regulatory constraints make it difficult to correctly collect and charge for services. There is an increasing need for systems that automate coding and billing and utilize new technologies such as artificial intelligence and machine learning to increase billing accuracy. Improving revenue collection and billing accuracy helps healthcare organizations maximize revenue, decrease rejections, and enhance financial performance while remaining in regulatory compliance.

Key Developments:

  • In March 2023, Satori Healing, LLC recently selected eClinicalWorks and healow for enhanced patient satisfaction and Revenue Cycle Management (RCM) services. eClinicalWork's revenue cycle management would enable Satori Healing LLC to have real-time access to financial data.
  • In September 2022, AGS Health announced the launch of "AGS AI Platform" which uses Artificial Intelligence and automation for providing end-to-end revenue cycle management. The AI-based platform would enable healthcare organizations to enhance their day-to-day operations inclusive & overall revenue cycle performance including productivity reports, intelligent worklists, and customizable dashboards.

Company Products:

  • Claims Management: eClinicalWorks provides solutions to help you manage your claims from submission to payment. These systems automate the production, scrubbing, and submission of claims, reducing mistakes and increasing reimbursement rates.
  • Denial Management: Their RCM solutions offer denial management tools that allow them to quickly detect and address claim denials. Organizations can resubmit claims quicker and save money by simplifying the process.
  • Coding and Documentation: To guarantee accurate and compliant coding practices, McKesson's RCM services include coding and documentation support. This improves coding accuracy, lowers audit risks, and ensures appropriate compensation.
  • Patient Statements and Collections: eClinicalWorks allows for the creation and distribution of patient statements, allowing for the open and unambiguous disclosure of financial responsibility. They also provide collections management solutions to assist organizations in streamlining and tracking their collection procedures.

Segmentation

By Product Type

  • Integrated Solutions
  • Standalone Solutions
  • Services

By Function

  • Claims & Denial Management
  • Medical Coding & Billing
  • Payment Remittance
  • Insurance Eligibility Verification
  • Others

By Deployment

  • On-Premises
  • Cloud-Based

By End-User

  • Hospitals
  • Physician Practices
  • Diagnostic Laboratories
  • Ambulatory Surgical Centers
  • Others

By Geography

  • North America
  • United States
  • Canada
  • Mexico
  • South America
  • Brazil
  • Argentina
  • Others
  • Europe
  • United Kingdom
  • Germany
  • France
  • Italy
  • Spain
  • Others
  • Middle East and Africa
  • Saudi Arabia
  • UAE
  • Others
  • Asia Pacific
  • Japan
  • China
  • India
  • South Korea
  • Indonesia
  • Taiwan
  • Others

TABLE OF CONTENTS

1. INTRODUCTION

  • 1.1. MARKET OVERVIEW
  • 1.2. Market Definition
  • 1.3. Scope of the Study
  • 1.4. Market Segmentation
  • 1.5. Currency
  • 1.6. Assumptions
  • 1.7. Base, and Forecast Years Timeline

2. RESEARCH METHODOLOGY

  • 2.1. Research Data
  • 2.2. Sources
  • 2.3. Research Design

3. EXECUTIVE SUMMARY

  • 3.1. Research Highlights

4. MARKET DYNAMICS

  • 4.1. Market Drivers
  • 4.2. Market Restraints
  • 4.3. Porters Five Forces Analysis
    • 4.3.1. Bargaining Power of Suppliers
    • 4.3.2. Bargaining Power of Buyers
    • 4.3.3. Threat of New Entrants
    • 4.3.4. Threat of Substitutes
    • 4.3.5. Competitive Rivalry in the Industry
  • 4.4. Industry Value Chain Analysis

5. HEALTHCARE REVENUE CYCLE MANAGEMENT MARKET, BY PRODUCT TYPE

  • 5.1. Introduction
  • 5.2. INTEGRATED SOLUTIONS
  • 5.3. STANDALONE SOLUTIONS
  • 5.4. SERVICES

6. HEALTHCARE REVENUE CYCLE MANAGEMENT MARKET, BY FUNCTION

  • 6.1. Introduction
  • 6.2. Claims & Denial Management
  • 6.3. Medical Coding & Billing
  • 6.4. Payment Remittance
  • 6.5. Insurance Eligibility Verification
  • 6.6. Others

7. HEALTHCARE REVENUE CYCLE MANAGEMENT MARKET, BY DEPLOYMENT

  • 7.1. Introduction
  • 7.2. ON-PREMISES
  • 7.3. CLOUD-BASED

8. HEALTHCARE REVENUE CYCLE MANAGEMENT MARKET, BY END-USER

  • 8.1. Introduction
  • 8.2. Hospitals
  • 8.3. Physician Practices
  • 8.4. Diagnostic Laboratories
  • 8.5. Ambulatory Surgical Centers
  • 8.6. Others

9. HEALTHCARE REVENUE CYCLE MANAGEMENT MARKET, BY GEOGRAPHY

  • 9.1. Introduction
  • 9.2. North America
    • 9.2.1. United States
    • 9.2.2. Canada
    • 9.2.3. Mexico
  • 9.3. South America
    • 9.3.1. Brazil
    • 9.3.2. Argentina
    • 9.3.3. Others
  • 9.4. Europe
    • 9.4.1. United Kingdom
    • 9.4.2. Germany
    • 9.4.3. France
    • 9.4.4. Italy
    • 9.4.5. Spain
    • 9.4.6. Others
  • 9.5. The Middle East and Africa
    • 9.5.1. Saudi Arabia
    • 9.5.2. UAE
    • 9.5.3. Others
  • 9.6. Asia Pacific
    • 9.6.1. Japan
    • 9.6.2. China
    • 9.6.3. India
    • 9.6.4. South Korea
    • 9.6.5. Indonesia
    • 9.6.6. Taiwan
    • 9.6.7. Others

10. COMPETITIVE ENVIRONMENT AND ANALYSIS

  • 10.1. Major Players and Strategy Analysis
  • 10.2. Emerging Players and Market Lucrativeness
  • 10.3. Mergers, Acquisitions, Agreements, and Collaborations
  • 10.4. Vendor Competitiveness Matrix

11. COMPANY PROFILES

  • 11.1. CERNER CORPORATION
  • 11.2. EPIC SYSTEMS CORPORATION
  • 11.3. ALLSCRIPTS HEALTHCARE SOLUTIONS, INC.
  • 11.4. ATHENAHEALTH, INC. (ACQUIRED BY VERITAS CAPITAL AND EVERGREEN COAST CAPITAL)
  • 11.5. MCKESSON CORPORATION
  • 11.6. QUEST DIAGNOSTICS INCORPORATED
  • 11.7. GE HEALTHCARE
  • 11.8. EXPERIAN INFORMATION SOLUTIONS, INC.
  • 11.9. CHANGE HEALTHCARE
  • 11.10. WAYSTAR (FORMERLY KNOWN AS ZIRMED)