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2023年至2028年醫療保健收益週期管理市場預測
市場調查報告書
商品編碼
1410064

2023年至2028年醫療保健收益週期管理市場預測

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個工作天內

價格
簡介目錄

醫療保健收益週期管理市場預計將從2021年的532.05億美元成長到2028年的1,163.07億美元，複合年成長率為11.82%。

醫療保健收益周期管理 (RCM) 是醫療保健營運的重要組成部分，重點關注患者照護的財務方面。 RCM 包括與病患服務收益業務、管理和徵收相關的所有行政和臨床業務。 RCM 在醫療保健組織中至關重要，因為它可確保正確申請、快速付款處理和收益。近年來，由於醫療報銷系統日益複雜、監管變化和技術改進，醫療收益周期管理（RCM）市場規模不斷擴大和變化。醫療保健成本上升、基於價值的護理模式的趨勢以及對更快的財務處理的需求等趨勢正在推動該行業的發展。此外，電子健康記錄(EHR)、醫療編碼系統和資料分析工具的使用正在改變收益週期管理格局。

醫療收益周期管理市場中醫療報銷系統的複雜性不斷增加

日益複雜的醫療報銷體係是醫療保健企業面臨的重大挑戰。保險報銷流程複雜且容易出錯，因為它涉及相關人員、規則和編碼要求。隨著支付模式的發展和基於價值的護理的實施，報銷系統變得越來越複雜。為了確保正確和及時的賠償，醫療保健提供者必須穿越複雜的法律和法規。這種複雜性增加了管理負擔，並增加了錯誤、延誤和財務損失的風險。解決醫療報銷系統日益複雜的問題需要新穎的解決方案和技術來加快業務並提高準確性和效率。

對簡化財務流程的需求推動醫療保健收益周期管理市場的成長

在醫療保健產業，改善財務業務的願望是一個基本驅動力。醫療保健公司正在尋找簡化和最佳化其財務流程的方法，以提高效率並減少費用。這包括自動化財務活動、加速申請和索賠處理以及增強收益週期管理。透過簡化的財務程序，醫療保健提供者可以減少管理工作、加快支付週期、消除錯誤並提高整體財務績效。醫療保健產業對業務效率和財務永續性的關注正在推動對創新解決方案和技術的需求，從而為醫療保健組織提供無縫且有效的財務管理。

醫療收益周期管理市場採用電子健康記錄(EHR)

電子健康記錄(EHR) 的使用已成為醫療收益週期管理業務不可或缺的一部分。 EHR 透過數位化病患資訊來自動化文件和申請流程，使醫療保健專業人員能夠更有效地處理和追蹤財務資料。與 EHR 整合的收益週期管理系統可協助醫療保健組織最佳化編碼、提高申請準確性並減少申請錯誤。 EHR 和 RCM 系統的整合透過簡化工作流程、提高編碼準確性以及實現高效的申請和支付程序來擴大市場。

北美是最大的醫療保健收益周期管理市場

北美在醫療收益周期管理市場中佔據最大的市場佔有率。這是由於該地區完善的醫療基礎設施、高昂的醫療成本、先進的付款系統以及大型收益週期管理解決方案供應商的存在。此外，《健康保險互通性與課責法案》(HIPAA) 等嚴格的法律要求正在推動北美地區採用收益週期管理系統。該地區專注於開發高效的財務程序、最佳化報銷和加強收益徵收，將其定位為領先的醫療收益周期管理市場系統。

需要在醫療收益週期管理 (RCM) 市場中獲取收益並提高申請準確性

準確及時的申請對於醫療機構確保適當的報銷、財務穩定和優質的患者照護至關重要。申請不準確可能會導致申請、收入損失和合規問題。日益複雜的醫療保健報銷系統、新的支付結構和監管限制使得準確的服務收取和申請變得困難。人們越來越需要能夠自動編碼和申請並利用人工智慧和機器學習等新技術來提高申請準確性的系統。提高收益收集和申請準確性有助於醫療保健組織最大限度地提高收益、減少拒絕並增強財務績效，同時保持監管合規性。

主要進展

2023 年 3 月，Satori Healing, LLC 最近選擇了 eClinicalWorks 和 heow，以提高病患滿意度和收益週期管理 (RCM) 服務。 2022年9月，AGS Health宣布推出AGS AI平台，該平台利用人工智慧和自動化提供端到端的收益週期管理。基於人工智慧的平台使醫療保健組織能夠提高日常業務和收益週期的績效，包括生產力報告、智慧型工作清單和可自訂的儀表板。

公司產品

  • 申請管理： eClinicalWorks 提供管理申請從提交到付款的整個過程的解決方案。這些系統會自動建立、清理和提交申請，減少錯誤並提高報銷率。
  • 拒絕管理： RCM 解決方案提供拒絕管理工具來快速偵測和解決申請問題。透過簡化流程，組織可以更快地重新提交申請並降低成本。
  • 編碼和文件： McKesson 的 RCM 服務包括編碼和文件支持，以確保準確且合規的編碼實踐。這提高了編碼準確性，降低了審核風險，並確保適當的補償。
  • 病患報表與收集：eClinicalWorks 可以建立和分發病患報表，從而公開、清楚地揭露財務責任。 eClinicalWorks 也提供催收管理解決方案，協助您簡化和追蹤催收程序。

目錄

第1章簡介

  • 市場概況
  • 市場定義
  • 調查範圍
  • 市場區隔
  • 貨幣
  • 先決條件
  • 基準年和預測年時間表

第2章調查方法

  • 調查資料
  • 資訊來源
  • 研究設計

第3章執行摘要

  • 研究亮點

第4章市場動態

  • 市場促進因素
  • 市場抑制因素
  • 波特五力分析
    • 供應商的議價能力
    • 買方議價能力
    • 新進入者的威脅
    • 替代品的威脅
    • 業內競爭對手之間的對抗關係
  • 產業價值鏈分析

第5章醫療保健收益周期管理市場：依產品類型

  • 介紹
  • 綜合解決方案
  • 獨立解決方案
  • 服務

第6章醫療收益周期管理市場：依功能

  • 介紹
  • 管理投訴和拒絕
  • 醫療編碼和申請
  • 付款匯款
  • 驗證保險資格
  • 其他

第7章醫療收益周期管理市場：依發展分類

  • 介紹
  • 本地
  • 雲端基礎

第8章醫療收益周期管理市場：依最終用戶分類

  • 介紹
  • 醫院
  • 醫生治療
  • 診斷實驗室
  • 門診手術中心
  • 其他

第9章醫療收益周期管理市場：按地區

  • 介紹
  • 北美洲
    • 美國
    • 加拿大
    • 墨西哥
  • 南美洲
    • 巴西
    • 阿根廷
    • 其他
  • 歐洲
    • 英國
    • 德國
    • 法國
    • 義大利
    • 西班牙
    • 其他
  • 中東/非洲
    • 沙烏地阿拉伯
    • 阿拉伯聯合大公國
    • 其他
  • 亞太地區
    • 日本
    • 中國
    • 印度
    • 韓國
    • 印尼
    • 台灣
    • 其他

第10章競爭環境及分析

  • 主要企業及策略分析
  • 新興企業和市場盈利
  • 合併、收購、協議和合作
  • 供應商競爭力矩陣

第11章 公司簡介

  • 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）
簡介目錄
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)