U.S. Revenue Cycle Management Market Size to Hit Around USD 380.85 Bn By 2032
The U.S. revenue cycle management market size was exhibited at USD 141.6 billion in 2022 and is projected to hit around USD 380.85 billion by 2032, growing at a CAGR of 10.4% during the forecast period 2023 to 2032.
Key Takeaways:
U.S. Revenue Cycle Management Market Report Scope
| Report Attribute | Details |
| Market Size in 2023 | USD 156.33 Billion |
| Market Size by 2032 | USD 380.85 Billion |
| Growth Rate From 2023 to 2032 | CAGR of 10.4% |
| Base Year | 2022 |
| Forecast Period | 2023 to 2032 |
| Segments Covered | End user, Product type, Component, Delivery mode, Physician specialty, Sourcing, Function |
| Market Analysis (Terms Used) | Value (US$ Million/Billion) or (Volume/Units) |
| Report Coverage | Revenue forecast, company ranking, competitive landscape, growth factors, and trends |
| Key Companies Profiled | The SSI Group, Inc.; AllScripts Healthcare, LLC; McKesson Corporation; athenahealth, Inc.; Epic Systems Corporation; NXGN Management, LLC; eClinicalWorks; Oncospark, Inc. |
Growing data siloes emerging from multiple healthcare functionalities and departments are driving the need to consolidate and streamline unorganized workflows to boost efficiency and productivity in healthcare organizations. Furthermore, the growing trend of digital health and widespread adoption of healthcare IT solutions are anticipated to accelerate market growth. The market growth in the U.S. can also be attributed to the increasing healthcare IT spending and the growing trend of outsourcing RCM systems and services.
Healthcare systems in the U.S. are undergoing significant transformations and readily adopting electronic processes for claims and reimbursement management. The presence of numerous renowned healthcare facilities, increasing healthcare awareness and spending, and the growing digital literacy are expected to support the growth of the market. Favorable regulatory reforms from government agencies and regular technological advancements by market players are expected to boost market growth over the forthcoming years. The growing need for regular technological advancements is driving market players to revise their product development strategies to improve provider-patient relationship in healthcare facilities. Key participants are focusing on collaborations and strategic partnerships with other market players to combine expertise and grow their business footprint.
For instance, in January 2020, R1 RCM, Inc. entered into a strategic partnership with Rush University System for Health (RUSH) to achieve revenue cycle performance excellence and boost innovation in healthcare. As per the agreement, the platform by R1 RCM would be integrated with RUSH’s Epic EMR workflow, which uses enterprise-wide performance analytics and intelligent automation to improve the company’s current revenue cycle operations. In addition, the collaboration would aid R1 RCM to launch its innovation lab, which focuses on value-based care and incorporates advanced analytics to educate other healthcare institutions in preparing for the future healthcare workforce. This partnership is expected to enable significant improvements in serving patients and financial results in the Chicago metropolitan area.
Market players are introducing innovative product solutions to expand their product portfolio and grow their clientele. For instance, in June 2019, Homecare Homebase (HCHB) introduced a new RCM tool that would reduce the burden related to staffing and time-consuming administrative functions, which often restrict the home health agencies from spending more quality time with patients. Moreover, this new tool offers greater transparency into the murky RCM process that is suitable for agency management, by making use of HCHB dashboards and analytical systems. This new tool makes use of extensive knowledge of the billing process, which aids in achieving and maintaining high collection days and reducing outstanding days in accounts receivable (AR), enabling more time with patients.
Component Insights
The services segment dominated the market in 2022 and accounted for a revenue share of over 67.4%. Healthcare facilities are readily outsourcing RCM services from third-party vendors owing to the multiple advantages such as cost-effectiveness, staffing and training, and compliance to rules and regulations. The services segment is anticipated to register the fastest growth rate 11.2% over the forthcoming years owing to various strategic initiatives undertaken by established market players. For instance, Cerner Corporation divested its RCM outsourcing business to R1 RCM Inc. in 2020 to integrate the technological platform and capabilities of the two companies.
Similarly, in October 2019, SOC Telemed announced the completion of the pilot stages and beta testing of its RCM service that has been in use since January 2019, by deploying at strategic partner hospitals around the U.S. The company’s RCM service is focused on the billing of telemedicine services and its related financial liability from the hospital. This service aids in effectively capturing the available revenue for clinical partners, to ensure the sustainability of their telemedicine program through cost reduction.
Some of the RCM services offered to healthcare organizations are medical coding, medical billing, patient management solutions, and others. The software segment is expected to grow steadily owing to the growing demand for digitalization and streamlining of operational workflows to improve patient care. The growing amount of unorganized data rising from multiple healthcare functionalities requires centralization and consolidation, which is anticipated to contribute to the growth of the software segment.
Component Insights
The services segment dominated the market in 2022 and accounted for a revenue share of over 68.4%. Healthcare facilities are readily outsourcing RCM services from third-party vendors owing to the multiple advantages such as cost-effectiveness, staffing and training, and compliance to rules and regulations. The services segment is anticipated to register the fastest growth rate 11.2% over the forthcoming years owing to various strategic initiatives undertaken by established market players. For instance, Cerner Corporation divested its RCM outsourcing business to R1 RCM Inc. in 2020 to integrate the technological platform and capabilities of the two companies.
Similarly, in October 2019, SOC Telemed announced the completion of the pilot stages and beta testing of its RCM service that has been in use since January 2019, by deploying at strategic partner hospitals around the U.S. The company’s RCM service is focused on the billing of telemedicine services and its related financial liability from the hospital. This service aids in effectively capturing the available revenue for clinical partners, to ensure the sustainability of their telemedicine program through cost reduction.
Some of the RCM services offered to healthcare organizations are medical coding, medical billing, patient management solutions, and others. The software segment is expected to grow steadily owing to the growing demand for digitalization and streamlining of operational workflows to improve patient care. The growing amount of unorganized data rising from multiple healthcare functionalities requires centralization and consolidation, which is anticipated to contribute to the growth of the software segment.
Product Type Insights
The integrated system segment dominated the market in 2022 and accounted for a revenue share of over 73.4% owing to the constant technological advancements and widespread adoption of integrated RCM solutions by healthcare organizations. The integrated solutions segment is anticipated to register the fastest growth rate 10.6% over the forthcoming years. Integrated solutions provide a synchronized and streamlined platform for financial activities with a standardized data collection and analysis process.
Integrated systems are end-to-end systems enhancing an organization’s data sharing and interoperability capabilities. Integrated solutions enable the healthcare workforce to enhance productivity, minimize costs, and increase net operating margins. Lastly, the growing need to reduce human errors and speed up administrative functions contributes to the growth of integrated RCM solutions.
Delivery Mode Insights
Web-based delivery mode dominated the market in 2022 and accounted for a revenue share of over 58.6%. Web-based solutions are being increasingly implemented since these solutions can be installed off-site and do not require additional hardware or storage. Affordability and rapid deployment are some of the benefits offered by web-based solutions. athernaOne, e-Hospital Systems, Simplex HIMES, and Advanced HIMS are some examples of web-based practice management solutions.
The cloud-based segment is anticipated to register the fastest growth rate 11.10% over the forthcoming years. Cloud computing is revolutionizing the healthcare industry and offers increased cost-effectiveness and higher flexibility to users. Furthermore, cloud-deployed solutions offer safe and secure medical data sharing and automate backend processes. Cloud-based solutions enable healthcare facilities seamlessly manage electronic health records, and patient portals, and operate mobile applications. Lastly, cloud-deployed solutions are developed to improve operations, enhance resource procurement, and improve infrastructure dependability.
End-user Insights
The hospitals segment dominated the market in 2022 and accounted for a revenue share of over 56.0%. The growing presence of renowned and well-established hospitals in the U.S. and a growing number of patient care regulatory reforms and guidelines introduced by regulatory agencies are driving the hospitals segment. Hospitals are focusing on implementing innovative revenue cycle management solutions by collaborating with vendors to transform the reimbursement scenario, which is anticipated to boost segment growth. Moreover, the growing demand to optimize hospitals’ workflow to improve efficiency and productivity is driving the adoption of integrated RCM systems in hospitals.
The physician and clinical services segment is anticipated to register the fastest growth rate over the forecast period owing to the growing number of physicians in the U.S. In physician offices and clinical services, revenue cycle management systems are used by nursing staff, office managers, and consultants to ensure the smooth functioning of the healthcare facility. Moreover, the Covid-19 pandemic increased the demand for remote monitoring and physician consultations, which is anticipated to contribute to the segment growth. Private physician offices and clinical services are readily outsourcing RCM systems and services to address their unmet financial needs.
Physician Specialty Insights
The others segment dominated the U.S. market in 2022 and accounted for a revenue share of over 72.0% owing to the growing insurance coverage policies for various applications, which directly impact the demand for revenue cycle management solutions in different healthcare specialties. For example, substance abuse billing is the area where addiction/rehab centers face challenges due to loss in revenue and rescheduled payments. Numerous drug rehabilitation hubs and psychiatric organizations are shutting down due to the rapidly changing regulations and insurance policies.
The cardiology segment is anticipated to register the fastest growth rate over the forthcoming years. Cardiology treatments are expensive procedures and require RCM services as it enhances the procedure effectiveness, patient care, and seamlessly manages medical billing. According to the Centers for Disease Control and Prevention estimates, approximately 6.2 million American adults have heart failure and in 2019, heart failure was the underlying cause of 874,613 deaths. The rising prevalence of cardiovascular diseases directly increases the workload burden on healthcare providers and healthcare payers, which is expected to drive the segment. Thus, in order to handle the patient medical data, RCM is used for easy handling of the patient’s records. The billing workforce must need to have a comprehensive knowledge of the correct codes and converters necessary for cardiology methods like various forms of percutaneous coronary intrusions, pacemakers, and peripheral vascular methods.
Sourcing Insights
The in-house segment dominated the U.S. market in 2022 and accounted for a revenue share of over 71.6% owing to the multiple benefits associated with in-house sourcing such as maintaining complete control of entire coding operations, patient information confidentiality, and accessibility of in-house medical billers. One of the major challenges faced by in-house RCM services is the requirement of a lot of medical staff to handle the patient’s medical data. Healthcare providers need to employ trained billers and coders, which can result in backlogs if a single of them is ineffective, jeopardizing the entire revenue cycle. The outsourced RCM services segment is anticipated to register the fastest growth rate over the forecast period. Outsourced RCM services have become an attractive opportunity for small, medium, and large healthcare companies as executives and providers are focused on decreasing costs and improving efficiency.
In addition, the healthcare industry is observing an increase in the outsourcing of billing activities by physicians and hospitals due to mandatory execution of the intricate ICD-10 coding structure, growing care costs, and a national decree to implement electronic medical records to sustain compensation levels. Outsourcing of RCM lowers staff responsibility and improves collection level and pace by decreasing denials. In addition, the contracted companies generally deliver on-demand details regarding everyday finances. However, these services can be expensive, with fees centered on subscriptions or percentage of collection. Many companies are entering into partnerships to improve their services. For instance, in April 2018, Cognizant purchased Bolder Healthcare Solutions—an RCM vendor for physician practices, hospitals, and other professional organizations. In addition, R1 RCM Inc. acquired Intermedix Corp. in February 2018. Intermedix Corp offers practice management, RCM, and analytics solutions to emergency medical facilities and physicians.
Function Insights
The claims management segment dominated the U.S. market in 2022 and accounted for a revenue share of over 52.0% owing to the rapidly growing patient pool, increasing geriatric population, and the emergence of favorable government initiatives pertaining to medical insurance coverages. The change in population demographics, along with the increase in risk or value-based reimbursement model, is driving the need for improved prediction and supervision of revenue cycles, especially for high- and at-risk patient populations. Many U.S.-based providers still struggle with low operating margins, due to poor accounts receivable and growing average denial numbers. On average, providers pay USD 25 to rework each claim that is refused. Under the U.S. health plan, the average number of claims processed is 1 billion and it covers roughly 100 million individuals. Around 10% to 20% of the overall claims are refused or need recycling because of ineffective claim management.
The care management segment is anticipated to register the fastest growth rate over the forecast period owing to the increasing demand for virtual health applications to handle healthcare emergencies. The growing prevalence of chronic disorders is a major concern. Chronic conditions result in the highest morbidity and mortality in the U.S., and the monetary costs are also high. Annually, in the U.S., the expenditure on treating chronic illnesses is nearly USD 3 trillion and the lost productivity cost is over USD 1 billion. These health consequences and high costs are largely avoidable as some chronic conditions can be avoided or controlled to lower their impact. Mobile health apps can change the healthcare business by enhancing a patient’s capability to handle circumstances in a considerably easy manner.
Some of the prominent players in the U.S. Revenue Cycle Management Market include:
Segments Covered in the Report
This report forecasts revenue growth at country levels and provides an analysis of the latest industry trends in each of the sub-segments from 2018 to 2032. For this study, Nova one advisor, Inc. has segmented the U.S. Revenue Cycle Management market.
By End-user
By Product Type
By Component
By Delivery Mode
By Physician Specialty
By Sourcing
By Function
Chapter 1 Methodology and Scope
1.1 Market Segmentation and Scope
1.2 Research Methodology
1.2.1 Information procurement
1.3 Information or Data Analysis
1.4 Market Formulation & Validation
1.5 List of Secondary Sources
1.6 List of Primary Sources
Chapter 2 Executive Summary
2.1 Industry Insights
2.2 Segment Insight
2.3 Competitive Insight
2.4 Market Snapshot
Chapter 3 The U.S. Revenue Cycle Management (RCM) Market Variables, Trends & Scope
3.1 Penetration & Growth Prospect Mapping
3.2 Regulatory Framework
3.2.1 Reimbursement framework
3.2.1.1 Regulatory Modifications Influencing Radiology Reimbursement
3.2.1.2 Regulatory Modifications Influencing Cardiology Reimbursement
3.2.1.3 Preparing for Value-Based Reimbursement in Oncology Practices
3.2.2 Standards & Compliances
3.3 Market Dynamics
3.3.1 Market Driver Analysis
3.3.1.1 Technological Advancements
3.3.1.2 Increase in Outsourcing of RCM
3.3.1.3 Increasing Adoption of mHealth
3.3.1.4 Growth of High-deductible Health Plans (HDHPs)
3.3.2 Market Restraint Analysis
3.3.2.1 Increasing Payer Partnerships
3.3.2.2 Lack of Professionals to Handle RCM Processes
3.3.3 Market Opportunities
3.4 The U.S. Revenue Cycle Management Market Analysis Tools
3.4.1 The U.S. Revenue Cycle Management (RCM) Market - PEST Analysis
3.4.1.1 Political Landscape
3.4.1.2 Economic Landscape
3.4.1.3 Social Landscape
3.4.1.4 Technology Landscape
3.4.2 Industry Analysis - Porter’s
3.4.2.1 Bargaining power of suppliers - Moderate
3.4.2.2 Bargaining power of buyers - Moderate
3.4.2.3 Threat of substitution - Low
3.4.2.4 Threat of new entrants - Moderate
3.4.2.5 Competitive rivalry - High
3.5 Pricing Trends, by Physician Specialty
3.6 Product Adoption Patterns Analysis
3.7 Technology Trends in the RCM
3.8 Covid-19 Impact on the U.S. RCM Market
Chapter 4 The U.S. Revenue Cycle Management Market : Competitive Analysis
4.1 Recent Developments & Impact Analysis, by Key Market Participants
4.1.1 Healthcare veteran launched HealthRev Partners
4.1.2 Waystar Health launched Hubble
4.1.3 R1 RCM, Inc. launched R1 Professional
4.1.4 SOC Telemed launched RCM service offering
4.1.5 Mastercard launched a new unit for healthcare billing and data security
4.1.6 Homecare Home-base launched new RCM tool
4.1.7 Apprio, Inc. introduced ApprioHealth
4.1.8 The SSI Group, Inc. launched a new machine learning capability for predicting payor remittance
4.1.9 Healthcare Administrative Partners launched MIPS Measure Assurance Services
4.1.10 Patientco launched PatientWalletSM
4.2 Vendor Landscape
4.2.1 Key company market share analysis, 2023
4.2.2 Company market position analysis
4.2.3 Market Differentiators
4.2.4 Synergy Analysis: Major Deals & Strategic Alliances
4.2.4.1 Investment
4.2.4.2 Partnership
4.2.4.3 Merger & Acquisition
4.2.5 List of key emerging companies/technology disruptors/innovators
Chapter 5 The U.S. Revenue Cycle Management (RCM) Market: End-user Estimates & Trend Analysis
5.1 The U.S. Revenue Cycle Management (RCM) Market: End-user Movement Analysis, USD Billion, 2023 & 2032
5.2 Hospitals
5.2.1 The U.S. RCM market revenue estimates and forecasts for hospitals, 2020 - 2032
5.3 Physician & Clinical Services
5.3.1 The U.S. RCM market revenue estimates and forecasts for Physician and Clinical Services, 2020 - 2032
Chapter 6 The U.S. Revenue Cycle Management (RCM) Market: Product Type Estimates & Trend Analysis
6.1 The U.S. Revenue Cycle Management (RCM) Market: Product Type Movement Analysis, USD Billion, 2023 & 2032
6.2 Integrated System
6.2.1 The U.S. integrated RCM system market revenue estimates and forecasts, 2020 - 2032
6.3 Standalone System
6.3.1 The U.S. standalone RCM system market revenue estimates and forecasts, 2020 - 2032
Chapter 7 The U.S. Revenue Cycle Management (RCM) Market: Component Estimates & Trend Analysis
7.1 The U.S. Revenue Cycle Management (RCM) Market: Component Movement Analysis, USD Billion, 2023 & 2032
7.2 Software Solution
7.2.1 The U.S. RCM Software Solution market revenue estimates and forecasts, 2020 - 2032
7.3 Services
7.3.1 The U.S. RCM Services market revenue estimates and forecasts, 2020 - 2032
Chapter 8 The U.S. Revenue Cycle Management (RCM) Market: Delivery Mode Estimates & Trend Analysis
8.1 The U.S. Revenue Cycle Management (RCM) Market: Delivery Mode Movement Analysis, USD Billion, 2023 & 2032
8.2 On-premise
8.2.1 The U.S. On-premise RCM market revenue estimates and forecasts, 2020 - 2032
8.3 Web-based
8.3.1 The U.S. web-based RCM market revenue estimates and forecasts, 2020 - 2032
8.4 Cloud-based
8.4.1 The U.S. Cloud-based RCM market revenue estimates and forecasts, 2020 - 2032
Chapter 9 The U.S. Revenue Cycle Management (RCM) Market: Physician Specialty Estimates & Trend Analysis
9.1 The U.S. Revenue Cycle Management (RCM) Market: Physician specialty Movement Analysis, USD Billion, 2023 & 2032
9.2 Oncology
9.2.1 The U.S. RCM market revenue estimates and forecasts for oncology, 2020 - 2032
9.3 Cardiology
9.3.1 The U.S. RCM market revenue estimates and forecasts for Cardiology, 2020 - 2032
9.4 Anesthesia
9.4.1 The U.S. RCM market revenue estimates and forecasts for Anesthesia, 2020 - 2032
9.5 Radiology
9.5.1 The U.S. RCM market revenue estimates and forecasts for Radiology, 2020 - 2032
9.6 Pathology
9.6.1 The U.S. RCM market revenue estimates and forecasts for Pathology, 2020 - 2032
9.7 Pain Management
9.7.1 The U.S. RCM market revenue estimates and forecasts for pain Management, 2020 - 2032
9.8 Emergency Services
9.8.1 The U.S. RCM market revenue estimates and forecasts for Emergency Services, 2020 - 2032
9.9 Others
9.9.1 The U.S. RCM market revenue estimates and forecasts for Others, 2020 - 2032
Chapter 10 The U.S. Revenue Cycle Management (RCM) Market: Sourcing Estimates & Trend Analysis
10.1 The U.S. Revenue Cycle Management (RCM) Market: Sourcing Movement Analysis, USD Billion, 2023 & 2032
10.2 In-house
10.2.1 The U.S. In-house RCM market revenue estimates and forecasts, 2020 - 2032
10.3 External RCM Apps/Software
10.3.1 The U.S. External RCM Apps/Software market revenue estimates and forecasts, 2020 - 2032
10.4 Outsourced RCM Services
10.4.1 The U.S. Outsourced RCM Services market revenue estimates and forecasts, 2020 - 2032
Chapter 11 The U.S. Revenue Cycle Management (RCM) Market: Function Estimates & Trend Analysis
11.1 The U.S. Revenue Cycle Management (RCM) Market: Function Movement Analysis, USD Billion, 2023 & 2032
11.2 Product Development
11.2.1 The U.S. RCM market revenue estimates and forecasts for Product development, 2020 - 2032
11.3 Member Engagement
11.3.1 The U.S. RCM market revenue estimates and forecasts for member Engagement, 2020 - 2032
11.4 Network Management
11.4.1 The U.S. RCM market revenue estimates and forecasts for Network Management, 2020 - 2032
11.5 Care Management
11.5.1 The U.S. RCM market revenue estimates and forecasts for Care Management, 2020 - 2032
11.6 Claims Management
11.6.1 The U.S. RCM market revenue estimates and forecasts for Claims Management, 2020 - 2032
11.7 Risk and Compliance
11.7.1 The U.S. RCM market revenue estimates and forecasts for risk and compliance, 2020 - 2032
Chapter 12 Company Profiles
12.1 The SSI Group, Inc.
12.1.1 Company Overview
12.1.2 Financial Performance
12.1.3 Product Benchmarking
12.1.4 Strategic Initiatives
12.2 Allscripts Healthcare, LLC
12.2.1 Company Overview
12.2.2 Financial Performance
12.2.3 Product Benchmarking
12.3 Cerner Corporation
12.3.1 Company Overview
12.3.2 Financial Performance
12.3.2.1 Product Benchmarking
12.4 McKesson Corporation
12.4.1 Company Overview
12.4.2 Financial Performance
12.4.3 Product Benchmarking
12.5 Athenahealth, Inc. (Veritas Capital Fund Management, L.L.C. and Evergreen Coast Capital)
12.5.1 Company Overview
12.5.1.1 Financial Performance
12.5.1.2 Product Benchmarking
12.5.1.3 Strategic Initiatives
12.6 Oncospark, Inc.
12.6.1 Company Overview
12.6.2 Financial Performance
12.6.3 Product Benchmarking
12.7 R1 RCM, Inc.
12.7.1 Company Overview
12.7.2 Financial Performance
12.7.3 Product Benchmarking
12.7.3.1 Strategic Initiatives
12.8 Epic Systems Corporation
12.8.1 Company Overview
12.8.2 Financial Performance
12.8.3 Product Benchmarking
12.9 Eclinicalworks
12.9.1 Company Overview
12.9.2 Financial Performance
12.9.3 Product Benchmarking
12.9.4 Strategic Initiatives
12.10 NXGN Management, LLC
12.10.1 Company Overview
12.10.2 Financial Performance
12.10.3 Product Benchmarking
12.10.4 Strategic Initiatives
Cross-segment Market Size and Analysis for
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