US RCM Growth Opportunities

US RCM Growth Opportunities

Internal Challenges due to COVID-19 Accelerated the Shift to Revenue Cycle Management (RCM) Outsourcing

RELEASE DATE
29-Mar-2022
REGION
North America
Research Code: K646-01-00-00-00
SKU: HC03525-NA-MT_26421
$4,950.00
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SKU
HC03525-NA-MT_26421
$4,950.00
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Description

This research service provides an overview of the US revenue cycle management, revenue forecast, and competitive analysis of various legacy and modular RCM solutions. This study explores RCM applications across front-end, middle, and back-end processes and the end users are hospitals and ambulatory physician practices. In addition, it offers detailed insight into the RCM outsourcing market in the US.

RCM refers to the several administrative and clinical functions for capturing, managing, and collecting patient service revenue. The RCM process starts with admission (patient access) and continues to accounts receivable (payment and collections). Several RCM solutions (for example, IT applications and services) help healthcare providers perform different functions.

The top three strategic imperatives impacting RCM are:

Internal Challenges: Healthcare organizations are looking for improved efficiency, faster reimbursement, and profitability by reducing billing errors, lowering cost, and optimizing collection during COVID-19. Pent-up demand for elected surgeries, due from the last two years, is further requiring providers to bolster the productivity of their incumbent RCM solutions.

Transformative Mega Trends: COVID-19 pandemic has led to a surge of patients with long-term symptoms that vary from traditional chronic conditions with new comorbidities to the unprecedented prevalence of rare diseases. As a result, robust clinical risk management has become imperative to new-age RCM, leading vendors to transform their RCM platforms’ underlying clinical logic, financial template, and codes.

Customer Value Chain Compression: Providers use and prefer a mix of in-house and outsourced RCM to meet their organizational needs. Vendors for this outsourcing appear to be very fragmented based on expertise in specific areas of need across front-end, middle, and back-end processes.

Author: Koustav Chatterjee

Table of Contents

Why Is It Increasingly Difficult to Grow?

The Strategic Imperative 8™

The Impact of the Top Three Strategic Imperatives on US RCM

Growth Opportunities Fuel the Growth Pipeline Engine™

Scope of Analysis

End User and Product Segmentation of RCM

Summary RCM Process Pathway

Current State of the US RCM

Current State of US RCM—Level of Satisfaction for Incumbent RCM Processes

Current State of US Hospital RCM—Level of Satisfaction for Outsourced RCM Processes

Current State of US Physician Practices RCM—Level of Satisfaction for Outsourced RCM Processes

Impact of COVID-19 on the Shift to RCM Outsourcing

COVID-19’s Impact on RCM & Outsourcing—Discussion

Key Growth Metrics for US RCM

Growth Drivers for US RCM

Growth Restraints for US RCM

Forecast Assumptions, US RCM Market

Revenue Forecast, RCM

Revenue Forecast by Applications, RCM

Revenue Forecast Analysis, US RCM

Pricing Trends and Forecast Analysis, US RCM

Competitive Environment, US RCM Market

Competitive Overview

Competitive Overview (continued)

Key Growth Metrics for Hospital RCM

Market Segmentation

Revenue Forecast by Application, Hospital RCM Software

Revenue Forecast by Application, Hospital RCM Services

Forecast Analysis, Hospital RCM

Key Growth Metrics for Physician Practices RCM

Revenue Forecast, Physician Practices RCM

Revenue Forecast by Application, Physician Practices RCM Software

Revenue Forecast by Application, Physician Practices RCM Services

Forecast Analysis by End User, Physician Practices RCM

Growth Opportunity 1—Big Tech will help Legacy CDI Solution Providers Expand Scope from Disparate OPDs and ICUs to Enterprise-level Case Management

Growth Opportunity 1—Big Tech will help Legacy CDI Solution Providers Expand Scope from Disparate OPDs and ICUs to Enterprise-level Case Management (continued)

Growth Opportunity 2—Overhaul of Front-end RCM Processes for Physician Practices will Improve End-user Satisfaction

Growth Opportunity 2—Overhaul of Front-end RCM Processes for Physician Practices will Improve End-user Satisfaction (continued)

Growth Opportunity 3—Hospital RCM Back-end Processes are Ready for Outsourcing After COVID-19 to Improve Collection and Ratings

Growth Opportunity 3—Hospital RCM Back-end Processes are Ready for Outsourcing After COVID-19 to Improve Collection and Ratings (continued)

Your Next Steps

Why Frost, Why Now?

List of Exhibits

List of Exhibits (continued)

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Related Research
This research service provides an overview of the US revenue cycle management, revenue forecast, and competitive analysis of various legacy and modular RCM solutions. This study explores RCM applications across front-end, middle, and back-end processes and the end users are hospitals and ambulatory physician practices. In addition, it offers detailed insight into the RCM outsourcing market in the US. RCM refers to the several administrative and clinical functions for capturing, managing, and collecting patient service revenue. The RCM process starts with admission (patient access) and continues to accounts receivable (payment and collections). Several RCM solutions (for example, IT applications and services) help healthcare providers perform different functions. The top three strategic imperatives impacting RCM are: Internal Challenges: Healthcare organizations are looking for improved efficiency, faster reimbursement, and profitability by reducing billing errors, lowering cost, and optimizing collection during COVID-19. Pent-up demand for elected surgeries, due from the last two years, is further requiring providers to bolster the productivity of their incumbent RCM solutions. Transformative Mega Trends: COVID-19 pandemic has led to a surge of patients with long-term symptoms that vary from traditional chronic conditions with new comorbidities to the unprecedented prevalence of rare diseases. As a result, robust clinical risk management has become imperative to new-age RCM, leading vendors to transform their RCM platforms’ underlying clinical logic, financial template, and codes. Customer Value Chain Compression: Providers use and prefer a mix of in-house and outsourced RCM to meet their organizational needs. Vendors for this outsourcing appear to be very fragmented based on expertise in specific areas of need across front-end, middle, and back-end processes. Author: Koustav Chatterjee
More Information
No Index No
Podcast No
Author Koustav Chatterjee
Industries Healthcare
WIP Number K646-01-00-00-00
Is Prebook No
GPS Codes 9564-B1,9600-B1,9612-B1