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1622929

後端收入週期管理市場：依產品/服務、交付類型、地區劃分，2024-2031 年

Back-End Revenue Cycle Management Market By Product And Service (Software, Services), By Delivery Mode (On-Premise, Cloud-Based), And Region for 2024-2031

出版日期: 2024年10月05日 | 出版商:

Verified Market Research | 英文 202 Pages | 商品交期: 2-3個工作天內

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簡介目錄

後端收入週期管理市場評估，2024-2031

後端收入週期管理（RCM）市場預計在未來幾年將穩定成長。這種增長可歸因於多種因素，包括醫療保健帳單日益複雜。隨著新編碼系統的採用、基於價值的支付變得普遍以及醫療保健計劃的整合，醫療保健計費流程變得更加複雜。這種複雜性需要使用可以自動執行任務並簡化工作流程的 RCM 解決方案。2023年市場規模為107.1億美元，預計2031年將擴大至160.8億美元，2024年至2031年複合年增長率為5.21%。

市場成長的另一個推動因素是醫療保健提供者對高效收入週期管理的需求不斷增長。報銷減少、醫療費用增加以及提高病患滿意度的壓力都促成了這項需求。RCM 解決方案可協助醫療保健提供者改善現金流量、減少索賠拒絕並加快收款速度。

後端收入週期管理市場定義/概述

後端收入週期管理 (RCM) 是醫療保健產業的關鍵流程。RCM 專注於患者就診後發生的關鍵操作，以確保從保險公司等付款人收取適當的收入。這個複雜的過程由指定系統監督，涉及多個步驟。第一步是計費。患者接受治療後，我們會編製一份帳單，其中包含有關所提供服務的詳細資訊。該索賠將以電子方式或紙本形式提交給您的保險公司。後端 RCM 確保聲明符合所有相關編碼和格式規定。

推動市場成長的關鍵因素是什麼？

隨著醫療保健成本持續上升，醫療保健組織被迫加強其收入週期運作。後端 RCM 解決方案有助於識別和恢復遺漏的索賠、提高計費準確性並簡化計費管理。透過有效的後端處理實現收入優化是市場成長的主要驅動力。

醫療報銷格局不斷變化，規則複雜，支付方案多元。後端 RCM 解決方案可以幫助醫療保健提供者適應這些變化、確保準確的編碼和文件、提交索賠並成功管理拒絕。處理如此複雜的醫療保健報銷的能力為使用後端 RCM 技術的提供者提供了顯著的好處。

此外，醫療保健行業正在從按服務收費的方式轉向基於價值的護理。後端 RCM 技術可以與患者資料互動並管理品質指標，使提供者能夠在基於價值的護理模式中展示價值並最大化回報。與這種不斷變化的醫療保健支付系統集成，使後端 RCM 解決方案成為醫療保健提供者的重要工具。

後端RCM市場面臨的主要課題是什麼？

後端 RCM 系統必須與其他醫療保健 IT 系統交互，例如電子健康記錄 (EHR) 和實踐管理軟體。然而，在這些不同的系統之間實現完美的資料流是困難且耗時的。不一致的資料格式和缺乏互通性標準會導致收入週期中的錯誤、延遲和低效率，並限制市場發展。

此外，RCM 需要瞭解複雜編碼和計費規則的熟練員工。醫療保健產業缺乏合格的醫療編碼員和計費員。此外，對新員工進行後端 RCM 系統和法規培訓既昂貴又耗時，阻礙了市場擴張。

The back-end revenue cycle management (RCM) market is expected to experience steady growth in the coming years. This growth can be attributed to several factors, including the increasing complexity of healthcare billing. As new coding systems are adopted, value-based payments become more common, and health plans consolidate, the healthcare billing process becomes more intricate. This complexity necessitates the use of RCM solutions that can automate tasks and streamline workflows. The market was valued at USD 10.71 Billion in 2023 and is expected to expand toUSD 16.08 Billion in 2031, growing at aCAGR of 5.21% from 2024 to 2031.

Another driver of market growth is the rising need for efficient revenue cycle management among healthcare providers. Declining reimbursement rates, increasing costs of care, and the pressure to improve patient satisfaction all contribute to this need. RCM solutions can be instrumental in improving providers' cash flow, reducing claim denials, and expediting payment collection.

Back-End Revenue Cycle Management Market: Definition/ Overview

Back-end revenue cycle management (RCM) is a crucial process within the healthcare industry. It focuses on the essential tasks that occur after a patient visit to ensure proper revenue collection from payers, like insurance companies. This intricate process is overseen by a designated system and involves several steps. The first step involves claims processing. After a patient receives care, detailed information regarding the services rendered is compiled into a claim. This claim is then submitted electronically or on paper to the responsible insurance company. Back-end RCM ensures the claim adheres to all relevant coding and formatting regulations.

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What are the Primary Factors Bolstering the Growth of the Market?

The ever-increasing expense of healthcare forces providers to enhance their revenue cycle operations. Back-end RCM solutions assist in identifying and recovering missed charges, improving billing accuracy, and streamlining claims management. This emphasis on revenue optimization through effective back-end procedures is a significant driver of market growth.

The healthcare reimbursement landscape is continually changing, with complex rules and several payment schemes. Back-end RCM solutions can assist healthcare providers in keeping up with these changes, ensuring accurate coding and documentation for claims submissions, and successfully managing denials. This capacity to handle the complexities of healthcare reimbursement provides a considerable advantage to providers who use back-end RCM technologies.

Furthermore, the healthcare sector is moving away from a fee-for-service approach and toward value-based care, in which clinicians are compensated on patient outcomes rather than the volume of services delivered. Back-end RCM technologies can interact with patient data and manage quality measures, enabling providers to demonstrate value and maximize compensation in value-based care models. This integration with the changing healthcare payment system establishes back-end RCM solutions as an important tool for healthcare providers.

What are the Key Challenges Faced by the Back-End Revenue Cycle Management Market?

Back-end RCM systems have to interact with other healthcare IT systems, including electronic health records (EHR) and practice management software. However, enabling a flawless data flow across these various systems is difficult and time-intensive. Inconsistent data formats and a lack of interoperability standards cause errors, delays, and inefficiencies in the revenue cycle, limiting market development.

Furthermore, RCM requires skilled staff who comprehend complex coding and billing rules. The healthcare business is experiencing a scarcity of qualified medical coders and billers. Furthermore, educating new workers on back-end RCM systems and regulations is costly and time-consuming, hence impeding market expansion.

Category-Wise Acumens

What are the Potential Drivers that Increase Demand for Back-End RCM Services?

The service segment is estimated to dominate the market during the forecast period. Healthcare billing and coding standards are complex and continually growing. Healthcare firms can ensure accuracy and compliance by outsourcing these operations to specialized RCM service providers rather than investing in considerable in-house expertise. The complexity of the regulatory landscape drives up demand for RCM services.

The healthcare industry is experiencing a shortage of competent RCM personnel. Outsourcing back-end RCM services enables healthcare firms to tap into a pool of experienced employees without paying the costs involved with hiring, training, and managing in-house professionals. Labor shortages and the opportunity for cost reductions encourage healthcare providers to use RCM services.

Furthermore, RCM service providers provide a wide range of services, allowing healthcare businesses to outsource certain activities or their complete back-end RCM operation. This flexibility and adaptability are especially appealing to smaller practices or those with changing workloads. The ability to tailor services to specific needs reinforces the services segment's dominance.

Country/Region-wise Acumens

What Factors Support the Dominance of North America in the Market?

North America is estimated to dominate the Back-End Revenue Cycle Management Market during the forecast period. The US healthcare system, in particular, is distinguished by a complicated web of laws and coding standards for medical billing. North American healthcare businesses must constantly update and adjust laws such as ICD-10 (International Classification of Diseases, Tenth Revision) coding. This complexity needs powerful back-end RCM solutions to assure proper coding, claims filing, and compliance, resulting in increased demand for advanced RCM services and software across the region.

North America has a well-developed healthcare IT infrastructure, with many providers already utilizing electronic health records (EHR) and other digital technologies. Back-end RCM solutions can effortlessly interface with the existing infrastructure, allowing for more efficient data interchange and task automation. This early adoption of healthcare IT establishes North America as a leader in the use of advanced RCM systems.

Furthermore, North America has some of the world's highest healthcare expenses. This imposes a considerable financial strain on healthcare providers, who are increasingly focused on managing their revenue cycle to maximize reimbursements while reducing denials. Back-end RCM solutions assist in streamlining procedures, decreasing errors, and increasing cash flow, making them an essential tool for healthcare enterprises in North America.

How Do Rising Government Initiatives Promote the Market Growth in the Asia Pacific?

The Asia Pacific region is estimated to exhibit the highest growth during the forecast period. Many governments in the Asia Pacific are actively encouraging healthcare IT adoption through financial initiatives and legislative changes. This emphasis on healthcare infrastructure expansion creates a favorable environment for the introduction of back-end RCM technologies. As healthcare institutions become more digitalized, the requirement for effective RCM solutions to manage billing and claims processing grows.

The deployment of EHR systems in the Asia Pacific is constantly growing. These devices create massive volumes of patient data, which can then be used by back-end RCM software to automate processes, increase coding accuracy, and simplify revenue cycles. The creation and implementation of interoperability standards would enable easy data sharing between various healthcare IT systems, hence increasing the effectiveness of RCM solutions.

Furthermore, healthcare providers in Asia Pacific are becoming aware of the advantages of back-end RCM solutions, such as increased cash flow, fewer denials, and more efficient processes. As competition in the healthcare sector heats up, cost efficiency becomes a top focus. Back-end RCM solutions can assist healthcare businesses in the Asia Pacific in meeting these objectives by lowering administrative expenses and increasing revenue cycle efficiency.

Competitive Landscape

The Back-End Revenue Cycle Management Market is a dynamic environment characterized by the interplay of established vendors, resourceful startups, and innovative technology providers. These participants offer a diverse array of solutions to address the evolving needs of healthcare organizations seeking to optimize their revenue cycle.

Some of the prominent players operating in the Back-End Revenue Cycle Management Market include:

Athenahealth, Cerner, Allscripts Healthcare Solutions, Eclinicalworks, Optum, Inc., Mckesson, Conifer Health Solutions, Gebbs Healthcare Solutions, The SSI Group, Mckesson Corporation, R1 RCM Inc., eClinicalWorks, Allscripts Healthcare Solutions, Inc., Veradigm LLC.

Latest Developments

In January 2024, R1 RCM Inc. acquired Acclara from Providence, a health systems provider, to strengthen its market position and implement advanced technology solutions, aiming to improve patient and customer outcomes.

In July 2023, TELCOR launched version 21.3 of TELCOR RCM, which includes expanded use of web APIs, Report Designer, and an Executive Module to improve laboratory productivity and collections.

In June 2022, R1 RCM Inc. acquired Cloudmed to offer a leading platform for healthcare provider revenue cycle management (RCM) and drive digital transformation through automation and AI.

1 INTRODUCTION OF GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET

1.1 Overview of the Market
1.2 Scope of Report
1.3 Assumptions

2 EXECUTIVE SUMMARY

3 RESEARCH METHODOLOGY OF VERIFIED MARKET RESEARCH

3.1 Data Mining
3.2 Validation
3.3 Primary Interviews
3.4 List of Data Sources

4 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET OUTLOOK

4.1 Overview
4.2 Market Dynamics
- 4.2.1 Drivers
- 4.2.2 Restraints
- 4.2.3 Opportunities
4.3 Porters Five Force Model
4.4 Value Chain Analysis
4.5 Regulatory Framework

5 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET, BY PRODUCT AND SERVICE

5.1 Overview
5.2 Software
5.3 Services

6 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET, BY DELIVERY MODE

6.1 Overview
6.2 On Premise
6.3 Cloud-based

7 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET, BY GEOGRAPHY

7.1 Overview
7.2 North America
- 7.2.1 U.S.
- 7.2.2 Canada
- 7.2.3 Mexico
7.3 Europe
- 7.3.1 Germany
- 7.3.2 The U.K.
- 7.3.3 France
- 7.3.4 Rest of Europe
7.4 Asia Pacific
- 7.4.1 China
- 7.4.2 Japan
- 7.4.3 India
- 7.4.4 Rest of Asia Pacific
7.5 Rest of the World
- 7.5.1 Latin America
- 7.5.2 Middle East and Africa

8 GLOBAL BACK-END REVENUE CYCLE MANAGEMENT MARKET COMPETITIVE LANDSCAPE

8.1 Overview
8.2 Company Market Share
8.3 Vendor Landscape
8.4 Key Development Strategies

9 COMPANY PROFILES

9.1 Athenahealth
- 9.1.1 Overview
- 9.1.2 Financial Performance
- 9.1.3 Product Outlook
- 9.1.4 Key Developments
9.2 Cerner
- 9.2.1 Overview
- 9.2.2 Financial Performance
- 9.2.3 Product Outlook
- 9.2.4 Key Developments
9.3 Allscripts Healthcare Solutions
- 9.3.1 Overview
- 9.3.2 Financial Performance
- 9.3.3 Product Outlook
- 9.3.4 Key Developments
9.4 Eclinicalworks
- 9.4.1 Overview
- 9.4.2 Financial Performance
- 9.4.3 Product Outlook
- 9.4.4 Key Developments
9.5 Optum, Inc.
- 9.5.1 Overview
- 9.5.2 Financial Performance
- 9.5.3 Product Outlook
- 9.5.4 Key Developments
9.6 Mckesson
- 9.6.1 Overview
- 9.6.2 Financial Performance
- 9.6.3 Product Outlook
- 9.6.4 Key Developments
9.7 Conifer Health Solutions
- 9.7.1 Overview
- 9.7.2 Financial Performance
- 9.7.3 Product Outlook
- 9.7.4 Key Developments
9.8 Gebbs Healthcare Solutions
- 9.8.1 Overview
- 9.8.2 Financial Performance
- 9.8.3 Product Outlook
- 9.8.4 Key Developments
9.9 The SSI Group
- 9.9.1 Overview
- 9.9.2 Financial Performance
- 9.9.3 Product Outlook
- 9.9.4 Key Developments
9.10 R1 RCM Inc.
- 9.10.1 Overview
- 9.10.2 Financial Performance
- 9.10.3 Product Outlook
- 9.10.4 Key Developments