DUBLIN: The "U.S. Revenue Cycle Management Market - Focused Insights 2025-2030" report has been added to ResearchAndMarkets.com's offering.

The U.S. Revenue Cycle Management Market was valued at USD 141.61 billion in 2024, and is expected to reach USD 272.78 billion by 2030, rising at a CAGR of 11.55%.

The U.S. revenue cycle management market report consists of exclusive data on 55 vendors. The market is a dynamic and competitive landscape characterized by a growing demand for technology-driven solutions, consolidation among players, and the emergence of new entrants leveraging advanced technologies like artificial intelligence (AI) and automation.

Companies like Change Healthcare, Epic Systems Corporation, Experian, McKesson Corporation, Oracle, R1 RCM, Veradigm, and SSI Group dominate the RCM market, offering end-to-end solutions for billing, claims management, and regulatory compliance. These companies have longstanding relationships with large healthcare providers and are expanding their portfolios through acquisitions and partnerships to stay ahead in the market.

MARKET TRENDS & DRIVERS

Shift from Computer-Assisted Coding (CAC) to Autonomous Coding

The healthcare industry is transitioning from Computer-Assisted Coding (CAC) to Autonomous Coding due to advancements in AI and machine learning. Unlike CAC, which assists coders with code suggestions using NLP, autonomous coding fully automates the process, minimizing human involvement. This shift aims to improve efficiency, accuracy, and cost-effectiveness in medical coding and billing, addressing issues like human error, fatigue, and evolving standards. Studies highlight its growing adoption and benefits.

A 2023 Frost & Sullivan report indicates that over 30% of healthcare organizations are piloting or planning autonomous coding solutions. A TruCode report reveals these systems can reduce coding time by up to 50% while enhancing accuracy. Autonomous coding is poised to revolutionize Revenue Cycle Management (RCM) by increasing operational efficiency, improving compliance, and boosting revenue collection, with AI systems becoming smarter and more adaptable over time.

Increasing Adoption of Third-party Managed RCM Solutions

The adoption of third-party managed Revenue Cycle Management (RCM) solutions is reshaping the U.S. healthcare market as providers face financial pressures, regulatory challenges, and a shift to value-based care. Outsourcing RCM helps healthcare organizations streamline operations, improve cash flow, and reduce costs, allowing them to focus on patient care. A 2023 Healthcare IT News survey found that 40% of healthcare providers outsource RCM functions, primarily to reduce operational expenses by avoiding the costs of maintaining in-house teams.

Third-party vendors bring specialized expertise in billing, coding, and collections, along with advanced technologies like automation and AI, which improve efficiency and reduce errors. A KPMG report highlights that 56% of providers are outsourcing non-core functions like RCM to prioritize clinical excellence. This trend reflects the growing preference for cost-effective, expert-driven solutions to optimize revenue cycles while focusing internal resources on delivering high-quality patient care.

INDUSTRY RESTRAINTS

The Role of Cybersecurity and Data Protection

Cybersecurity and data protection are major challenges in the revenue cycle management (RCM) market due to the sensitive nature of healthcare data and rising cyber threats. RCM systems handle vast amounts of personal, medical, and financial data, making them attractive targets for attacks. Compliance with regulations like HIPAA adds complexity, requiring robust safeguards to protect data and ensure operations.

Many healthcare providers and RCM vendors face difficulties in addressing these risks due to limited budgets, outdated systems, and a lack of cybersecurity expertise. Threats such as ransomware, data breaches, and system downtime can disrupt the revenue cycle, causing financial losses, reputational harm, and potential legal penalties.

RECENT VENDORS ACTIVITIES

• In 2024, Leading healthcare technology and RCM company CorroHealth finalized its acquisition of the Xtend healthcare revenue cycle management business from Navient, further positioning the company as the clear leader in revenue cycle management consultancy and technology.
• In August 2024, R1 RCM announced its agreement to be acquired by private equity firms TowerBrook Capital Partners and Clayton, Dubilier & Rice in a deal valued at $8.9 billion. The transaction is expected to close by the end of 2024.

KEY TAKEAWAYS

• By Component Type: The post-cycle segment holds the largest market share of over 57%. The segment has gained importance as healthcare organizations face mounting challenges related to insurance claim rejections, compliance with changing regulations, and the need for efficient cash flow management.
• By Delivery Mode: The cloud-based segment shows the highest growth of 12.22% driven by the demand for efficiency, cost reduction, and improved patient experiences.
• By Solution Type: The integrated segment holds the largest market share due to hospitals and physician offices increasingly adopting advanced systems to address financial and operational challenges.
• By Service Type: The ambulatory care segment shows the highest growth driven by rising healthcare costs, the adoption of advanced technologies, and shifts towards value-based care.
• By End-User: The hospital segment leads the U.S. revenue cycle management market, driven by high patient volumes, diverse services, and multiple payment systems like private insurance, Medicare, and Medicaid.
• Growth Factor: The U.S. revenue cycle management market is set to grow due to the rise of generative AI and LLMs and growth in urgent care, ambulatory surgery centers, & radiology services.

KEY QUESTIONS ANSWERED

• How big is the U.S. revenue cycle management market?
• What is the growth rate of the U.S. revenue cycle management market?
• What are the latest trends in the US revenue cycle management market?
• Which component has the largest share of the US revenue cycle management market?
• Who are the key players in the U.S. revenue cycle management market?

Key Attributes:

COMPETITIVE LANDSCAPE

Key Vendors

• Change Healthcare
• Epic Systems Corporation
• Experian
• McKesson Corporation
• Oracle
• R1 RCM
• Veradigm
• SSI Group

Other Prominent Vendors

• Abax Health
• Access Healthcare
• Acrologic Business Solutions
• AdvancedMD
• Advantum Health
• AdvantEdge Healthcare Solutions
• AKASA
• Bellmedex
• Bizmatics
• Cantata Health Solutions
• CareCloud
• Cognizant
• Cosentus
• Coronis Health
• The Craneware Group
• CorroHealth
• CureMD Healthcare
• Data Marshall
• DrChrono
• EHealthSource
• Greenway Health
• Qualifacts
• IntelliRCM
• Tebra
• Medical Billers and Coders
• MGSI
• MRO Corp
• NextGen Healthcare
• OSP
• Persistent Systems
• PMMC
• Promantra
• Quadax
• QWay Healthcare
• Rectangle Health
• ReMedics
• Revele
• RevenueXL
• Right Medical Billing
• Serbin Medical Billing
• SHOAR
• Synergen Health
• Rectangle Health
• Unified Health Services
• Vee Technologies
• Ventra Health
• Waystar

For more information about this report visit https://www.researchandmarkets.com/r/m2qtrn

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Fonte: Business Wire