The U.S. medical billing outsourcing market size is poised to reach USD 7.8 billion by 2026, based on a new report by Grand View Research, Inc., exhibiting a CAGR of 11.0% during the forecast period. Increasing population of baby boomers and rising chronic diseases among young generation are resulting in widened base of patients in the country.
Furthermore, growing burden on revenues & profits, declining Medicare payments, and mounting billing volumes are leading to need to decrease in-house processing costs. Therefore, hospitals are increasingly outsourcing their billing activities. The challenge mounts when billing process mandates adherence to the International Classification of Diseases-10th revision (ICD-10) code along with dealing with rising healthcare costs and declining reimbursements. Challenges in managing in-house billing processes include setbacks experienced in IT structure, untrained staff, billing errors, and lack of proper financial policy in place.
In order to curb or alleviate these challenges, several healthcare providers, such as acute care hospitals and clinics/physician offices, prefer outsourcing their medical billing process. Studies suggest that in 2015, 95.0% of independent physicians acknowledged that outsourcing revenue management is right decision.
Acceptance of Revenue Cycle Management (RCM) in various healthcare facilities varies with application. Scheduling, coding, billing, patient registration, and claims processing are adopted more than other RCM applications in the U.S.
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Further key findings from the study suggest:
- Advantages associated with outsourcing of medical billing services include improvement in billing process by decreasing errors, swift turnaround time, and smooth administrations for hospitals and other medical institutes
- Outsourced medical billing is likely to witness the highest growth during the forecast period owing to growing focus on minimizing the cost of healthcare delivery and improving patient & physician relationship
- The front end services segment dominated the market in 2018 as they increase downstream cash flow and decrease rework & cost to collect
- On the other hand, the middle-end services market is expected to register the fastest growth during the forecast period
- By end use, hospitals accounted for the largest revenue share in the U.S. medical billing outsourcing market in 2018. Errorless billing procedures and minimization of loss is a focus of RCM providers
- Physician offices, however, are estimated to post a higher CAGR during the same period. According to the Black Book’s 2016 RCM survey, demand from physicians’ offices are increasing as they want to align financial and clinical outcomes
- Some of the key players in this market are Allscripts; Accretive Health, Inc.; Cerner Corporation; Experian Information Solutions, Inc.; EClinicalWorks; GE Healthcare; Genpact; McKesson Corporation; Kareo; Quest Diagnostics; and The SSI Group.