Key Findings & Highlights:

The report focuses on revenue cycle management services, along with analytics and RPA implementation.

The market for outsourced revenue cycle management services is changing, driven by a number of trends. These include:

• Healthcare providers are facing increased costs due to medical coding errors
• Healthcare providers are facing reduced A/R intake and have to cope with A/R follow-up, a time consuming process
• Healthcare providers do not have adequately trained personnel who can provide RCM services in a low cost environment
• Lack of medical coding audit trails and operational process audits leads to time delays and greater costs from human error
• There is a lack of clarity between payers and providers for certain offerings, as to who is most appropriate to provide services such as telemedicine, remote monitoring, transition of care, and wellness management
• ACOs which offer new types of bundled services need guidance on engaging with patients on a post-discharge basis, to maximize CMS reimbursements by reducing hospitals readmissions.
• Patients with one or multiple chronic care conditions including asthma, COPD, diabetes, hypertension, and lipid disorders are projected to increase in the coming decades in the U.S. and other developed economies, as a result of dietary habits and lifestyle choices. Moreover, an increasing proportion of these patients will be elderly, adding risks for further health complications leading to hospitalization. Providers, and consequently vendors, will be required to keep these specific population groups out of hospital, in order to reduce healthcare costs, one of the mandates of the ACA
• Accelerating healthcare start-ups that operate on (technology leveraging) new care models might disrupt the healthcare market by standardizing procedures on payer/provider clinical data integration, thus making EHR systems less isolated. Genomics is also important for payers and providers as a lot of investments have been observed in this market, in order to understand disease predisposition and risks, while significant investment is made in diabetes population monitoring.
• This report investigates the impact of these trends in revenue cycle management in the healthcare provider services market, to identify both the precise change in customer requirements and the change in vendor offerings and delivery capabilities that are being put in place to respond to these requirements.