Global Mid-Revenue Cycle Management/Clinical Documentation Improvement Market By Product & Service (Solutions, Consulting Services), By End-User (Healthcare Providers, Healthcare Payers), By Region, and Key Companies - Industry Segment Outlook, Market Assessment, Competition Scenario, Trends and Forecast 2022-2032

Mid-Revenue Cycle Management/Clinical Documentation Improvement Market Overview:

The Mid-Revenue Cycle Management/Clinical Documentation Improvement Market is projected to reach a valuation of USD 174.95 Bn by 2032 at a CAGR of 7.9%, from USD 4.5 Bn in 2021.

Revenue cycle management is the process used by healthcare systems to track revenues and collect cash for the treatment of patients, from their initial appointment or initial interaction with the healthcare system to their final payment of dues.

This entire process encompasses identifying, managing, and collecting patient service revenues from insurers and patients. This process begins when a patient makes an appointment for medical services and ends when all claims and payments from a patient and their respective insurer have been collected.

Revenue cycle management includes key components such as Pre-Cycle/Patient Access, Mid-Cycle, and Post-Cycle. The middle of the revenue cycle consists of four key elements: clinical documentation, case management, charge processing, and the charge description master, as well as coding.

Clinical documentation captures an accurate picture of a patient’s presentation and cares offered by a healthcare organization, whether inpatient, outpatient, or physician services. Case management ensures that the patients are placed in accurate patient status and are efficiently discharged. The accuracy of the discharge disposition can financially impact a medical facility/organization through shared reimbursement methodologies.

Charge processing is capturing all of a patient’s charges in a timely manner using the charge description master (CDM) tool. This file is a list of all services, tests, and supplies that are provided to patients. CDI will impact your case mix index, evaluation and management levels, and hierarchical condition reporting categories.

Coding is the process of reflecting clinical documentation and charges through ICD-10-CM/PCS or CPT codes. A coder reviews clinical documentation and translates words into code to paint a clearer picture of a given payer.

Detailed Segmentation

This market is categorized on the basis of Product & Service, End User, and Region:

By Product & Service

• Solutions
  • Clinical Coding
  • Clinical Documentation Improvements
  • Charge Capture
  • Clinical Documentation
  • Diagnosis-related Grouping
  • Pre-bill Review
• Consulting Services

By End-User

• Healthcare Providers
  • Inpatient Settings
  • Outpatient Settings
• Healthcare Payers

By Region

• North America
• Europe
• Asia-Pacific
• South America
• Middle East and Africa

Market Dynamics

Factors such as increasing healthcare expenditures, the important need to manage unstructured healthcare data, and alterations in revenue due to medical billing errors are all contributing to the revenue growth of this market.

While changing technological scenarios in developing economies, as well as the integration of AI with the healthcare revenue cycle management is expected to provide several opportunities for this market to expand over the forecast period.

However, constraints in developing countries concerning adequate IT infrastructure as well as data security concerns are expected to hinder the economic growth of this market to a certain extent.

The COVID-19 pandemic is also expected to positively impact this market’s further expansion. For instance, after the re-opening of outpatient surgery centers, previously canceled elective surgeries are now being undertaken via outpatient surgery centers.

Physicians and patients favor outpatient surgery centers due to safety issues related to this pandemic. As a result, cash flow at outpatient surgery centers is steadily increasing, requiring the aid of mid-revenue cycle management solutions. As a result, alterations in coding practices are expected to accelerate the adoption of outsourced mid-revenue-cycle solutions, in turn, positively impacting market growth prospects in the process.

Key players:

• Nuance Communications Inc.
• Chartwise Medical Systems Inc.
• Craneware
• 3M Company
• Streamline Health Solutions LLC
• Nthrive Inc.
• Dolbey Systems
• Optum Inc.
• Cerner Corporation
• Vitalware LLC.

Recent Developments

• Acquisitions/Mergers/Takeovers: In February, Nuance announced the acquisition of Saykara Inc.
• Craneware launches Trisus pricing transparency.
• 3M announced a strategic investment in Repairify Inc.
• Streamline Health Solutions LLC partnered with MHMR Authority of Brazos Valley in Bryan, Texas, to supply the agency’s next EHR platform.
• Streamline Health Solutions entered into an agreement with Methodist Hospitals for Streamline Health eValuator.
• AMN Healthcare Services Inc. has completed two acquisitions: MedPartners, a leading national mid-revenue cycle firm; and two related brands in healthcare leadership solutions, Phillips DiPisa, and Leaders

For the Mid-Revenue Cycle Management/Clinical Documentation Improvement Market research study, the following years have been considered to estimate the market size: