The medical billing outsourcing market was valued at USD 6.3 billion in 2015 and is anticipated to reach a value of USD 16.9billion by 2024, according to a new report by Grand View Research, Inc. Large amount of medical code representation for diagnosis and treatment coupled with the presence of multiple payers renders medical billingan intricate part of any medical practice, posing significant challenges. The challenge mounts when this 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 the 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. According to studies, in 2015, 95% of independent physicians have acknowledged that outsourcing revenue management is the right decision.
Healthcare providers face certain challenges in ascertaining the disadvantages of in-house operation or benefits of outsourcing revenue management operations;hence, they arrived at this decision by implementing thorough assessment and evaluation of the revenue percentage they spend on several billing operations. Currently, the healthcare system is witnessing a subsequent increase in outsourcing of medical billing services by hospitals and physicians. This increase is attributed to factors such as obligatory implementation of complex ICD-10 coding system, increasing healthcare costs, and federal mandate to implement electronic medical records (EMR) to maintain reimbursement levels.
Furthermore, clinics/physician offices are gradually outsourcing their revenue management to cut unnecessary costs and prevent the burden of managing an administrative team to ensure effectivehandling of in-house billing functions.
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Further key findings from the study suggest:
- North America reported highest revenue growth in this market. The U.S. is witnessing rapid changes in healthcare structure reflected by implementation of new medical coding system known as the ICD-10 coding as well as pressure from the government to implement EMR management system. These changing regulations coupled with rising healthcare costs are major growth drivers for the market in this region.
- Multispecialty medical groups are implementing consolidation requiring electronic health record (EHR) integration and building large healthcare networks This integrationcreates a need forRevenue CycleManagement (RCM), which in turn demands additional expertise and trained personnel to manage the same. Consolidation of large healthcare practices is expected to be a one of the factors that will help in the growth of the market.
- Hospitals end-use segment accounts for the largest market share in the medical billing outsourcing market. The ability to gain total control over billing procedures and minimize loss is the main focus of these providers. As healthcare costs rise and profits are decline, RCMoutsourcing is expected to be the best practice considered by these care facilities to manage their revenue.
- Some of the key players in this industry include Accretive Health, Inc.; Allscripts; Cerner Corporation; EClinicalWorks; Experian Information Solutions, Inc.; GE Healthcare; Genpact; HCL; Kareo; McKesson Corporation; Quest Diagnostics; and The SSI Group.