U.S. Medical Billing Outsourcing Market Size, Share & Trends Analysis Report By End Use (Hospitals, Physician Offices), By Service, By Component (In-House, Outsourced), And Segment Forecasts, 2019 - 2026

Published: Feb, 2019 | Pages: 90 | Publisher: Grand View Research
Industry: ICT | Report Format: Electronic (PDF)

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.

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.

 Table of Contents

Chapter 1 Research Methodology
                  1.1 Information Procurement
                  1.2 Data Analysis

Chapter 2 Executive Summary

Chapter 3 Medical Billing Outsourcing Market Variables, Trends & Scope
                  3.1 Market Lineage outlook
                      3.1.1 Parent market outlook
                  3.2 Market Segmentation & Scope
                  3.3 Market Driver Analysis
                      3.3.1 Growing focus on increasing the profitability and revenue generated by the business
                      3.3.2 Federal mandate to implement digital record keeping by healthcare providers
                      3.3.3 Rapidly changing healthcare regulations
                  3.4 Market Restraint Analysis
                      3.4.1 High threat of data breaching
                  3.5 Penetration & Growth Prospect Mapping
                  3.6 Major Deals & Strategic Alliances Analysis 
                      3.6.1 Mergers & acquisitions 
                      3.6.2 Licensing & partnership 
                  3.7 SWOT Analysis 
                  3.8 Heat Map Analysis, 2018
                  3.9 List of Market Players 

Chapter 4 U.S. Medical Billing Outsourcing Market: Component Type Estimates & Trend Analysis
                  4.1 U.S. Medical Billing Outsourcing Market: Component Movement Analysis
                  4.2 U.S. Medical Billing Outsourcing Component Type market share analysis, 2018 & 2026
                  4.3 In-House
                      4.3.1 In-house billing market, 2015 - 2026 (USD Million)
                  4.4 Outsourced
                      4.4.1 Outsourced billing market, 2015 - 2026 (USD Million)

Chapter 5 U.S. Medical Billing Outsourcing Market: Service Estimates & Trend Analysis
                  5.1 U.S. Medical Billing Outsourcing Market: Service Movement Analysis
                  5.2 Front End
                      5.2.1 Front end services market, 2015 - 2026 (USD Million)
                  5.3 Middle End
                      5.3.1 Middle end services market, 2015 - 2026 (USD Million)
                  5.4 Back End
                      5.4.1 Back end services market, 2015 - 2026 (USD Million)

Chapter 6 U.S. Medical Billing Outsourcing Market: End Use Estimates & Trend Analysis
                  6.1 U.S. Medical Billing Outsourcing Market: End Use Movement Analysis
                  6.2 Hospitals
                      6.2.1 Hospital end use market, 2015 - 2026 (USD Million)
                  6.3 Physician Offices
                      6.3.1 Physician offices end use market, 2015 - 2026 (USD Million)
                  6.4 Others
                      6.4.1 Others end use market, 2015 - 2026 (USD Million)

Chapter 7 Competitive Landscape
                  7.1 Recent Developments & Impact Analysis
                  7.2 Company Profiles
                      7.2.1 Experian Information Solutions, Inc.
                          7.2.1.1 Company overview
                          7.2.1.2 Financial performance
                          7.2.1.3 Product benchmarking
                          7.2.1.4 Strategic initiatives
                      7.2.2 R1 RCM, Inc. (Accretive Health)
                          7.2.2.1 Company overview
                          7.2.2.2 Financial performance
                          7.2.2.3 Product benchmarking
                          7.2.2.4 Strategic initiatives
                      7.2.3 Quest Diagnostics
                          7.2.3.1 Company overview
                          7.2.3.2 Financial performance
                          7.2.3.3 Product benchmarking
                      7.2.4 Allscripts Healthcare Solutions, Inc.
                          7.2.4.1 Company overview
                          7.2.4.2 Financial performance
                          7.2.4.3 Product benchmarking
                          7.2.4.4 Strategic initiatives
                      7.2.5 Kareo, Inc.
                          7.2.5.1 Company overview
                          7.2.5.2 Financial performance
                          7.2.5.3 Product benchmarking
                      7.2.6 Cerner Corporation
                          7.2.6.1 Company overview
                          7.2.6.2 Financial performance
                          7.2.6.3 Product benchmarking
                          7.2.6.4 Strategic initiatives
                      7.2.7 Mckesson Corporation
                          7.2.7.1 Company overview
                          7.2.7.2 Financial performance
                          7.2.7.3 Product benchmarking
                          7.2.7.4 Strategic initiatives
                      7.2.8 eClinicalWorks, LLC
                          7.2.8.1 Company overview
                          7.2.8.2 Financial performance
                          7.1.8.3 Product benchmarking

List of Tables

TABLE 1 U.S. medical billing outsourcing market, by component, 2015 - 2026 (USD Million)
TABLE 2 U.S. medical billing outsourcing market, by service 2015 - 2026 (USD Million)
TABLE 3 U.S. medical billing outsourcing market, by end user 2015 - 2026 (USD Million)

List of Figures

FIG. 1 Market research process
FIG. 2 Information procurement
FIG. 3 Primary research pattern
FIG. 4 Market research approaches
FIG. 5 Value-chain-based sizing & forecasting
FIG. 6 QFD modelling for market share assessment
FIG. 7 Market trends & outlook
FIG. 8 Market segmentation & scope
FIG. 9 Market driver relevance analysis (Current & future impact)
FIG. 10 Market restraint relevance analysis (Current & future impact)
FIG. 11 Penetration & Growth Prospect Mapping
FIG. 12 Heat Map Analysis, 2015
FIG. 13 Medical billing outsourcing market, by component type outlook: Key takeaways
FIG. 14 U.S. in-house billing market, 2015 - 2026 (USD Million)
FIG. 15 U.S. outsourced billing market, 2015 - 2026 (USD Million)
FIG. 16 Medical billing outsourcing market: Service type analysis
FIG. 17 Medical billing outsourcing market, by service outlook: Key takeaways
FIG. 18 Front end service market, 2015 - 2026 (USD Million)
FIG. 19 Middle end service market, 2015 - 2026 (USD Million)
FIG. 20 Back end service market, 2015 - 2026 (USD Million)
FIG. 21 Medical billing outsourcing market, by end use outlook: Key takeaways
FIG. 22 Hospital market, 2015 - 2026 (USD Million)
FIG. 23 Physician offices market, 2015 - 2026 (USD Million)
FIG. 24 Others market, 2015 - 2026 (USD Million)