​Medical Billing Outsourcing Market Size will Hit USD 23.7 billion by 2027

Recent Research Study on "Medical Billing Outsourcing Market (By Component: Outsourced And In-House; By Service: Back End, Middle End, And Front End; By End-Use: Physician Office, Hospital, And Others) - Global Market Size, Trends Analysis, Segment Forecasts, Regional Outlook 2020 - 2027".

The global medical billing outsourcing market was valued at USD 9.5 billion in 2019 and expected to reach USD 23.7 billion by 2027 and poised to grow at a compound annual growth rate (CAGR) 12.1% during the forecast period 2020 to 2027.

A large amount of clinical code representation for diagnosis and treatment coupled with the presence of multiple payers, renders medical billing an intricate part of any clinical practice, posing significant challenges. Currently, the healthcare system is witnessing a subsequent rise in the outsourcing of clinical billing services by hospitals and physicians due to obligatory implementation of complex ICD-10 coding systems, increasing healthcare costs, and a 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 effective handling of in-house billing functions. In addition, multispecialty healthcare groups are implementing consolidation requiring EHR integration and building large healthcare networks. This integration creates a need for revenue cycle management (RCM), which, in turn, demands additional expertise and trained personnel to manage the same. Thus, the consolidation of large healthcare practices is also expected to be one of the factors fueling market growth.

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Component Insights

In-house and outsourced are the major components of the medical billing outsourcing market. The outsourced segment held the largest market share in the component segment in 2019 and is expected to register the highest CAGR in the coming years. Medical billing outsourcing significantly reduces costs and proves as a good fit for small and medium practices. Since the last 5 years, physician practices (acute care hospitals and clinics/physicians) are facing challenging times as reimbursements have declined and costs are rising, and the newly introduced regulations have made business more complex. Hence the demand for medical billing outsourcing is expected to increase in years to come.

Service Insights

Front-end services consist of processes like scheduling, preregistration, registration, eligibility, insurance verification, and pre-authorization. The front-end service constitutes the major function of medical billing outsourcing and accounted for the highest share in the market for medical billing outsourcing, in 2019. However, front-end services are gradually facing a decline in revenue growth due to market saturation and increased competition. Middle-end services are expected to observe the fastest growth rate in the coming years due to the entry of new market players and growing awareness among healthcare practitioners.

End-Use Insights

The hospital segment held the highest revenue share in the market for medical billing outsourcing in 2019 as hospitals were prime users of such services due to high claim volume. Consolidations of hospitals further increase the complexity of billing and reimbursement procedures. Hence, the demand is high in hospitals.

Currently, private clinics and physician offices are also outsourcing several services. Hence, the physician office segment is likely to expand at the fastest CAGR in the market for medical billing outsourcing during the forecast period. The rise in the number of services provided by physicians and change in government regulations are responsible for a significant number of physicians adopting RCM services at their medical facilities.

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Regional Insights

North America held the highest share of the market for medical billing outsourcing in 2019. The presence of a number of healthcare providers in the U.S. has turned their focus on end-to-end outsourcing firms for managing their billing processes. Due to increased awareness about the benefits offered by the outsourcing firms, providers are relying on the companies to maximize operating margins and manage high-volume transactions. Developing regions, such as the Asia Pacific and Latin America, are expected to record lucrative CAGRs in the forecast years as outsourcing practices are being standardized across the globe.

The newly introduced International Classification of Diseases-10th revision (ICD-10) has made medical billing business even more complex in nature. Owing to this, the demand for revenue cycle management (RCM) has increased drastically. In addition, providers are choosing the companies offering the right combination of RCM with electronic medical records (EMR) for improved patient outcomes.

Companies like AthenaHealth, Inc., and eClinicalWorks are providing RCM services that offer EHR software. Other large EMR providers have begun offering RCM services as well, including GE Healthcare; McKesson; and Allscripts Healthcare Solutions, Inc. Kareo, Inc., a practice management software provider released a free EMR with RCM services to physicians.

Medical Billing Outsourcing Market Share Insights

Some of the key companies in the market for medical billing outsourcing include R1 RCM, Inc.; Cerner Corporation; Allscripts Healthcare Solutions, Inc.; Experian Information Solutions, Inc.; eClinicalWorks; GE Healthcare; Genpact; HCL Technologies Limited; Kareo, Inc.; McKesson Corporation; Quest Diagnostics; Athenahealth Inc.; and The SSI Group, LLC. Partnerships, mergers and acquisitions, and technological advancement are some of the key business strategies undertaken by these companies to expand their geographical reach and service offerings. For instance, in July 2019, Cerner Corporation partnered with Amazon Web Services (AWS) for access to its cloud space and global infrastructure to drive healthcare IT innovations. The partnership is expected to improve clinical efficiency and lower operational budgets for healthcare organizations.

In February 2019, Veritas Capital acquired athenahealth, Inc. in collaboration with Evergreen Coast Capital, as a minority investor. Virence Health, a subsidiary of Veritas Capital, combined with athenahealth to gain access to its network-enabled services for hospital and ambulatory customers.

In another acquisition in July 2018, Veritas Capital acquired GE Healthcare’s Enterprise Financial Management asset which includes its RCM business, Ambulatory Care Management asset, and Workforce Management assets.

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Report Scope

Few of the prominent players in the medical billing outsourcing market are as follows:

• Allscripts Healthcare Solutions, Inc.
• R1 RCM, Inc.
• Cerner Corporation
• Experian Information Solutions, Inc.
• eClinicalWorks LLC
• GE Healthcare
• Kareo, Inc.
• Genpact
• McKesson Corporation
• Quest Diagnostics

Market Segmentation

By Component

• Outsourced
• In-house

By Service

• Back End
• Middle End
• Front End

By End-User

• Physician Office
• Hospital
• Others

By Regional Outlook

• North America
  • U.S.
  • Canada
• Europe
  • U.K.
  • Germany
  • France
• Asia Pacific
  • China
  • India
  • Japan
  • South Korea
• Rest of the World

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Table of Content

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