의료비 청구 아웃소싱 시장 예측(-2030년) : 서비스 유형별, 구성요소별, 최종사용자별, 지역별 세계 분석

According to Stratistics MRC, the Global Medical Billing Outsourcing Market is accounted for $13.93 billion in 2023 and is expected to reach $35.44 billion by 2030 growing at a CAGR of 14.3% during the forecast period. Medical billing outsourcing is the practice of allowing third-party companies to handle the medical billing for healthcare facilities, including hospitals, specialty clinics, radiology departments, and private clinics. These outsourced medical billing services are required for the complex and evolving healthcare industry, regulatory compliance and risk management, and easing the billing burden on healthcare practitioners and providers. The various benefits associated with it, including an increased focus on patient care, reduced billing errors, and cost-effectiveness, have increased the adoption of these services by healthcare providers.

According to World Health Organization (WHO) study in June 2021, cesarean section use is increasing internationally, accounting for more than one-fifth (21%) of all childbirths, for which hospitalization is required.

Market Dynamics:

Driver:

Rising healthcare expenditures

Factors such as an ageing population, an increased prevalence of chronic diseases, and advanced medical treatments contribute to higher patient volumes and complex billing requirements. This surge in healthcare demand places immense pressure on healthcare providers to manage billing processes efficiently. Moreover, by leveraging specialised expertise, advanced technology, and streamlined processes offered by outsourcing companies, healthcare providers can handle larger patient volumes effectively. Thus, outsourcing becomes a strategic solution to manage costs while maintaining quality healthcare services.

Restraint:

Managing difficult billing processes

The service provider may have significant difficulties in managing or conducting intricate billing procedures for clinics and hospitals. Various issues, including changing billing codes, managing enormous amounts of patient data, protecting patient privacy, and requiring qualified personnel, contribute to this challenge. Major errors or service delays can also result from a lack of collaboration between billing service providers and healthcare practitioners. Thus, it is observed to be a major restraint for the market.

Opportunity:

Rise of telehealth and remote healthcare services

Outsourcing companies can specialise in tailored billing solutions for virtual consultations, remote monitoring, and digital health platforms. By offering expertise in coding, reimbursement processes, and compliance with telehealth billing regulations, these firms enable healthcare providers to navigate the complexities of remote care. In addition, by leveraging advanced technology, they streamline billing operations for telehealth services, ensuring accuracy, optimising revenue cycles, and positioning themselves as indispensable partners in supporting the expanding landscape of remote healthcare.

Threat:

Lack of skilled workforce

The insufficient availability of trained professionals in billing and coding can hinder outsourcing firms from delivering high-quality services and meeting client demands. This shortage might lead to delays in processing, increased errors, and compromised efficiency, impacting the overall effectiveness of outsourcing services. Also, the inability to retain skilled talent can disrupt operational continuity, affecting service levels and undermining the competitiveness and reliability of outsourcing companies within the market.

Covid-19 Impact

The COVID-19 pandemic has accentuated the need for streamlined processes due to increased healthcare demands and evolving billing regulations. The industry witnessed a surge in telehealth services, prompting a shift in billing dynamics. Remote work became prevalent, impacting workflow efficiency. Financial strains on healthcare providers led to heightened scrutiny of billing costs, driving outsourcing for cost-effective solutions. However, disruptions in operations, resource constraints, and uncertainties regarding healthcare policies created challenges.

The outsourced medical billing segment is expected to be the largest during the forecast period

The outsourced medical billing segment is estimated to hold the largest share. Outsourced medical billing involves healthcare providers contracting specialised third-party companies to handle their billing processes externally. These dedicated service providers manage tasks like coding, claim submissions, and revenue cycle management on behalf of healthcare facilities. By outsourcing, providers leverage the expertise of these specialised firms, reducing operational burdens, ensuring compliance with regulations, and improving revenue flow. Furthermore, it offers cost-effectiveness, scalability, and access to advanced technology and skilled professionals.

The hospitals segment is expected to have the highest CAGR during the forecast period

The hospitals segment is anticipated to have lucrative growth during the forecast period. Hospitals leverage outsourcing to streamline complex billing processes, including coding, claim submissions, and revenue management. By partnering with dedicated billing service providers, hospitals aim to enhance operational efficiency, reduce administrative burdens, and ensure compliance with stringent regulations. Moreover, outsourcing allows hospitals to focus on delivering quality patient care while relying on expert external resources equipped with advanced technology and industry knowledge to manage the intricacies of medical billing within the evolving healthcare landscape.

Region with largest share:

Asia Pacific commanded the largest market share during the extrapolated period owing to cost advantages, skilled labour availability, and technological advancements. Countries like India and the Philippines emerged as key outsourcing hubs due to their robust IT infrastructure and a large pool of trained professionals offering cost-effective services. Furthermore, the region's expanding healthcare industry, coupled with the adoption of outsourcing for administrative tasks, drove market expansion.

Region with highest CAGR:

North America is expected to witness profitable growth over the projection period, owing to the complexity of the U.S. healthcare system, stringent regulatory compliance requirements like HIPAA, and the need for efficient revenue cycle management. Many outsourcing companies in North America leverage advanced software, AI-driven solutions, and automation tools to streamline billing processes, enhance accuracy, and ensure compliance with changing regulations. Furthermore, the growing aging population and increasing healthcare needs have resulted in higher patient volumes, creating more billing complexities.

Key players in the market

Some of the key players in the Medical Billing Outsourcing Market include Oracle, GE Healthcare, Veradigm, LLC, R1RCM Inc., McKesson Corporation, Kareo, Inc., eClinicalWorks, Promantra Inc., AdvancedMD, Inc., Quest Diagnostics Incorporated, Allscripts Healthcare Solutions Inc., HCL Technologies, Cerner Corporation, Experian Information Solutions Inc., The SSI Groups, Genpact, CareCloud Inc., Athenahealth inc., Billing Paradise and Altera Digital Health Inc.

Key Developments:

In February 2023, GeBBS Healthcare Solutions announced the acquisition of CPa Medical Billing, a provider of Revenue Cycle Management (RCM) services to federally qualified health centers and other multi-specialty physician groups.

In April 2022, Omega Healthcare acquired ApexonHealth, an AI and automation-based revenue cycle management and payor solutions provider. ApexonHealth provides services, such as medical billing, coding, and collections processes, and offers virtual nursing services.

In March 2022, Omega Healthcare announced the acquisition of Reventics, a U.S.-based company, to expand its Revenue Cycle Management (RCM) services by leveraging cloud-native platforms - RevCDI and RevMAX for improvement in clinical documentation and revenue cycle management.

In April 2021, Cerner Corporation announced the acquisition of Kantar Health, a division of Kantar Group, for $375 million in cash, to accelerate innovation in life sciences research and improve patient outcomes worldwide.

Service Types Covered:

• Front End
• Middle End
• Back End

Components Covered:

• Outsourced Medical Billing
• In-house Medical Billing

End Users Covered:

• Hospital
• Physician Office
• Other End Users

Regions Covered:

• North America
  • US
  • Canada
  • Mexico
• Europe
  • Germany
  • UK
  • Italy
  • France
  • Spain
  • Rest of Europe
• Asia Pacific
  • Japan
  • China
  • India
  • Australia
  • New Zealand
  • South Korea
  • Rest of Asia Pacific
• South America
  • Argentina
  • Brazil
  • Chile
  • Rest of South America
• Middle East & Africa
  • Saudi Arabia
  • UAE
  • Qatar
  • South Africa
  • Rest of Middle East & Africa

What our report offers:

• Market share assessments for the regional and country-level segments
• Strategic recommendations for the new entrants
• Covers Market data for the years 2021, 2022, 2023, 2026, and 2030
• Market Trends (Drivers, Constraints, Opportunities, Threats, Challenges, Investment Opportunities, and recommendations)
• Strategic recommendations in key business segments based on the market estimations
• Competitive landscaping mapping the key common trends
• Company profiling with detailed strategies, financials, and recent developments
• Supply chain trends mapping the latest technological advancements

Free Customization Offerings:

All the customers of this report will be entitled to receive one of the following free customization options:

• Company Profiling
  • Comprehensive profiling of additional market players (up to 3)
  • SWOT Analysis of key players (up to 3)
• Regional Segmentation
  • Market estimations, Forecasts and CAGR of any prominent country as per the client's interest (Note: Depends on feasibility check)
• Competitive Benchmarking
  • Benchmarking of key players based on product portfolio, geographical presence, and strategic alliances

Table of Contents

1 Executive Summary

2 Preface

• 2.1 Abstract
• 2.2 Stake Holders
• 2.3 Research Scope
• 2.4 Research Methodology
  • 2.4.1 Data Mining
  • 2.4.2 Data Analysis
  • 2.4.3 Data Validation
  • 2.4.4 Research Approach
• 2.5 Research Sources
  • 2.5.1 Primary Research Sources
  • 2.5.2 Secondary Research Sources
  • 2.5.3 Assumptions

3 Market Trend Analysis

• 3.1 Introduction
• 3.2 Drivers
• 3.3 Restraints
• 3.4 Opportunities
• 3.5 Threats
• 3.6 End User Analysis
• 3.7 Emerging Markets
• 3.8 Impact of Covid-19

4 Porters Five Force Analysis

• 4.1 Bargaining power of suppliers
• 4.2 Bargaining power of buyers
• 4.3 Threat of substitutes
• 4.4 Threat of new entrants
• 4.5 Competitive rivalry

5 Global Medical Billing Outsourcing Market, By Service Type

• 5.1 Introduction
• 5.2 Front End
• 5.3 Middle End
• 5.4 Back End

6 Global Medical Billing Outsourcing Market, By Component

• 6.1 Introduction
• 6.2 Outsourced Medical Billing
• 6.3 In-house Medical Billing

7 Global Medical Billing Outsourcing Market, By End User

• 7.1 Introduction
• 7.2 Hospital
• 7.3 Physician Office
• 7.4 Other End Users

8 Global Medical Billing Outsourcing Market, By Geography

• 8.1 Introduction
• 8.2 North America
  • 8.2.1 US
  • 8.2.2 Canada
  • 8.2.3 Mexico
• 8.3 Europe
  • 8.3.1 Germany
  • 8.3.2 UK
  • 8.3.3 Italy
  • 8.3.4 France
  • 8.3.5 Spain
  • 8.3.6 Rest of Europe
• 8.4 Asia Pacific
  • 8.4.1 Japan
  • 8.4.2 China
  • 8.4.3 India
  • 8.4.4 Australia
  • 8.4.5 New Zealand
  • 8.4.6 South Korea
  • 8.4.7 Rest of Asia Pacific
• 8.5 South America
  • 8.5.1 Argentina
  • 8.5.2 Brazil
  • 8.5.3 Chile
  • 8.5.4 Rest of South America
• 8.6 Middle East & Africa
  • 8.6.1 Saudi Arabia
  • 8.6.2 UAE
  • 8.6.3 Qatar
  • 8.6.4 South Africa
  • 8.6.5 Rest of Middle East & Africa

9 Key Developments

• 9.1 Agreements, Partnerships, Collaborations and Joint Ventures
• 9.2 Acquisitions & Mergers
• 9.3 New Product Launch
• 9.4 Expansions
• 9.5 Other Key Strategies

10 Company Profiling

• 10.1 Oracle
• 10.2 GE Healthcare
• 10.3 Veradigm, LLC
• 10.4 R1RCM Inc.
• 10.5 McKesson Corporation
• 10.6 Kareo, Inc.
• 10.7 eClinicalWorks
• 10.8 Promantra Inc.
• 10.9 AdvancedMD, Inc.
• 10.10 Quest Diagnostics Incorporated
• 10.11 Allscripts Healthcare Solutions Inc.
• 10.12 HCL Technologies
• 10.13 Cerner Corporation
• 10.14 Experian Information Solutions Inc.
• 10.15 The SSI Groups
• 10.16 Genpact
• 10.17 CareCloud Inc.
• 10.18 Athenahealth inc.
• 10.19 Billing Paradise
• 10.20 Altera Digital Health Inc.