Healthcare Claims Management Market (By Product: Medical Billing, Claims Processing; By Component; By Solution Type; By Deployment Mode; By End-use) - Global Industry Analysis, Size, Share, Growth, Trends, Revenue, Regional Outlook and Forecast 2022-2030

Published Date : Aug 2022 | No. of Pages : 150+ Pages | Category : Healthcare

The global healthcare claims management market was valued at USD 21.8 billion in 2021 and it is predicted to surpass around USD 136.97 billion by 2030 with a CAGR of 22.66% from 2022 to 2030

Healthcare Claims Management Market Size 2021 to 2030

Report Highlights

  • The medical billing segment held the largest revenue share of over 55.04% in 2021. 
  • The software segment accounted for the largest revenue share of over 65.12% in 2021. The segment is expected to maintain its dominance throughout the forecast period. 
  • The integrated solutions segment dominated the market and accounted for a revenue share of over 70.09% in 2021. It is expected to maintain its dominance throughout the forecast period. 
  • Healthcare providers held the largest revenue share of over 65.26% in 2021. The healthcare providers segment is anticipated to rise moderately over the forecast period.
  • The web-based segment held the largest revenue share of over 45.32% in 2021. 
  • North America led the overall market with a revenue share of over 35% in 2021. 

The rising complexity of claims administration and the medical billing process is one of the most immediate concerns confronting health insurance companies and other private payers. The capacity to digitize every stage of the claims process, implying process improvement, from data entry to claims management and billing processing, holds enormous promise for increasing medical billing and claims management efficiency and accuracy. When done correctly, the result may be cheaper expenses and a better customer experience. Thus, improvements to the overall healthcare organization’s process are expected to propel industry growth. 

Furthermore, the growing importance of denial management is expected to further boost industry growth. According to a Kaiser Family Foundation recent analysis, around 17% of in-network claims were refused across HealthCare.gov issuers in 2019 and approximately 14% were denied in 2018. Specific issuer rates differed greatly from these averages. As a result, financial strategists who are truly focused on the transition from volume to value undervalue it. This is a mistake since dealing with rejections is as important now as it was decades ago. 

The global COVID-19 pandemic has had a mixed impact on the overall market. Furthermore, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was designed in developed countries such as the U.S. to provide healthcare resources required to combat COVID-19. The CARES Act incorporated medical billing rules, which increased claim denials and their management. This will further boost the overall market for medical billing and healthcare claims management. 

Despite the expected rise in the market, there have been rising concerns in terms of data privacy. For instance, modern technologies such as cloud, mobile, and next-generation databases are increasingly being used to manage, store, and retrieve such claims data as technology advances. These elements have conspired to form healthcare data security an ongoing concern for the overall healthcare industry. To guarantee that patients have the data protection they need and deserve, rules and regulations governing healthcare data are always evolving. 

Due to the clear nascent nature of technology innovation in the medical billing and claims processing market, the share is widely distributed across various competitors. This is bolstered by the fact that a large number of businesses have joined the market due to the minimum capital requirements for establishing and maintaining technological infrastructure. However, there has been a reduced risk of entry to some extent due to the complexity in the healthcare medical billing and claims processing market dynamics. 

Larger, established players and well-known players have a credibility advantage, which reduces the threat of entry from smaller, less established players with minimal IT experience in healthcare. However, due to the expanding number of advanced solution providers, such as CareCloud, Inc., and AdvancedMD, who are increasingly focusing on lowering claim denial rates and improving the medical billing rates, the industry is set to experience a higher new entrant rate. 

Scope of The Report

Report Coverage Details
Market Size in 2021 USD 21.8 billion
Revenue Forecast by 2030 USD 136.97 billion
Growth rate from 2022 to 2030 CAGR of 22.66%
Base Year 2021
Forecast Period 2022 to 2030
Segmentation Product, component, solution type, deployment mode, end-use, region
Companies Covered McKesson Corporation; The SSI Group, Inc.; Quest Diagnostics; Kareo; Optum, Inc. (a subsidiary of UnitedHealth Group); Conifer Health Solutions; CareCloud; eClinicalWorks; IBM; Cerner Corporation

 

Product Insights

The medical billing segment held the largest revenue share of over 55.04% in 2021. Increasing internet usage, digitization, higher healthcare spending, and demand for risk and compliance management are key factors driving the medical billing segment. Medical billing is further categorized into professional billing and institutional billing. Professional billing is the process of submitting claims for medical services or treatments performed by physicians or healthcare professionals to persons who have insurance. Furthermore, one distinguishing feature of physician billing from professional billing is that it contains medical coding, which may result in pricing variations and be a factor in determining out-of-pocket spending. 

Unlike professional billing, where errors can occur for a variety of reasons, including technical errors, institutional billing services are error-free. The majority of hospitals and healthcare providers pick these services since they specialize in medical billing. Institutional billing is larger than the physician billing industry, and this trend is projected to continue as more hospitals and major clinics begin to use institutional billing services, which will ultimately influence the entire medical billing segment to expand throughout the forecast period. 

The target population's need for high-quality healthcare services is being prioritized, and technology-related services are being adopted at an increasing pace. As a result, the healthcare claims processing segment is anticipated to grow throughout the forecast period. The claims processing devices are popular among a wide spectrum of customers globally, and demand for them is increasing, which will help the healthcare claims processing segment grow over the forecast period. Furthermore, the expanding health insurance sector is positively influencing the overall industry growth. 

Component Insights

The software segment accounted for the largest revenue share of over 65.12% in 2021. The segment is expected to maintain its dominance throughout the forecast period. The healthcare industry has been revolutionized by overall digitization, which has improved patient treatment guidance systems and software technologies that have provided simple access to healthcare data through cost-effective automated billing and claims processing systems. Medical billing and claims processing software have several advantages, including more accurate bills, fewer administrative errors, fewer insurance claim denials, invoice tracking, and speedier payments, which boosts efficiency and accuracy even more. 

Medical billing and claims processing services are used to process, fill out, and monitor health insurance claims to save time. Medical offices had to make greater billing and payment tracking modifications in 2020 due to new pandemic realities. As the number of COVID-19 patients grew, practitioners were forced to administer the therapies owing to a lack of resources around the world. This helped the medical billing and claims processing service provider get attention, which, in turn, led to higher revenue growth for the competitors in this industry. 

One of the key driving causes for practitioners opting for medical billing and claims processing services is the hassle-free procedure of settling claims with features such as the availability of skilled coders familiar with the newest medical codes and claims processing. The significant risk of data breaches connected with medical billing in the U.S., on the other hand, is likely to stifle market expansion throughout the forecast period. According to Becker's Healthcare reported statistics, nearly 50 million Americans' health records have been compromised in 2021, which is almost three times more than in the previous three years. 

Solution Type Insights

The integrated solutions segment dominated the market and accounted for a revenue share of over 70.09% in 2021. It is expected to maintain its dominance throughout the forecast period. Navigating convoluted insurance requirements, recognizing best practices for data gathering, and evaluating data to uncover possibilities for improvement are skills that are unrelated to patient care but equally critical for any healthcare institution that wants to stay in business. For the reasons outlined above, providers are constantly looking for methods to improve claim management and medical billing systems. Thus, implementing an integrated billing and claims processing system, which offers several benefits, is one method to do so. 

Standalone solutions are primarily focused on certain features and capabilities. When compared to an integrated solution, this sort of solution can provide more features. Following the development of the criteria, a particular choice of one standalone solution that best meets those needs might be made. Furthermore, even though integrated solutions have a limitation of restricted functionality, the rising acceptance of integrated solutions may hinder the growth of the standalone segment over the forecast period. 

End-use Insights

Healthcare providers held the largest revenue share of over 65.26% in 2021. The healthcare providers segment is anticipated to rise moderately over the forecast period, with growth aided by the adoption of rigorous regulatory rules in various countries such as the U.S. Due to IT infrastructure limits in emerging nations, the healthcare providers segment has faced challenges. This is mostly because the price is a key impediment to the adoption of advanced technology such as claims processing software. As advanced deployment modes, such as Cloud-based solutions, gain popularity, implementation of such solutions due to high maintenance costs hinders smaller healthcare provider organizations from adopting such solutions, which might hinder market growth over the forecast period. 

Healthcare payers in this market are expected to expand rapidly during the forecast period, supported by the implementation of stringent regulatory requirements, an in-house lack of experienced individuals for claims processing, and growing healthcare costs and related frauds. Payers have also helped healthcare providers by providing a cloud-based and web-based portal that provides accurate and timely information about not just the pandemic but also assists them to handle medical billing and related claims.

Furthermore, increased occurrences of data breaches and loss of confidentiality, and migration from legacy systems are likely to hinder the growth of the healthcare payers in the market. 

Deployment Mode Insights 

The web-based segment held the largest revenue share of over 45.32% in 2021. The web-based and cloud-based segments both have a strong competitive presence in the market. Sales of cloud-based billing and claims processing services and solutions, which can be hosted on public or private clouds, make up the cloud-based billing and claims processing market. Cloud billing is a concept that refers to a hybrid of cloud computing and electronic billing. Furthermore, cloud medical billing is revolutionizing the computer system, offering increased billing flexibility and data accessibility. 

With the rise of the cloud, billing has evolved from a stand-alone back-office solution to a critical component of the whole statement process. Furthermore, regardless of the industry, overall cloud billing services assist organizations in saving money while still offering excellent customer service. According to a Flexera study from 2021, 93% of organizations are using cloud-based technology, with 73% seeking to optimize their present cloud utilization for cost savings. As a result, the cloud-based billing industry's overall growth is being supported by a growing need for cheaper capital and operating costs.

A web browser is required to use web-based medical billing and claims processing systems. Web software is made by combining handwriting (user) with scripting languages like Java and Adobe Flash (server). To allow online web services to work, the web browser relies on the parts of the webserver installed on the device. 

The web-based segment would see similar positive acceptance by applicants as a cloud-based system, but market growth would vary over time as cloud-based systems are still preferred since a web-based system requires internet connectivity to access the system. While needing an online internet connection is a limitation compared to a cloud-based system, it does have the advantage of allowing users to access the system from anywhere. 

Since the hardware, data, and software platform are within your control and ownership, thus, it is anticipated that throughout the forecast period, on-premise billing and claims processing software and services would contribute to the segment growth. Furthermore, this growth will undoubtedly increase as the system's adoption increases; however, this growth of traditional on-premise medical billing and claims processing systems will be relatively less in comparison to cloud-based and web-based systems, which have gained popularity and acceptance in the aftermath of the pandemic. 

Regional Insights

North America led the overall market with a revenue share of over 35% in 2021. This can be attributed to an increase in patient load and healthcare coverage, adoption of EHRs and e-prescribing services, growing government spending, and improving healthcare infrastructure.

With the increased awareness regarding medical claims and rising medical treatment costs, Asia Pacific (APAC) is expected to be the fastest-growing region in the forecast period. Factors such as the quick expansion of the healthcare business in India attempts to improve the quality of healthcare delivery in Japan, and the adoption of healthcare IT systems in countries with well-developed healthcare systems such as China is expected to contribute to Asia's strong growth over the forecast period. 

Key Players

  • McKesson Corporation
  • The SSI Group, Inc.
  • Quest Diagnostics
  • Kareo
  • Optum, Inc (a subsidiary of UnitedHealth Group)
  • Conifer Health Solutions
  • CareCloud
  • eClinicalWorks
  • IBM
  • Cerner Corporation 

Market Segmentation

  • By Product Outlook
    • Medical Billing
      • Professional
      • Institutional
    • Claims Processing
  • By Component Outlook
    • Software
    • Services
  • By Solution Type Outlook
    • Integrated Solutions
    • Standalone Solutions
  • By Deployment Mode Outlook
    • Cloud-based
    • On-premise
    • Web-based
  • By End-use Outlook
    • Healthcare Providers
    • Healthcare Payers
  • By Regional Outlook
    • North America
      • U.S.
      • Canada
    • Europe
      • U.K.
      • Germany
      • France
      • Italy
      • Spain
    • Asia Pacific
      • Japan
      • China
      • India
      • Australia
      • South Korea
    • Latin America
      • Brazil
      • Mexico
      • Argentina
    • Middle East & Africa
      • South Africa
      • Saudi Arabia
      • Israel

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