Revenue Cycle Management Market: Growth, Size, Share, and Trends

DRIVER: Growing regulatory requirements and government initiatives

In the US, the Patient Protection and Affordable Care Act (PPACA) has led to the restructuring of private insurance, Medicare, and Medicaid systems. In line with these changes, the “Meaningful Use” rules of the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health Act (HITECH) have mandated the adoption of electronic medical/health records (EMR/EHR) that will increase data interoperability. This will ease data exchange between healthcare organizations, providers, and payers. This, in turn, would drive the adoption of patient access solutions such as eligibility verification and medical necessity management.

Under the Hospital Value-Based Purchasing (HVBP) Program, Medicare rewards hospitals with payments based on their performance on certain quality measures or how much they improve their performance. Such programs motivate healthcare providers to perform their core and financial functions well, thereby increasing the adoption of RCM solutions.

Some RCM solutions and their benefits in managing regulatory compliance in line with laws and regulations are listed below:

• The Coronavirus Aid, Relief, and Economic Security (CARES) Act expands the current Accelerated and Advance Payment Program to include all Medicare providers throughout the country. All qualified providers, including hospital-based radiology practices, may request up to 100% of the Medicare payment amount for three months.
• Computer-assisted coding tools fulfill complicated regulatory requirements in line with the mandatory implementation of ICD-10 coding standards, which results in the greater adoption of these systems to manage compliance by healthcare providers and payers.

NHS England is advancing a strategic program to integrate and utilize data from general practices, hospitals, and other care settings for healthcare research and service planning. A major milestone was reached in November 2023, when 90% of hospital trusts had adopted electronic patient record (EPR) systems, meeting the government's target ahead of the December 2023 deadline, as outlined in the June 2022 digital health plan. With 189 NHS hospital trusts implementing EPR systems, the UK is on track for full EPR adoption across all trusts by March 2025. This progress reflects a strong commitment to healthcare digitization, improved patient outcomes, and efficient data sharing across care environments.

Globally, similar digital transformation efforts are reshaping healthcare markets. China’s “Healthy China 2030” initiative targets the expansion of the national health services industry to approximately USD 2.4 trillion by 2030, aiming to double its size within a decade. This ambitious roadmap is accelerating the deployment of healthcare IT solutions, including revenue cycle management (RCM) systems, to enhance care quality and operational efficiency. In Australia and New Zealand, value-based care models—such as Australia’s Practice Incentives Programme and New Zealand’s Primary Health Organization Performance Programme—are being deployed to drive performance improvements and better health outcomes. Meanwhile, India’s Union Budget 2024–25 allocates USD 10.70 billion (Rs. 89,287 crores) toward healthcare transformation, with a strong focus on digital infrastructure, accessibility, and innovation. These regional developments are collectively fueling the adoption of RCM solutions, positioning them as critical enablers of healthcare modernization and sustainable system-wide improvements.

RESTRAINT: IT infrastructural constraints in emerging economies

RCM solutions are typically integrated with EHR or practice management suites, where the EHR manages the patient’s clinical data while the RCM system processes the claims for payments. However, the success of RCM largely depends on the IT infrastructure and support within the organization. The software solutions offered by RCM companies to providers require IT expertise and infrastructure to function properly. This is necessary to obtain patient information from various departments as well as healthcare providers. Collective data from all these departments is used for correct billing and sharp coding, claims denial management, and establishing effective health data security. Most developing markets lack the required interoperability infrastructure to implement revenue cycle management solutions due to budgetary constraints. These infrastructural loopholes prove a major constraint to the growth of the revenue cycle management market in developing regions.