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Growing Need to Maintain Revenue Integrity and Manage Unstructured Healthcare Data to Drive Market Growth

   January 28, 2021

The mid-revenue cycle management/clinical documentation improvement solutions and services are significant for maintaining revenue integrity and driving financial stability in hospitals as reimbursement models are being adopted. To achieve revenue integrity, healthcare organizations have to achieve operational efficiency, compliance, and optimal earned reimbursement. The mid-revenue cycle management/clinical documentation improvement solutions and services help healthcare providers and payers maintain revenue integrity and prevent any revenue loss or compliance risks by a systematic overview in every process within the revenue cycle.

Mid-revenue cycle management/clinical documentation improvement solutions comprise clinical coding, clinical documentation improvement, charge capture, clinical documentation, diagnosis-related grouping, and pre-bill review. These solutions improve revenue cycle productivity by eliminating coding errors and manual coding practices and their compatibility with hospital management solutions. Mid-revenue cycle management/clinical documentation improvement services include consulting services, such as implementation and optimization services.

With rising healthcare spending, the adoption of revenue cycle management solutions is becoming important for healthcare providers. Mid-revenue cycle management solutions have helped providers keep healthcare costs down, simultaneously improving patient outcomes. These mid-revenue cycle solutions help healthcare organizations better deliver value-based-care service offerings to the patients, effective maintenance of related documentation, error-free claims processing, and reducing the patients’ past dues, ultimately resulting in higher revenues and profits. Mid-cycle revenue solutions are also useful in uncovering patterns in denied claims, further helping providers recover lost revenues. With the help of revenue cycle programs, providers can shift to value-based reimbursement practices as a cost-control measure.

Across healthcare settings, 80% of the medical data remains untapped and unstructured after its creation. Health information systems tend to ignore, not save, or abandon this data type. Unstructured data in medical facilities typically consist of medical video data from medical imaging devices, biosignal data displayed on the screens of patient monitors in ICUs or operating rooms and wearable health monitoring devices, and verbal or non-verbal data generated by patients and medical staff during communication. The lack of management of this data can result in repeat medical tests or procedures, further increasing the cost burden on patients and health systems. Therefore, healthcare providers are adopting solutions that are most effective in recording and enhancing the use of unstructured medical data.

Healthcare providers struggle to balance the conflicting goals of enhancing the quality of care and maintaining profitability. Healthcare settings are under constant pressure to deliver superior care while minimizing clinical and administrative expenses. However, the effective use of unstructured data, billing and accounting packages, and clinical management systems poses challenges in improving decision-making. Therefore, the providers of healthcare IT solutions are innovating approaches to manage the issues related to unstructured data.

Thus, advancements in healthcare solutions and the growing need to curb revenue leakage by managing unstructured healthcare data are expected to drive the demand for mid-revenue cycle management solutions.

Moreover, due to the outbreak of the COVID-19 pandemic, after the reopening of outpatient surgery centers, the previously canceled elective surgeries were operated through outpatient surgery centers. The physicians and patients preferred outpatient surgery centers due to the COVID-19 pandemic's safety concerns. This resulted in gradually growing cash flows in outpatient surgery centers, requiring solutions like mid-revenue cycle management. Further, the ambulatory surgery centers, to safeguard their staff, began outsourcing medical billing & coding and claim processing, positively influencing outsourcing revenue cycle operations. Thus, alterations in coding practices is expected to drive the adoption of outsourced mid-revenue cycle solutions.

However, during the pandemic's peak, healthcare organizations faced many challenges due to a sudden increase in hospital in-patients. The healthcare organizations were presented with tremendous financial pressures due to COVID-19 treatment costs, revenue shortfalls due to canceled elective surgeries, shutdown, or layoff within outpatient surgery centers. These financial challenges have reduced budgets for implementation or upgradation of digital health solutions, negatively influencing the market growth.

Emerging economies such as India, Malaysia, and Brazil offer significant growth opportunities for healthcare organizations to adopt healthcare IT solutions like EHR, mHealth, eHealth, and revenue cycle management. These countries have high patient volumes, a high burden on their healthcare systems, and are focused on building their healthcare infrastructure. The exponential infrastructural growth in these countries has spawned many local vendors. The growing investments in healthcare infrastructure, rising number of new hospitals, various initiatives toward increasing insurance penetration, supportive regulations, the need to improve healthcare access in rural areas, and shortage of healthcare professionals offer significant opportunities for increasing the adoption of simple as well as complex healthcare IT solutions, including revenue cycle management.

According to Meticulous Research, the global mid-revenue cycle management/clinical documentation improvement market is expected to grow at a CAGR of 6.6% to reach $4.55 billion by 2027.

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