United States Healthcare Denial Management Markets, 2022-2027 - Rising Importance of Denial Management in Medical Claims & Reducing Reimbursement Rates and Increasing Denials

DUBLIN, Jan. 28, 2022 /PRNewswire/ -- The "U.S. Healthcare Denial Management Market - Industry Outlook & Forecast 2022-2027" report has been added to ResearchAndMarkets.com's offering.

The U.S. healthcare denial management market size was valued at USD 3.57 billion in 2021 and is expected to reach USD 5.94 billion by 2027, growing at a CAGR of 8.86% during the forecast period.

Over the past several years, the claim denial rates in hospitals moved upwards but reached new highs with the public health emergency of COVID-19. During this time, the medical claim denials have risen 11% nationwide in the US, with the most denial rates accounting for 13.1% in the Pacific Coast and 12.9% in the Northeast.

In the US, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was developed for providing healthcare resources that were needed to fight COVID-19. CARES Act included medical billing provisions, leading to an uptick in claim denials. This will further drive Healthcare Claims Management in the country.

U.S. HEALTHCARE DENIAL MANAGEMENT MARKET SEGMENTATION

Integrated held the major share by type. This can be attributed to the fact that EHR integrated with denial management has many benefits. This includes easy access to health information, improved diagnostics, and treatment, data privacy and security, minimizing medical errors, enhancing efficiency, and reducing costs.

Cloud-based solutions give insurers the flexibility to service policyholders and efficiently manage heavy workloads. Increasing adoption of the cloud-based model across several regions is enabling a mechanism to distribute the system and data across different locations. Also, cloud-based solutions mitigate the risk of data loss or inaccessibility due to a disaster. All these factors will drive the growth of cloud-based solutions in denials management programs.

KEY GROWTH FACTORS

• A growing number of medical claim denials
• Increasing payer complexities for healthcare claims
• Shift Towards Value-based Reimbursement
• Errors in Medical Billing and Healthcare Claims
• Need for standardization & trained professionals

KEY HIGHLIGHTS

• The rise in automation and AI-based denial management is a major trend in the market by helping in better managing claim denials.
• The growing need to reduce and manage claim denial as well as decrease the revenue impact to healthcare systems due to the loss in denials is contributing to the increase in adoption of denial management software
• The shift toward value-based solutions in the market is encouraging healthcare companies to shift towards automated denial management solutions.
• To maximize reimbursement and recuperate the lost healthcare revenue, providers have started enhancing claim denial management with various strategies which will increase the adoption of the healthcare denial management market in the US.

VENDOR LANDSCAPE

• The key players in the healthcare denial management market are UnitedHealth Group, McKesson Corporation, Change Healthcare, eClinicalWorks, Experian, Allscripts Healthcare Solutions, etc.
• There has been a rise in acquisitions of many third-party vendors by large companies. For instance, ARMC, specializing in denials management, was recently acquired by Longshore Capital Partners and Revco Solutions to expand geographic coverage and add an extra service for its clients.

Key Vendors

• UnitedHealth Group
• McKesson
• Change Healthcare
• eClinicalWorks
• Experian
• Allscripts Healthcare Solutions

Other Prominent Vendors

• 24/7 Medical Billing Services
• 3D Solutions
• 3Gen Consulting
• 4D Global
• Accenture
• Access Healthcare
• Acrologic Business Solutions
• AdvancedMD
• AdvantEdge Healthcare Solutions
• Advantum Health
• Aergo Solutions
• Aetna
• Alaska Billing Services
• AllianceMed
• BillingParadise
• Bizmatics
• CareCloud
• ChartLogic
• Cigna
• Cognizant
• Coronis Health
• Craneware
• Credit Management Company
• CureMD Healthcare
• Data Marshall
• DrChrono
• EHealthSource
• Greenway Health
• Golden West Medical Billing
• InSync Healthcare Solutions
• IntelliRCM
• Intersect Healthcare
• iSalus
• Kareo
• McBee Associates
• MedEx Medical Billing
• Medforce Technologies
• Medical Billers and Coders
• Medmecs Billing Services
• MGSI
• MRO
• NXGN Management
• OSP
• Persistent Systems
• PMMC
• Procure Billing Solutions
• Promantra
• Quadax
• QWay Healthcare
• R1 RCM
• Resolutions Billing & Consulting
• Revele
• RevenueXL
• Right Medical Billing
• Savista
• Superior Medical Management
• TriMed Technologies
• Vee Technologies
• Vitruvian MedPro
• Waystar

Key Topics Covered:

1 Research Methodology

2 Research Objectives

3 Research Process

4 Scope & Coverage
4.1 Market Definition
4.2 Base Year
4.3 Scope Of The Study

5 Report Assumptions & Caveats
5.1 Key Caveats
5.2 Currency Conversion
5.3 Market Derivation

6 Market at a Glance

7 Introduction
7.1 Overview

8 Market Opportunities & Trends
8.1 AI & Automation Improving Denial Management
8.2 Rising Importance Of Denial Management In Medical Claims
8.3 Reducing Reimbursement Rates And Increasing Denials
8.4 Increase In Outsourcing Of Denial Management

9 Market Growth Enablers
9.1 Growing Volume Of Medical Claim Denials
9.2 Increasing Payer Complexities For Healthcare Claims
9.3 Shift Toward Value-Based Reimbursement
9.4 Errors In Medical Billing And Healthcare Claims

10 Market Restraints
10.1 Lack Of Financial Resources & Outdated Strategies
10.2 Need For Standardization & Trained Professionals
10.3 Growing Concern For Data Security & Privacy Issues

11 Market Landscape
11.1 Market Overview
11.2 Market Size & Forecast
11.2.1 Component Insights
11.2.2 Type Insights
11.2.3 Delivery Mode Insights
11.2.4 End-User Insights
11.3 Impact Of Covid-19 On US Denials Management
11.4 Five Forces Analysis

12 Component
12.1 Market Snapshot & Growth Engine
12.2 Market Overview
12.3 Soft Denial
12.4 Hard Denial

13 Type
13.1 Market Snapshot & Growth Engine
13.2 Market Overview
13.3 Integrated
13.4 Standalone

14 Delivery Mode
14.1 Market Snapshot & Growth Engine
14.2 Market Overview
14.3 Web & Cloud-Based
14.4 On-Premises

15 End-User
15.1 Market Snapshot & Growth Engine
15.2 Market Overview

16 Healthcare Providers
16.1 Market Overview
16.2 Market Size & Forecast
16.3 Healthcare Providers: Type
16.3.1 Hospitals: Market Size & Forecast
16.3.2 Physician's Office: Market Size & Forecast
16.3.3 Others: Market Size & Forecast

17 Healthcare Payers
17.1 Market Overview
17.2 Market Size & Forecast

18 Competitive Landscape
18.1 Competition Overview
18.2 Market Share Analysis
18.2.1 UNITEDHEALTH Group In US Healthcare Denial Management Market
18.2.2 MCKESSON In US Healthcare Denial Management Market
18.2.3 Change Healthcare In US Healthcare Denial Management Market
18.2.4 ECLINICAL works In US Healthcare Denial Management Market
18.2.5 Experian Information Solutions In US Healthcare Denial Management Market
18.2.6 Allscripts Healthcare In US Healthcare Denial Management Market

19 Key Company Profiles

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