Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Mid-Revenue Cycle Management, CDI Market to Reach $4.5B by 2023

Providers are increasingly seeking mid-revenue cycle management solutions to ensure accurate clinical documentation, coding, and data accuracy.

Mid-revenue cycle management and clinical documentation improvement

Source: Thinkstock

By Jacqueline LaPointe

- The revenue cycle is traditionally broken into the front and back ends. But a new market report shows providers are still looking to bolster the middle of their revenue cycles.

According to a recent Markets and Markets report, the mid-revenue cycle management and clinical documentation market is projected to reach $4.5 billion by 2023, growing at a compound annual growth rate (CAGR) of 7.9 percent.

Mid-revenue cycle management encompasses all the processes done between patient access and the business office. Clinical documentation, clinical coding, charge capture, pre-bill reviews, and other claim preparation processes occur in the “mid” revenue cycle.

The mid-revenue cycle was buzzword around 2015, the Advisory Board reports.

Traditionally, the revenue cycle is split between the front-end, which deals with patient access and other more patient-facing financial processes, and the back-end, which manages claims, bills, and account resolution.

But the advent of value-based purchasing and pay-for-performance models really had providers concentrating on what happens after patient access and before medical billing. Processes such as clinical documentation improvement and coding became top priorities for providers relying on performance bonuses and accurate payments based on patient risk.

“In the past, many executives didn't consider documentation to be a financial function. But the reality is that pay-for-performance is driving an increasing important relationship between quality and finance,” explained James Green, Managing Partner at the Advisory Board Company.

“And quality is measured based on what is written in patient's charts. If that's not accurate, then quality-based payments will suffer. Finance leaders need to understand this connection, and be crystal clear on the financial impact they can expect.”

The importance of the mid-revenue cycle has only grown since 2015 as value-based purchasing continues to push out fee-for-service. And providers are seeking revenue cycle management technology that caters to the middle of their cycles.

Researchers at Markets and Markets reported that providers are increasingly using mid-revenue cycle management solutions for a number of reasons. Chief among them is the need to reduce costs in the face of ever-increasing healthcare spending.

Providers also want mid-revenue cycle management technology to check the loss of revenue due to medical billing and coding errors, resolve issues stemming from declining reimbursement rates, manage the increasing volume of unstructured data, and maintain regulatory compliance.

Solutions that integrate with EHR systems will account for a large portion of the market growth, researchers added.

“The large share of the solutions segment can be attributed to the benefits offered by mid-revenue cycle solutions when they are integrated with EHRs/EMRs, encoder systems, voice/text/speech recognition software, CDI, transcription systems, and other hospital information management systems,” they wrote. “Moreover, these solutions also eliminate the duplication of administrative work of entering selected codes into each record. They also decrease the potential for data documentation, charge capture, and coding errors, and improve the overall mid-revenue cycle process.”

However, researchers forecast health IT infrastructure restraints, a lack of skilled IT professionals, and the security risks associated with health IT will restrain the global mid-revenue cycle management market during the period.

Key market players in the mid-revenue cycle management market from 2018 to 2023 will be 3M Company, Optum, Nuance, M*Modal, nThrive, Dolbey Systems, Streamline Health, Vitalware, Chartwise, Craneware, Epic Systems, Cerner, ezDI Inc., Iodine Software, Flash Code, and TruCode.

Researchers noted that Optum was the largest solution provider in the mid-revenue cycle management and clinical documentation improvement market in 2017.

They also pointed out that many of the vendors in the mid-revenue cycle management space have recently engaged in new partnerships or mergers. For example, Nuance partnered with Epic Systems in 2018 to incorporate their artificial intelligence-powered virtual assistant platform into Epic EHR systems.

That same year, M*Modal teamed up with Enjoin to explore risk-adjustment services for outpatient clinical documentation improvement programs, while Vitalware partnered with BurstIQ to implement BurstIQ’s blockchain analytics and machine learning tools into their solutions.

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