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Valued at $15.2 billion in 2019, the global medical coding market is projected to witness a CAGR of 9.6% during the forecast period (2020–2030). Rising incidence of insurance frauds and growing demand to modernize hospital billing procedures are the key growth factors driving the medical coding industry.
In 2019, the ICDs category accounted for the largest market size in the medical coding industry, on the basis of classification system. It is also expected to maintain the same trend throughout the forecast period. This is due to fact that ICD helps to organize information into standard groupings of diseases that allows easy storage, retrieval, and analysis of health information for evidenced-based decision-making, and sharing health information among healthcare institutions, countries, and regions.
The hospital category, based on end user, is projected to witness the fastest growth in the medical coding market, during the forecast period. The category also accounted for the largest size in the market. Globally, hospitals are considered the first choice of patients for medical procedures. Further, it is expected that by 2022, ICD-11 will be adopted by all countries, as the new standard. ICD-11 has around 55,000 codes, which is four times the diagnostic codes present in ICD-10. Additionally, majority of the hospitals in countries, such as the U.S., Germany, France, and the U.K., utilize medical coding whenever a patient arrives, as part of their revenue management process. This is further expected to support the high growth of the market in this category during the forecast period.
Europe held the largest share in the medical coding market in 2019, mainly due to the high-patient visits and mandates of medical coding in healthcare settings. Medical coding has enabled European healthcare bodies in generating statistical analysis of diseases and recommending suitable therapies. Besides, it has helped healthcare insurance providers in quick and easy reimbursement of medical bills. The outbreak of COVID-19 in the region, primarily in countries such as Italy, Spain, Germany, the U.K., and Russia, has further pushed the need for medical coding for the direct surveillance of the pandemic and the efficient allocation and management of medical resources.
Globally, the APAC medical coding market is expected to witness the fastest growth during the forecast period. The digitization of health records in countries, such as China, India, South Korea, and Indonesia, is projected to drive the demand for medical coding services in the region. Further, improving health insurance facilities in these countries is also driving the market growth. Medical coding procedures have ensured efficient and timely approval of medical claims and encouraged a large number of people than before to take health insurance.
Moreover, developing economies of the region, including India, Indonesia, Vietnam, and Thailand, are adopting electronic health records (EHRs) for better monitoring of diseases and related diagnostic procedures. This structural change from the paper-based system to the electronic system has driven the requirement for coding services in the region and is expected to boost the growth of the regional medical coding market in coming years.
The prominent trend in the medical coding market is increasing utilization of CACS. Generally, medical coding procedures are performed by medical coders, but the growing technological advancements and rising adoption of technologies, such as artificial intelligence (AI), natural language processing (NLP), and internet of medical things (IoMT), in the healthcare vertical are raising the demand for CACS. It offers numerous advantages over manual coding, including higher coding productivity and efficiency, and consistent implementation of coding rules. A study performed by American Health Information Management Association (AHIMA) stated that coders who used a CACS spend nearly 22% less time in coding a record than coders who do not utilize a CACS.
The incidence of insurance frauds in the healthcare industry is increasing, globally, which plays a pivotal role in the growth of the medical coding market. This situation is resulting in the incursion of excessive financial losses, which amount to billions of dollars every year, as estimated by the National Heath Care Anti-Fraud Association (NHCAA). Furthermore, in 2018, around $3.6 trillion was spent on healthcare services (which included expenditure for healthcare goods and services, public health activities, net cost of health insurance, and investment related to healthcare) in the U.S., which represented billions of health insurance claims, out of which some claims were fraudulent.
By using the medical coding and billing standards due to their advantages, medical billers generate uniform checklists, which are to be followed according to the process claims. Additionally, irregularities in these checklists support medical billers in spotting any fraud, before the document is submitted to an insurance company.
|Base Year (2019) Market Size||$15.2 billion|
|Forecast Period (2020-2030) CAGR||9.6%|
|Report Coverage||Market Trends, Revenue Estimation and Forecast, Segmentation Analysis, Regional and Country Breakdown, Companies’ Strategical Developments, Company Profiling|
|Market Size by Segments||Classification System, End User, Geography|
|Market Size of Geographies||U.S., Canada, Germany, France, Italy, U.K., Spain, Netherlands, Norway, Japan, China, India, Australia, South Korea, Brazil, Mexico, Saudi Arabia, South Africa|
|Market Players||Optum Inc., Nuance Communications Inc., 3M Company, Precision Practice Management, Parexel International Corporation, Dolbey Systems Inc., Aviacode Inc., Medical Record Associates LLC, Maxim Healthcare Services Inc., Oracle Corporation|
|Secondary Sources and References (Partial List)||American Health Information Management Association (AHIMA), American Medical Association (AMA), Canadian Institute for Health Information (CIHI), Centers for Disease Control and Prevention (CDC), European Medical Association (EMA), National Heath Care Anti-Fraud Association (NHCAA), World Health Organization (WHO)|
Medical billing procedures have been much more effective since the arrival of medical coding systems, especially the current procedural terminology (CPT) medical code. It has been developed by the American Medical Association (AMA) to help standardize and facilitate medical billing procedures. The coding system comprises alpha-numerical codes, which are designated to describe several treatments and services that a medical facility or a doctor performs on patients. These sets of codes are defined and entered into a database, which is used for billing insurance organizations for the services rendered. By using this billing system, medical professionals are better able to keep a track of the receipt of their medical payments and financial records, which, in turn, is benefitting the growth of the medical coding market.
The global medical coding market is fragmented in nature, with presence of several key players, including Aviacode Inc., Medical Record Associates LLC, Maxim Healthcare Services Inc., Oracle Corporation, 3M Company, and Parexel International Corporation.
In recent years, the players in the medical coding industry have been focusing on partnerships and collaborations, as part of their strategic measures. For instance:
The medical coding market report offers comprehensive market segmentation analysis along with market estimation for the period 2014–2030.
Based on Classification System
Based on End User