Profile: R1 RCM Inc (RCM.OQ)
17 May 2019
R1 RCM Inc., incorporated on July 2, 2003, is a provider of revenue cycle management (RCM) and physician advisory services (PAS) to healthcare providers. The Company is engaged in providing management services of revenue cycle operations for the United States-based hospitals and other medical services providers. The Company's primary service offering consists of end-to-end RCM, which the Company deploys through a co-managed relationship or an operating partner relationship. Under a co-managed relationship, the Company leverage its customers' existing RCM staff and processes, and supplement them with its management, subject matter specialists, technology and other resources. Under an operating partner relationship, the Company provides revenue cycle infrastructure to providers, including all revenue cycle personnel, technology and process workflow. The Company also offers modular services, allowing customers to engage the Company for only specific components of its end-to-end RCM service offering. The Company's PAS offering assists hospitals in complying with payer requirements regarding whether to classify a hospital visit as an in-patient or an out-patient observation case for billing purposes. The Company also provides customers with retrospective appeal management service support for both governmental and commercial payers. Its physicians conduct detailed retrospective reviews of medical records to identify medical necessity for hospital services and the required documentation to support an appeal.
The Company's 'R1 Access' software offers workflow in customer central business offices and at its scaled shared service centers for pre-registration, financial clearance and financial counseling. The platform processes patient accounts through rules engines tuned to identify defects in demographic data, authorization processes, insurance benefits and eligibility and medical necessity. Its rules engines in R1 Access are also used to calculate patient cost estimates and prior balance accounts receivables. For the uninsured, the platform enables staff triage patients to find coverage for their visit. Its R1 Link delivers insight and defect detection capabilities of its rules engines in real-time to point of service emergency department and registration areas within the hospitals and clinics. When defects or inconsistent data are detected in the data entry or registration process, users receive targeted messages alerting them to resolve the issue while the patient is still in front of them.
The 'R1 Contact', the Company's patient contact application, provides the workflow and data for patient contact center representatives. It enables financial discussions with patients on outstanding balances. The 'R1 Contract', its contract modeling platform, is used to calculate the maximum allowed reimbursement for each claim based upon models of the Company's customer's contract with each payer. The 'R1 Analytics', the Company's Web-based reporting and analytics platform, produces over 300 reports derived from the financial, process and productivity data that the Company accumulates as a result of its services, which enables the Company to monitor and identify areas for improvement in the efficacy of its RCM services. The 'R1 Decision' platform classifies defects in a proprietary nomenclature and distributes data to back end teams for follow up and resolution according to standard operating processes. Defects are identified and noted on accounts as they occur. This platform, along with the Company's 'Yield-Based Follow Up' application, is designed to provide a range of services to customer patient financial services departments and also to the Company's shared services.
Revenue Cycle Management Offering
The Company's primary RCM service offering consists of end-to-end RCM services, which addresses a range of revenue cycle challenges faced by healthcare providers. The Company uses the R1 Performance Stack operating model designed to fit into a healthcare provider's revenue cycle operations. The R1 Performance Stack consists of seven components: Comprehensive Gains, Assured Standardization, Dimensional Visibility, Analytics & Accountability, Proprietary Technologies, Proven Process and Experienced Talent. The Company's R1 Hub Technologies integrates across multiple host and payer systems. These are designed to scale and perform in a range of systems to enable end-to-end process integration.
Physician Advisory Services Offering
The Company's PAS offering provides concurrent level of care billing classification reviews, as well as retrospective chart audits to assist hospitals in properly billing payers for selected services. According to the policies of the Centers for Medicare & Medicaid Services (CMS), the decision to classify a patient as an in-patient or out-patient observation case for billing purposes is based on medical judgment that can only be made after the physician has considered a number of factors, including the patient's medical history and current medical needs, the severity of signs and symptoms, the medical predictability of adverse events and the patient's anticipated length of stay. Using the Company's Web portal, hospital customers transmit pertinent data about the case at hand to its trained physicians, who then leverage the Company's diagnosis guidelines and the information within its knowledge database to reach an informed billing classification judgment, which the Company then provides to its customers as a recommendation.
R1 RCM Inc
401 N Michigan Ave Ste 2700
CHICAGO IL 60611-4217