R1 RCM provides a comprehensive suite of technology-enabled and outsourced revenue cycle management (RCM) services, primarily targeting large hospitals, health systems, and physician groups. The core of their offering is Phare: Healthcare's First Revenue Operating System, an AI-powered platform designed for comprehensive automation and real-time claim adjudication. The platform leverages AI agents (R37 Lab) and workflow orchestration to streamline the entire patient journey, from patient access to final payment.
Key Features and Capabilities:
- End-to-End RCM Outsourcing: Full-service management of all revenue-generation functions, combining technology with dedicated operational teams.
- AI-Powered Automation (Phare™): Uses AI agents for tasks like coding, claims scrubbing, and follow-up, aiming for comprehensive automation across the revenue cycle.
- Patient Access (Phare Access): Delivers a seamless, self-service patient intake experience, including insurance verification, securing prior authorizations, and embedding accurate patient data at intake.
- Claims Management (Phare Claim): Autonomously codes encounters and optimizes claims to increase coding accuracy, reduce denials, and accelerate reimbursements.
- Collections & Follow-up (Phare Flow): Autonomously follows up on claims and manages denials to accelerate and maximize reimbursement, involving human experts for exceptions.
- Revenue Intelligence & Analytics: Provides sophisticated analytics and real-time dashboards for performance visibility, denial rates, collection efficiency, and days in accounts receivable.
- Modular Solutions: Offers flexible partnerships for specific areas like Revenue Integrity, Denials Management, and Clinical Documentation Integrity (CDI).
Target Users and Use Cases:
R1 RCM is designed for enterprise-scale healthcare organizations including large hospitals, multi-facility health systems, and large physician groups. The primary use case is to optimize financial performance by improving revenue capture, reducing the cost-to-collect (up to 50% claimed), accelerating cash flow, and enhancing the overall patient financial experience. The solution's enterprise-grade infrastructure is built to handle high transaction volumes and complex payer mixes while maintaining regulatory compliance.
