R1 RCM 10-Q 9 Nov 15 2015 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2015	Oct. 30, 2015
Document and Entity Information [Abstract]
Entity Registrant Name	Accretive Health, Inc.
Entity Central Index Key	1,472,595
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Document Type	10-Q
Document Period End Date	Sep. 30, 2015
Document Fiscal Year Focus	2,015
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Common Stock, Shares Outstanding		103,361,388

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Current assets:
Cash and cash equivalents	$ 137,716	$ 145,167
Restricted cash	0	5,000
Accounts receivable, net	5,137	4,438
Prepaid income taxes	5,425	6,138
Current deferred tax assets	99,987	62,322
Other current assets	7,798	7,389
Total current assets	256,063	230,454
Property, equipment and software, net	26,579	14,594
Non-current deferred tax assets	208,278	201,163
Goodwill and other assets, net	6	162
Total assets	490,926	446,373
Current liabilities:
Accounts payable	6,340	12,488
Current portion of customer liabilities	348,828	219,998
Accrued compensation and benefits	15,290	14,983
Other accrued expenses	12,261	15,680
Total current liabilities	382,719	263,149
Non-current portion of customer liabilities	323,293	317,065
Other non-current liabilities	8,421	8,405
Total liabilities	714,433	588,619
Stockholders' equity (deficit):
Common stock, $0.01 par value, 500,000,000 shares authorized,108,673,951 shares issued and 103,387,953 shares outstanding at September 30, 2015; 102,890,241 shares issued and 98,112,019 shares outstanding at December 31, 2014	1,087	1,029
Additional paid-in capital	317,543	307,075
Accumulated deficit	(487,220)	(397,517)
Accumulative other comprehensive loss	(2,465)	(1,763)
Treasury stock	(52,452)	(51,070)
Total stockholders' equity (deficit)	(223,507)	(142,246)
Total liabilities and stockholders’ equity (deficit)	$ 490,926	$ 446,373

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2015	Dec. 31, 2014
Statement of Financial Position [Abstract]
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	108,673,951	102,890,241
Common stock, shares outstanding	103,387,953	98,112,019

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Income Statement [Abstract]
Net services revenue	$ 15,842	$ 90,745	$ 48,898	$ 162,684
Operating expenses:
Costs of services	45,326	45,370	130,284	138,251
Selling, general and administrative	21,395	16,785	59,726	53,609
Restatement and other	3,964	13,846	5,850	67,907
Total operating expenses	70,685	76,001	195,860	259,767
Income (loss) from operations	(54,843)	14,744	(146,962)	(97,083)
Net interest income	73	100	147	252
Income (loss) before income tax provision	(54,770)	14,844	(146,815)	(96,831)
Income tax provision (benefit)	(21,800)	5,291	(57,112)	(34,862)
Net income (loss)	$ (32,970)	$ 9,553	$ (89,703)	$ (61,969)
Net Income (loss) per common share:
Basic (in dollars per share)	$ (0.34)	$ 0.10	$ (0.93)	$ (0.65)
Diluted (in dollars per share)	$ (0.34)	$ 0.10	$ (0.93)	$ (0.65)
Weighted average shares used in calculating net income (loss) per common share:
Basic (in shares)	97,230,069	95,775,597	96,358,342	95,750,887
Diluted (in shares)	97,230,069	97,250,282	96,358,342	95,750,887
Consolidated statements of comprehensive income (loss):
Net loss	$ (32,970)	$ 9,553	$ (89,703)	$ (61,969)
Other comprehensive income (loss):
Foreign currency translation adjustments	(429)	(253)	(702)	6
Comprehensive income (loss)	$ (33,399)	$ 9,300	$ (90,405)	$ (61,963)

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Operating activities:
Net loss	$ (89,703)	$ (61,969)
Adjustments to reconcile net loss to net cash provided by (used in) operations:
Depreciation and amortization	6,556	4,279
Share-based compensation	22,974	22,992
Loss on disposal	0	234
Recoveries for doubtful receivables	(79)	(455)
Deferred income taxes	(58,567)	(33,869)
Excess tax benefits from share-based awards	0	(176)
Changes in operating assets and liabilities:
Accounts receivable	(621)	16,539
Prepaid income taxes	632	2,646
Other assets	(334)	(2,328)
Accounts payable	(6,108)	685
Accrued compensation and benefits	311	1,960
Other liabilities	(3,648)	(4,228)
Customer liabilities	135,058	21,840
Net cash provided by (used in) operating activities	6,471	(31,850)
Investing activities:
Purchases of property, equipment and software	(18,304)	(3,206)
Net cash used in investing activities	(18,304)	(3,206)
Financing activities:
Exercise of vested options	1,331	0
Restricted cash released from letter of credit	5,000	0
Excess tax benefit from share-based awards	0	176
Purchase of treasury stock	(1,382)	(280)
Net cash provided by (used in) financing activities	4,949	(104)
Effect of exchange rate changes on cash	(567)	18
Net decrease in cash and cash equivalents	(7,451)	(35,142)
Cash and cash equivalents at beginning of period	145,167	228,891
Cash and cash equivalents at end of period	137,716	193,749
Supplemental disclosure of non-cash investing activities
Other liabilities related to purchases of property, equipment and software	$ 348	$ 0

Business Description and Basis

Business Description and Basis of Presentation	9 Months Ended
	Sep. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Basis of Presentation	BUSINESS DESCRIPTION AND BASIS OF PRESENTATION Business Description Accretive Health, Inc. with its subsidiaries (the "Company") is a leading provider of services that help healthcare providers generate sustainable improvements in their operating margins and cash flows while also improving patient, physician and staff satisfaction for its customers. The Company achieves these results for its customers through an integrated approach encompassing an end-to-end revenue cycle management service offering and physician advisory services. The Company does so by deploying a unique operating model that leverages its extensive healthcare site experience, innovative technology and process excellence. The Company also offers modular services, allowing clients to engage the Company for only specific components of its end-to-end revenue cycle management service offering. The Company’s primary service offering consists of revenue cycle management ("RCM"), which helps healthcare providers to more efficiently manage their revenue cycles. This encompasses patient registration, insurance and benefit verification, medical treatment documentation and coding, bill preparation and collections from patients and payers. The Company's physician advisory services 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 and consists of both concurrent review and retrospective chart audits to help its customers achieve compliant and accurate billing. The Company also provides its customers with retrospective appeal management service support for both governmental and commercial payers. Basis of Presentation The accompanying unaudited condensed consolidated financial statements reflect the Company's financial position as of September 30, 2015 , the results of operations for the three and nine months ended September 30, 2015 and 2014 , and the cash flows of the Company for the nine months ended September 30, 2015 and 2014 . These financial statements include the accounts of Accretive Health, Inc. and its wholly owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with accounting principles generally accepted in the United States (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information have been included. Operating results for the three and nine months ended September 30, 2015 , are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2015 . When preparing financial statements in conformity with GAAP, the Company must make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, expenses and related disclosures at the date of the financial statements. Actual results could differ from those estimates. For a more complete discussion of the Company’s significant accounting policies and other information, the unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements included in the Company's Annual Report on Form 10-K for the year ended December 31, 2014 .

Recent Accounting Pronouncement

Recent Accounting Pronouncements	9 Months Ended
	Sep. 30, 2015
Accounting Changes and Error Corrections [Abstract]
Recent Accounting Pronouncements	RECENT ACCOUNTING PRONOUNCEMENTS From time to time, new accounting pronouncements are issued by the Financial Accounting Standards Board ("FASB") and are adopted by the Company as of the specified effective date. Unless otherwise discussed, the Company's management believes that the impact of recently issued accounting pronouncements does not have a material impact on the Company's consolidated financial position, results of operations, and cash flows, or do not apply to the Company's operations. In May 2014, the FASB issued Accounting Standards Update No. 2014-09, "Revenue from Contracts with Customers" ("ASU 2014-09") , which provides guidance for revenue recognition. ASU 2014-09 requires that a company recognize revenue when it transfers promised goods or services to customers in an amount equal to the consideration to which the company expects to be entitled in exchange for those goods or services. ASU 2014-09 also requires additional disclosure about the nature, amount, timing and uncertainty of revenue and cash flows arising from customer contracts, including significant judgments and changes in judgments. On July 9, 2015, the FASB approved the deferral of the effective date of ASU 2014-09 by one year. As a result, ASU 2014-09 will be effective for the Company’s fiscal year beginning January 1, 2018, with retrospective applicability to prior periods. The Company may choose to adopt the standard as of the original effective date of annual reporting periods beginning after December 15, 2016; if it does so, the Company is required to apply the standard beginning in the first interim period within the year of adoption. The Company is currently evaluating the impact of the adoption of this prospective guidance on its consolidated financial statements.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2015
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	FAIR VALUE OF FINANCIAL INSTRUMENTS The Company has adopted the provisions of FASB Accounting Standards Codification ("ASC") Topic 820, “Fair Value Measurements”, which defines fair value, establishes a framework for measuring fair value in GAAP, and expands disclosures about fair value measurements. ASC 820 does not require any new fair value measurements, but provides guidance on how to measure fair value by providing a fair value hierarchy used to classify the source of the information. The fair value hierarchy distinguishes between assumptions based on market data (observable inputs) and an entity’s own assumptions (unobservable inputs). The hierarchy consists of three levels: • Level 1: Observable inputs such as quoted prices in active markets for identical assets and liabilities; • Level 2: Inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly. These include quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active, and model-derived valuations in which all significant inputs and significant value drivers are observable in active markets; and • Level 3: Valuations derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable. The following table includes assets that are measured at fair value on a recurring basis and are categorized using the fair value hierarchy (in thousands): September 30, 2015 December 31, 2014 (Unaudited) Level 1 assets Money market funds with maturities of less than 90 days — 137,802 Total $ — $ 137,802 During the three months ended September 30, 2015, the Company liquidated its investments in money market funds and did not reinvest the net proceeds. As of September 30, 2015, the Company does not have any financial assets or liabilities that are required to be measured at fair value.

Accounts Receivable and Allowan

Accounts Receivable and Allowance for Doubtful Accounts	9 Months Ended
	Sep. 30, 2015
Receivables [Abstract]
Accounts Receivable and Allowance for Doubtful Accounts	ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS Accounts receivable is comprised of unpaid balances pertaining to non-RCM service fees and net receivable balances for RCM customers after considering cost reimbursements owed to such customers, including related accrued balances. The Company maintains an estimated allowance for doubtful accounts to reduce its accounts receivable to the amount that it believes will be collected. This allowance is based on the Company’s historical experience, its assessment of each customer’s ability to pay, the length of time a balance has been outstanding, input from key customer resources assigned to each customer, and the status of any ongoing operations with each applicable customer. Movements in the allowance for doubtful accounts are as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Beginning balance $ 112 $ 253 $ 314 $ 740 (Recoveries)/Provision (34 ) 39 (79 ) (455 ) Write-offs (12 ) — (169 ) 7 Ending balance $ 66 $ 292 $ 66 $ 292

Property, Equipment, and Softwa

Property, Equipment, and Software	9 Months Ended
	Sep. 30, 2015
Property, Plant and Equipment [Abstract]
Property, Equipment, and Software	PROPERTY, EQUIPMENT AND SOFTWARE Property, equipment and software consist of the following (in thousands): September 30, 2015 December 31, 2014 (unaudited) Computer and other equipment $ 20,711 $ 17,701 Leasehold improvements 17,598 12,491 Software 20,687 12,398 Office furniture 4,903 3,152 Property, equipment and software, gross 63,899 45,742 Less: Accumulated depreciation and amortization (37,320 ) (31,148 ) Property, equipment and software, net $ 26,579 $ 14,594 The following table summarizes the allocation of depreciation and amortization expense between cost of services and selling, general and administrative expenses (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Cost of services $ 2,491 $ 1,053 $ 5,799 $ 3,142 Selling, general and administration 247 350 757 1,137 Total depreciation and amortization $ 2,738 $ 1,403 $ 6,556 $ 4,279

Customer Liabilities

Customer Liabilities	9 Months Ended
	Sep. 30, 2015
Other Liabilities Disclosure [Abstract]
Customer Liabilities	CUSTOMER LIABILITIES Customer liabilities consist of the following (in thousands): September 30, December 31, 2015 2014 (unaudited) Deferred customer billings, current $ 234,436 $ 132,063 Accrued service costs, current 96,237 68,077 Customer deposits, current 18,027 19,675 Deferred revenue, current 128 183 Current portion of customer liabilities 348,828 219,998 Deferred customer billings, non-current 323,293 317,065 Total customer liabilities $ 672,121 $ 537,063

Share-Based Compensation

Share-Based Compensation	9 Months Ended
	Sep. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Share-Based Compensation	SHARE-BASED COMPENSATION The share-based compensation expense relating to the Company’s stock options and restricted stock awards ("RSAs") for the three months ended September 30, 2015 and 2014 was $12.3 million and $5.4 million , respectively, with related tax benefits of approximately $4.5 million and $1.9 million , respectively. The share-based compensation expense relating to the Company’s stock options and RSAs for the nine months ended September 30, 2015 and 2014 was $25.3 million and $23.7 million , respectively, with related tax benefits of approximately $9.6 million and $8.5 million , respectively. Total share-based compensation expense that has been included in the Company's consolidated statements of operations was as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Share-based Compensation Expense Allocation Details: Cost of services $ 3,152 $ 1,736 $ 5,756 $ 5,614 Selling, general and administrative 9,163 3,488 19,562 10,077 Restatement and other — 144 — 8,049 Total share-based compensation expense (1) $ 12,315 $ 5,368 $ 25,318 $ 23,740 (1) Includes $1.9 million and $2.3 million in share-based compensation expense paid in cash during the three and nine months ended September 30, 2015, respectively, and $0.3 million and $0.6 million in share-based compensation expense paid in cash during both the three and nine months ended September 30, 2014, respectively. The Company uses the Black-Scholes option pricing model to determine the estimated fair value of each option as of its grant date. These inputs are subjective and generally require significant analysis and judgment to develop. The Company used Monte Carlo simulations to estimate the fair value of its RSAs with vesting based on market-based performance conditions as of their respective grant dates. Expected life is based on the market condition to which the vesting is tied. The following table sets forth the significant assumptions used in the Black-Scholes option pricing model and the Monte Carlo simulations and the calculation of share-based compensation expense for the nine months ended September 30, 2015 and 2014 : Nine Months Ended September 30, 2015 2014 Future dividends — — Risk-free interest rate 1.5% to 2.0% 1.9% to 2.2% Expected volatility 50% to 68% 50% Expected life 6.25 years 6.25 to 7.00 years Forfeitures 5.68% annually 5.68% annually The risk-free interest rate input is based on U.S. Treasury instruments, and expected volatility of the share price based upon review of the historical volatility levels of the Company’s common stock in conjunction with that of public companies that operate in similar industries or are similar in terms of stage of development or size and a projection of this information toward its future expected volatility. The Company used the simplified method to estimate the expected option life for 2015 and 2014 option grants. The simplified method was used due to the lack of sufficient historical data available to provide a reasonable basis upon which to estimate the expected term of each stock option. Stock Options A summary of the options activity during the nine months ended September 30, 2015 is shown below: Shares Weighted-Average Exercise Price Outstanding at January 1, 2015 19,924,405 $ 10.91 Granted 2,201,189 5.64 Exercised (1,230,281 ) 1.08 Canceled (3,889,964 ) 14.25 Forfeited (983,712 ) 8.43 Outstanding at September 30, 2015 16,021,637 $ 10.28 Outstanding and vested at September 30, 2015 9,052,988 $ 11.69 Outstanding and vested at December 31, 2014 11,879,209 $ 11.73 Restricted Stock Awards A summary of the restricted stock activity during the nine months ended September 30, 2015 is shown below: Weighted-Average Grant Date Fair Value Shares Outstanding at January 1, 2015 2,477,465 $ 8.71 Granted 4,553,429 3.48 Vested (842,183 ) 7.29 Forfeited (219,286 ) 8.22 Outstanding at September 30, 2015 5,969,425 $ 4.94 In most cases, RSA vesting is based on the passage of time. The amount of share-based compensation expense is based on the fair value of the Company's common stock on the respective grant dates and is recognized ratably over the vesting period. During the third quarter of 2015, the Company granted 500,000 shares of restricted stock with market vesting conditions to the Chairman of its Board of Directors. This RSA vests on the third anniversary of the date the Chairman was appointed, subject to (i) continued service as Chairman and (ii) the average closing price of the Company's stock price equals or exceeds twice the grant date stock price for a specific number of days or upon a change in control transaction. The amount of share-based compensation expense for RSAs with vesting tied to market-based performance conditions is recognized over the expected performance period, however, compensation expense already recognized is not adjusted if market-based conditions are not met. The Company's RSA agreements allow employees to surrender to the Company shares of common stock upon vesting of their RSAs in lieu of their payment of the required personal employment-related taxes. The Company does not withhold taxes in excess of minimum required statutory requirements. During the nine months ended September 30, 2015 and 2014, employees delivered to the Company 288,490 and 33,403 shares of stock, respectively, which the Company recorded at cost of approximately $1.4 million and $0.3 million , respectively, for the nine months ended September 30, 2015 and 2014. Shares surrendered in payment of personal employment-related taxes are held in treasury. Modification of share-based awards During the second quarter of 2015, in connection with the resignation of a member of the Company's Board of Directors (the "Board") who was also the former Chief Executive Officer of the Company, the Company modified the terms of awards previously granted to such Board member. This modification allowed for the continuation of vesting of options despite his resignation from the Board. This modification resulted in a net increase of share-based compensation expense for the nine months ended September 30, 2015 of $3.1 million . During the third quarter of 2015, the Compensation Committee of the Board approved the grant of cash bonuses to those participants in the Company's 2014 annual cash incentive bonus plan who received all or a portion of their 2014 annual cash incentive award in the form of restricted shares of the Company's common stock (the "2014 Bonus Plan RSA Grantees"). These bonuses were paid to 2014 Bonus Plan RSA Grantees on the second regularly scheduled payroll date following the Company’s scheduled second quarter earnings release on August 5, 2015 and were equal to the product of (i) $2.66 (which amount represents the difference of $5.38 , the trading price per share of the Company’s common stock as of the close of trading on the date that the Company determined the number of restricted shares to be granted to 2014 Bonus Plan RSA Grantees, minus $2.72 , the trading price per share of the Company’s common stock as of the close of trading on the second business day following the earnings release), multiplied by (ii) the number of restricted shares granted to the applicable 2014 Bonus Plan RSA Grantee. The aggregate number of restricted shares granted to 2014 Bonus Plan RSA Grantees was 683,401 . This modification resulted in a net increase of share-based compensation expense for both the three and nine months ended September 30, 2015 of $1.8 million . During the second quarter of 2014, the Company granted to the Chief Operating Officer (the "COO") retention equity awards subject to the approval of our stockholders of an amendment to our 2010 Stock Incentive Plan (the "2010 Plan"). In the event that the stockholders did not approve the amendment prior to December 31, 2014, then in lieu of the incentive equity awards, the COO would be entitled to receive cash payments following each date that any portion of such equity grant would have otherwise vested, equal to: (i) for stock options, the difference between the exercise price and the closing price of the common stock on the vesting date and (ii) for restricted stock, the closing price of the common stock on the vesting date. The Company determined that stockholder approval to amend the 2010 Plan would not occur by December 31, 2014 and accrued for these grants at the value as explained above. For the three and nine months ended September 30, 2015, the Company incurred $0.1 million and $0.5 million , respectively, of share-based compensation expense related to this grant. For the three and nine months ended September 30, 2014, the Company incurred $0.3 million and $0.6 million , respectively, of share-based compensation expense related to this grant. Additionally, during the second quarter of 2014, pursuant to a retention agreement, the Company modified the terms of an award previously granted to the COO. This modification allowed for the extension, under certain circumstances, of the exercise period of vested options from 60 days following the termination of employment to an expiration period tied to the COO's length of service, but in no case greater than two years or beyond the expiration of the respective option. This modification resulted in a net increase in share-based compensation expense of $0.2 million for the nine months ended September 30, 2014. As described in Note 8, Restatement and Other, during 2013, the Company failed to timely file its annual report on Form 10-K for the fiscal year ended December 31, 2012, and on March 4, 2013, its Registration Statement on Form S-8 ("Form S-8") was suspended. As a result, individuals were not permitted to exercise vested options during the period between March 4, 2013 and July 7, 2015, the date the Company's S-8 once again became effective. During the three months ended June 30, 2014, the Company modified the terms of the share-based awards granted to 39 employees (including the 13 who were affected in 2013), who were terminated under the 2013 restructuring plan to allow for the extension of the exercise period for vested options until such time as the Form S-8 has been effective for 60 consecutive days. These modifications resulted in a net increase in share-based compensation expense of $2.3 million for the nine months ended September 30, 2014. During the first quarter of 2014, in connection with the resignation of a senior executive from the Company, the Company modified the terms of awards previously granted to such senior executive. This modification extended the term to exercise vested options from 60 days following his effective resignation date to such time as the Form S-8 has been effective for 60 consecutive days. This modification resulted in a net increase of share-based compensation expense for the nine months ended September 30, 2014 of $5.6 million .

Restatement and Other

Restatement and Other	9 Months Ended
	Sep. 30, 2015
Restructuring and Related Activities [Abstract]
Restatement and Other	RESTATEMENT AND OTHER In the first quarter of 2013, the Company determined that it would restate its previously issued consolidated financial statements (the "Restatement"). The Restatement corrected accounting errors relating to timing of recognition of net services revenue, as well as the presentation of net services revenue and cost of services, and also certain capitalized costs for internal use software, goodwill, income taxes and other miscellaneous items. The Company completed the Restatement in December 2014. The Restatement has also resulted in the Company spending additional time and resources redesigning its accounting processes and internal controls over financial reporting. Restatement and other costs are comprised of reorganization-related and Restatement expenses and certain other costs. For the three and nine months ended September 30, 2015, the Company incurred $4.0 million and $5.9 million in Restatement and other costs, respectively. For the three and nine months ended September 30, 2014, the Company incurred $13.8 million and $67.9 million in Restatement and other costs, respectively. Reorganization-related In the second quarter of 2013, the Company initiated a restructuring plan consisting of reductions in workforce in order to align its organizational structure and resources to better serve its customers. The plan consisted of two separate staff reductions that occurred in 2013. In January 2014, the Company continued and revised the 2013 plan to include additional reductions to its workforce in certain corporate, administrative and management functions (the "Plan"). The Plan consists of severance payments, medical and dental benefits, outplacement job training for certain U.S.-based employees and relocation costs. In connection with the Plan, during the three and nine months ended September 30, 2014, the Company incurred pretax restructuring charges of $2.0 million and $16.3 million , respectively, primarily consisting of $2.0 million and $8.4 million , respectively, in severance and employee benefits and related expenses and $7.9 million of non-cash expense related to share based compensation for modification of existing options for affected employees during the nine months ended September 30, 2014. For both the three and nine months ended September 30, 2015, the Company incurred pretax restructuring charges of $2.4 million , consisting of $0.8 million in severance and employee benefits and $1.6 million in facilities related expenses. The Company’s reorganization liability activity is included in accrued compensation and benefits and accrued other in the accompanying condensed consolidated balance sheets. The Company’s reorganization activity was as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Reorganization liability, beginning balance $ 844 $ 2,982 $ 3,454 $ 1,143 Restructuring charges 2,428 1,953 2,428 16,292 Cash payments (852 ) (1,562 ) (3,462 ) (6,157 ) Non-cash payments — — — (7,905 ) Reorganization liability, ending balance $ 2,420 $ 3,373 $ 2,420 $ 3,373 Restatement For the three and nine months ended September 30, 2015 , the Company incurred $0.2 million and $2.4 million in Restatement-related costs, respectively. During the three and nine months ended September 30, 2014, the Company incurred $6.8 million and $45.5 million in Restatement-related costs, respectively. The Restatement-related costs incurred during the three and nine months ended September 30, 2015 and 2014 were due to professional service fees related to our restatement. Other During the three and nine months ended September 30, 2015, the Company incurred other costs of $1.4 million and $1.1 million , respectively, primarily consisting of $1.4 million in costs incurred related to the exploration of potential strategic alternatives during the three months ended September 30, 2015 offset during the nine months ended September 30, 2015 by a decrease of $0.3 million in employment tax expense relating to prior years during the six months ended June 30, 2015. During the three and nine months ended September 30, 2014 , the Company incurred other costs of $5.0 million and $6.1 million , respectively, in costs associated with its transformation office, which was created to provide continuity and cross functional accountability associated with the continued execution of the Company's turnaround plan during the period subsequent to Stephen Schuckenbrock's resignation as our Chief Executive Officer and prior to the appointment of Dr. Emad Rizk as our Chief Executive Officer ("Transformation Office").

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2015
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES Income tax provisions for interim periods are based on estimated annual income tax rates, adjusted to reflect the effects of any significant infrequent or unusual items which are required to be discretely recognized within the current interim period. The Company’s intention is to permanently reinvest its foreign earnings outside the United States. As a result, the effective tax rates in the periods presented are largely based upon the projected annual pre-tax earnings by jurisdiction and the allocation of certain expenses in various taxing jurisdictions where the Company conducts its business. These taxing jurisdictions apply a broad range of statutory income tax rates. The income tax benefit for the nine months ended September 30, 2015 and September 30, 2014 were higher than the amount derived by applying the federal statutory tax rate of 35% primarily due to the impact of state taxes. The tax rate is also impacted by discrete items that may occur in any given period. The Company corrected the statutory rate used in one of its state deferred calculations for the year ended December 31, 2013. The Company discovered this error in the process of preparing its annual and quarterly financial statements for the year ended December 31, 2014, and recorded the amount in the first quarter of 2014. The correction of this error increased tax expense for the nine months ended September 30, 2014 by approximately $2.4 million . The Company determined that this amount is immaterial for the nine months ended September 30, 2014 and the year ended December 31, 2014. The Company and its subsidiaries are subject to U.S. federal income taxes as well as income taxes in multiple state and foreign jurisdictions. The Company's 2013, 2012, and 2011 U.S. federal income tax returns are currently under examination. State jurisdictions have various open tax years. The statutes of limitations for most states range from three to six years. During the nine months ended September 30, 2015, the Company wrote off approximately $13.8 million of deferred tax assets due to the expiration and exercise of shared-based awards. The additional paid-in capital was reduced by the corresponding amount. In July 2015, the Company received an unsolicited letter from Ascension Health (the "Ascension Letter") indicating that, at that time, Ascension Health did not anticipate entering into a new master professional services agreement with the Company when the current agreement between the parties expires in 2017, and that Ascension Health was open to discussing a potential transaction under which the Company would be taken private by Ascension (alone or with a co-investor of its choosing) and remain a stand alone, for profit company servicing RCM customers. In July 2015, the Company began a formal process of evaluating strategic alternatives with its financial and legal advisors (the "Process"). The Process is still ongoing. The Company’s domestic net deferred tax asset balance at September 30, 2015 is $307.4 million . Of this amount, approximately $222.3 million is related to deferred customer billings and will be realized upon the occurrence of a contractual revenue recognition event. It is possible, however, that future developments regarding the Process and/or the Ascension Letter may cause the remaining balance to be subject to a valuation allowance should the realizability assessment change.

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Earnings Per Share	EARNINGS PER SHARE Basic net income per share is computed by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per share is computed by dividing net income by the weighted average number of common shares outstanding and potentially dilutive securities outstanding during the period under the treasury stock method. Under the treasury stock method, dilutive securities are assumed to be exercised at the beginning of the periods and as if funds obtained thereby were used to purchase common stock at the average market price during the period. Securities are excluded from the computations of diluted net income per share if their effect would be anti-dilutive to earnings per share. The following table sets forth the computation of basic and diluted earnings per share available to common shareholders for the three and nine months ended September 30, 2015 and 2014, respectively (in thousands, except share and per share data). Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Net income (loss) $ (32,970 ) $ 9,553 $ (89,703 ) $ (61,969 ) Basic weighted-average common shares 97,230,069 95,775,597 96,358,342 95,750,887 Add: Effect of dilutive securities — 1,474,685 — — Diluted weighted average common shares 97,230,069 97,250,282 96,358,342 95,750,887 Net income (loss) per common share (basic) $ (0.34 ) $ 0.10 $ (0.93 ) $ (0.65 ) Net income (loss) per common share (diluted) $ (0.34 ) $ 0.10 $ (0.93 ) $ (0.65 ) Because of their anti-dilutive effect, 21,991,062 and 19,345,399 common share equivalents comprised of stock options and restricted stock awards have been excluded from the diluted earnings per share calculation for the three months ended September 30, 2015 and 2014 , respectively. Stock options and restricted stock awards totaling 21,992,062 and 23,346,213 were not included in the computation of diluted income per share for the nine months ended September 30, 2015 and 2014, respectively, as these options and awards were anti-dilutive.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	COMMITMENTS AND CONTINGENCIES Revolving Credit Facility The Company previously maintained a line of credit with the Bank of Montreal in the amount of $3.0 million . The $3.0 million line of credit could only be utilized by the Company in the form of letters of credit and was secured by a $5.0 million demand deposit with the Bank of Montreal. The Company's line of credit expired on February 15, 2015 and was not renewed. As a result of such expiration, the Company has reclassified the $5.0 million from restricted cash into cash and cash equivalents at March 31, 2015. Legal Proceedings The Company is subject to various claims, other pending and possible legal actions for product liability and other damages, and other matters arising out of the conduct of the Company’s business. On a quarterly basis, the Company reviews material legal claims against the Company. The Company accrues for the costs of such claims as appropriate and in the exercise of its judgment and experience. However, due to a lack of factual information available to the Company about a claim, or the procedural stage of a claim, it may not be possible for the Company to reasonably assess either the probability of a favorable or unfavorable outcome of the claim or to reasonably estimate the amount of loss should there be an unfavorable outcome. Therefore, for many of the claims, the Company cannot estimate a range of loss. The Company believes, based on current knowledge and after consultation with counsel, that the outcome of such claims and actions will not have a material adverse effect on the Company’s results of operations or financial position. However, in the event of unexpected future developments, it is possible that the ultimate resolution of such matters, if unfavorable, could have a material adverse effect on the Company’s results of operations or financial position. Other than as described below, the Company is not presently a party to any material litigation or regulatory proceeding and is not aware of any pending or threatened litigation or regulatory proceeding against the Company which, individually or in the aggregate, could have a material adverse effect on its business, operating results, financial condition or cash flows. On January 19, 2012, the State of Minnesota, by its Attorney General, filed a complaint against the Company in the United States District Court for the District of Minnesota, alleging violations of federal and Minnesota state health privacy laws and regulations, Minnesota debt collection laws, and Minnesota consumer protection laws resulting from, among other things, the theft in Minnesota in July 2011 of an employee’s laptop that contained protected health information. On January 25, 2012, the Commissioner of the Minnesota Department of Commerce served the Company an administrative subpoena seeking information and documents about its debt collection practices and the privacy of personal and health data within its possession or control. On February 3, 2012, the Company entered into a Consent Cease and Desist Order with the Commissioner, voluntarily agreeing to cease all debt collection activity in the State of Minnesota. On July 30, 2012, without any admission of liability or wrongdoing, the Company entered into a Settlement Agreement, Release and Order with the Minnesota Attorney General to settle the lawsuit filed by the Minnesota Attorney General and the investigation commenced by the Minnesota Department of Commerce and to resolve fully all disputes which in any way related to, arose out of, emanated from, or otherwise involved such lawsuit or investigation and all investigations by the Minnesota Attorney General, the Minnesota Department of Commerce, and the Minnesota Department of Human Services relating to the Company. As part of the settlement, the Company paid a settlement sum of $2.5 million and voluntarily agreed to cease all remaining operations in Minnesota. On April 26, 2012 and May 1, 2012, the Company, along with certain of its former officers, was named as a defendant in two putative securities class action lawsuits filed in the U.S. District Court for the Northern District of Illinois, which were consolidated as Wong v. Accretive Health et al . The primary allegations are that the Company’s public statements, including filings with the SEC, were false and/or misleading about its violations of certain federal and Minnesota privacy and debt collection laws. On September 26, 2013, without any admission of liability or wrongdoing, the Company entered into a Settlement Agreement to resolve these suits for $14 million , which has been funded into escrow by its insurance carriers. On April 30, 2014, the U.S. District Court for the Northern District of Illinois granted final approval of the Settlement Agreement. A single objector to the Settlement Agreement appealed to the U.S. Court of Appeals for the Seventh Circuit, and on December 9, 2014, the court of appeals affirmed the district court’s approval of the settlement. On December 23, 2014, that objector submitted a petition for en banc rehearing, which was denied on January 26, 2015. In addition, the Company, along with certain of its directors and former officers, has been named in several putative shareholder derivative lawsuits filed in the U.S. District Court for the Northern District of Illinois on May 3, 2012 and July 31, 2012 (consolidated as Maurras Trust v. Accretive Health et al. ), in the Circuit Court of Cook County, Illinois on June 23, 2012 and June 27, 2012 (consolidated as In re Accretive Health , Inc. Derivative Litigation ) and in the Court of Chancery of the State of Delaware on November 5, 2012 ( Doyle v. Tolan et al .). The primary allegations are that its directors and officers breached their fiduciary duties in connection with the alleged violations of certain federal and Minnesota privacy and debt collection laws. On July 11, 2013, the Court of Chancery of the State of Delaware granted the Company's motion to stay Doyle v. Tolan et al. , in favor of the action pending in the U.S. District Court for the Northern District of Illinois. On September 24, 2013, the U.S. District Court for the Northern District of Illinois granted the Company's motion to dismiss without prejudice, giving plaintiffs in that case leave to file an amended consolidated complaint, which plaintiffs filed on October 22, 2013, amending their complaint to also include allegations with respect to the Restatement. On February 25, 2015, the Company entered a settlement agreement with plaintiffs in all of these suits that would resolve the derivative actions, on the basis of certain governance reforms already implemented and payment of attorneys' fees in the amount of $0.6 million . On July 23, 2015, the U.S. District Court for the Northern District of Illinois granted final approval of the settlement agreement. The Delaware and Cook County derivative suits are within the scope of the settlement approved by the federal district court and were dismissed on August 12, 2015 and August 17, 2015, respectively. On May 17, 2013, the Company, along with certain of its directors, former directors and former officers, was named as a defendant in a putative securities class action lawsuit filed in the U.S. District Court for the Northern District of Illinois ( Hughes v. Accretive Health, Inc. et al.). The primary allegations, relating to its March 8, 2013 announcement that the Company would be restating its prior period financial statements, are that its public statements, including filings with the SEC, were false and/or misleading with respect to its revenue recognition and earnings prospects. On November 27, 2013, plaintiffs voluntarily dismissed the Company’s directors and former directors (other than Mary Tolan). On January 31, 2014, the Company filed a motion to dismiss the complaint. On September 25, 2014, the Court granted the Company motion to dismiss without prejudice, however the plaintiffs filed a second amended complaint on October 23, 2014. On November 10, 2014, the Company filed a motion to dismiss the second amended complaint. While that motion was still pending, on January 8, 2015, plaintiffs filed a motion to amend the second amended complaint, seeking to add allegations regarding the recently issued Restatement. On April 22, 2015, the court granted plaintiffs’ motion to amend, and a third amended complaint was filed on May 13, 2015. The Company moved to dismiss the third amended complaint on June 3, 2015. That motion is fully briefed and awaiting decision. The Company continues to believe it has meritorious defenses and intends to vigorously defend itself, Mary Tolan, and its former officers against these claims. The outcome is not presently determinable. The SEC’s Division of Enforcement in the Chicago Regional Office is also conducting an investigation regarding the circumstances surrounding the Restatement. The Company is fully cooperating with the investigation. On February 11, 2014, the Company was named as a defendant in a putative class action lawsuit filed in the U.S. District Court for the Southern District of Alabama ( Church v. Accretive Health, Inc .). The primary allegation is that the Company attempted to collect debts without providing the notice required by the Fair Debt Collections Practices Act ("FDCPA"). The Company believes that it has meritorious defenses and intends to vigorously defend itself against these claims. The Company's summary-judgment motion is now fully briefed and pending before the Court. Class-certification proceedings have been deferred until that summary-judgment motion has been resolved. The outcome is not presently determinable. On July 22, 2014, the Company was named as a defendant in a putative class action lawsuit filed in the U.S. District Court for the Eastern District of Michigan ( Anger v. Accretive Health, Inc .). The primary allegations are that the Company attempted to collect debts without providing the notice required by the FDCPA and Michigan Fair Debt Collection Practices Act and failed to abide by the terms of an agreed payment plan in violation of those same statutes. On August 27, 2015, the Court granted in part and denied in part the Company's motion to dismiss. A scheduling conference was held on October 26, 2015, and the Company expects discovery to be underway shortly. The Company believes that it has meritorious defenses and intends to vigorously defend itself against these claims. The outcome is not presently determinable. On February 6, 2015, the Company was named as a defendant in a putative class action lawsuit filed in the U.S. District Court for the Eastern District of Michigan ( Cassale v. Accretive Health, Inc .). The primary allegations were that the Company attempted to collect debts without complying with the provisions of the FDCPA. The case was settled in April 2015. On February 24, 2015 (amended Feb. 25, 2015), the Plaintiff in the Church action (above) filed a motion with the Joint Panel for Multidistrict Litigation to transfer and consolidate the Church, Anger and Cassale actions for pretrial purposes in the Southern District of Alabama where the Church case is currently pending. That motion was withdrawn in May 2015. In April 2015, the Company was named among other defendants in an employment action brought by Jennifer Worthy, a former employee before the Maine Human Rights Commission ("MHRC") alleging that she was improperly terminated in retaliation for uncovering alleged Medicare fraud. The Company filed its response with the MHRC on May 19, 2015 seeking that the Company be dismissed entirely from the action. On June 23, 2015, the MHRC issued its Notice of Right to Sue and decision to terminate its process with respect to all charges asserted by the former employee. On January 12, 2015, Plaintiff Worthy filed a Second Amended Complaint (Filed under Seal), a qui tam False Claims Act case in the United States District Court in Maine ( Worthy v. Eastern Maine Healthcare Systems ) in which she makes the same allegations. The U.S. Department of Justice declined to intervene in the federal court action, and the case was unsealed in April 2015 but process has not been served on any defendant. The Company believes that it has meritorious defenses to both the potential employment law action for which the MHRC has granted the Notice of Right to Sue letter and the federal qui tam case, and intends to vigorously defend itself against these claims. The outcomes are not presently determinable. On June 17, 2015, the Company filed a confidential arbitration demand with the American Arbitration Association against Salem Hospital for unpaid fees due under the parties’ Health Services Agreement in an aggregate amount of $9.3 million . On July 31, 2015, Salem Hospital filed its answer, in which it denied the Company’s claims and asserted counterclaims against the Company in the amount of $2.7 million . The outcome is not presently determinable.

Segments and Customer Concentra

Segments and Customer Concentrations	9 Months Ended
	Sep. 30, 2015
Segment Reporting [Abstract]
Segments and Customer Concentrations	SEGMENTS AND CUSTOMER CONCENTRATIONS The Company has determined that it has a single operating segment in accordance with how its business activities are managed and evaluated. All of the Company’s significant operations are organized around the single business of providing end-to-end management services of revenue cycle operations for U.S.-based hospitals and other medical providers. Accordingly, for purposes of segment disclosures, the Company has only one reporting segment. All of the Company’s net services revenue and trade accounts receivable are derived from healthcare providers domiciled in the United States. Hospital systems affiliated with Ascension Health have accounted for a significant portion of the Company’s net services revenue each year since the Company’s formation. For the three and nine months ended September 30, 2015, three different customers, unaffiliated with Ascension Health, accounted for 59% and 54% , respectively, of the Company's net services revenues. For the three and nine months ended September 30, 2014, three customers accounted for 93% and 84% , respectively, of the Company's net services revenues, of which one customer is part of the affiliated Ascension Health system. The Ascension Health system, through its individual customer contracts with the Company, accounted for more than 78% and 76% of the Company’s total deferred customer billings at September 30, 2015 and December 31, 2014, respectively. The loss of the customers within this large health system would have a material adverse impact on the Company’s operations. In July 2015, the Company received a letter from Ascension Health indicating that, at this time, Ascension Health does not anticipate entering into a new master professional services agreement with the Company once the current agreement between the parties expires on August 6, 2017, but that it was open to discussing a potential acquisition of the Company. There are three customers whose individual balance is equal to or greater than 10% of total deferred customer billings at September 30, 2015, and, in the aggregate, account for 47% and 48% of the total deferred customer billings at September 30, 2015 and December 31, 2014, respectively, of which two customers are part of the affiliated Ascension Health system discussed above. The Company does not have a concentration of credit risk within accounts receivable as reported in the consolidated balance sheets with any one large customer at September 30, 2015 and December 31, 2014 .

Business Description and Basi18

Business Description and Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed consolidated financial statements reflect the Company's financial position as of September 30, 2015 , the results of operations for the three and nine months ended September 30, 2015 and 2014 , and the cash flows of the Company for the nine months ended September 30, 2015 and 2014 . These financial statements include the accounts of Accretive Health, Inc. and its wholly owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with accounting principles generally accepted in the United States (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information have been included. Operating results for the three and nine months ended September 30, 2015 , are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2015 .
Use of Estimates	When preparing financial statements in conformity with GAAP, the Company must make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, expenses and related disclosures at the date of the financial statements. Actual results could differ from those estimates.
Recent Accounting Pronouncements	RECENT ACCOUNTING PRONOUNCEMENTS From time to time, new accounting pronouncements are issued by the Financial Accounting Standards Board ("FASB") and are adopted by the Company as of the specified effective date. Unless otherwise discussed, the Company's management believes that the impact of recently issued accounting pronouncements does not have a material impact on the Company's consolidated financial position, results of operations, and cash flows, or do not apply to the Company's operations. In May 2014, the FASB issued Accounting Standards Update No. 2014-09, "Revenue from Contracts with Customers" ("ASU 2014-09") , which provides guidance for revenue recognition. ASU 2014-09 requires that a company recognize revenue when it transfers promised goods or services to customers in an amount equal to the consideration to which the company expects to be entitled in exchange for those goods or services. ASU 2014-09 also requires additional disclosure about the nature, amount, timing and uncertainty of revenue and cash flows arising from customer contracts, including significant judgments and changes in judgments. On July 9, 2015, the FASB approved the deferral of the effective date of ASU 2014-09 by one year. As a result, ASU 2014-09 will be effective for the Company’s fiscal year beginning January 1, 2018, with retrospective applicability to prior periods. The Company may choose to adopt the standard as of the original effective date of annual reporting periods beginning after December 15, 2016; if it does so, the Company is required to apply the standard beginning in the first interim period within the year of adoption. The Company is currently evaluating the impact of the adoption of this prospective guidance on its consolidated financial statements.

Fair Value of Financial Instr19

Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2015
Fair Value Disclosures [Abstract]
Assets Measured at Fair Value Categorized Using Fair Value Hierarchy	The following table includes assets that are measured at fair value on a recurring basis and are categorized using the fair value hierarchy (in thousands): September 30, 2015 December 31, 2014 (Unaudited) Level 1 assets Money market funds with maturities of less than 90 days — 137,802 Total $ — $ 137,802

Accounts Receivable and Allow20

Accounts Receivable and Allowance for Doubtful Accounts (Tables)	9 Months Ended
	Sep. 30, 2015
Receivables [Abstract]
Activity in Allowance for Doubtful Accounts	Movements in the allowance for doubtful accounts are as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Beginning balance $ 112 $ 253 $ 314 $ 740 (Recoveries)/Provision (34 ) 39 (79 ) (455 ) Write-offs (12 ) — (169 ) 7 Ending balance $ 66 $ 292 $ 66 $ 292

Property, Equipment, and Soft21

Property, Equipment, and Software (Tables)	9 Months Ended
	Sep. 30, 2015
Property, Plant and Equipment [Abstract]
Property, equipment, and software	Property, equipment and software consist of the following (in thousands): September 30, 2015 December 31, 2014 (unaudited) Computer and other equipment $ 20,711 $ 17,701 Leasehold improvements 17,598 12,491 Software 20,687 12,398 Office furniture 4,903 3,152 Property, equipment and software, gross 63,899 45,742 Less: Accumulated depreciation and amortization (37,320 ) (31,148 ) Property, equipment and software, net $ 26,579 $ 14,594 The following table summarizes the allocation of depreciation and amortization expense between cost of services and selling, general and administrative expenses (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Cost of services $ 2,491 $ 1,053 $ 5,799 $ 3,142 Selling, general and administration 247 350 757 1,137 Total depreciation and amortization $ 2,738 $ 1,403 $ 6,556 $ 4,279

Customer Liabilities (Tables)

Customer Liabilities (Tables)	9 Months Ended
	Sep. 30, 2015
Other Liabilities Disclosure [Abstract]
Schedule of Customer Liabilities	Customer liabilities consist of the following (in thousands): September 30, December 31, 2015 2014 (unaudited) Deferred customer billings, current $ 234,436 $ 132,063 Accrued service costs, current 96,237 68,077 Customer deposits, current 18,027 19,675 Deferred revenue, current 128 183 Current portion of customer liabilities 348,828 219,998 Deferred customer billings, non-current 323,293 317,065 Total customer liabilities $ 672,121 $ 537,063

Share-Based Compensation (Table

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule Share-Based Compensation Expense	Total share-based compensation expense that has been included in the Company's consolidated statements of operations was as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Share-based Compensation Expense Allocation Details: Cost of services $ 3,152 $ 1,736 $ 5,756 $ 5,614 Selling, general and administrative 9,163 3,488 19,562 10,077 Restatement and other — 144 — 8,049 Total share-based compensation expense (1) $ 12,315 $ 5,368 $ 25,318 $ 23,740 (1) Includes $1.9 million and $2.3 million in share-based compensation expense paid in cash during the three and nine months ended September 30, 2015, respectively, and $0.3 million and $0.6 million in share-based compensation expense paid in cash during both the three and nine months ended September 30, 2014, respectively.
Summary of Valuation Assumptions	The following table sets forth the significant assumptions used in the Black-Scholes option pricing model and the Monte Carlo simulations and the calculation of share-based compensation expense for the nine months ended September 30, 2015 and 2014 : Nine Months Ended September 30, 2015 2014 Future dividends — — Risk-free interest rate 1.5% to 2.0% 1.9% to 2.2% Expected volatility 50% to 68% 50% Expected life 6.25 years 6.25 to 7.00 years Forfeitures 5.68% annually 5.68% annually
Schedule of Stock Option Activity	A summary of the options activity during the nine months ended September 30, 2015 is shown below: Shares Weighted-Average Exercise Price Outstanding at January 1, 2015 19,924,405 $ 10.91 Granted 2,201,189 5.64 Exercised (1,230,281 ) 1.08 Canceled (3,889,964 ) 14.25 Forfeited (983,712 ) 8.43 Outstanding at September 30, 2015 16,021,637 $ 10.28 Outstanding and vested at September 30, 2015 9,052,988 $ 11.69 Outstanding and vested at December 31, 2014 11,879,209 $ 11.73
Schedule of Restricted Stock Awards Activity	A summary of the restricted stock activity during the nine months ended September 30, 2015 is shown below: Weighted-Average Grant Date Fair Value Shares Outstanding at January 1, 2015 2,477,465 $ 8.71 Granted 4,553,429 3.48 Vested (842,183 ) 7.29 Forfeited (219,286 ) 8.22 Outstanding at September 30, 2015 5,969,425 $ 4.94

Restatement and Other (Tables)

Restatement and Other (Tables)	9 Months Ended
	Sep. 30, 2015
Restructuring and Related Activities [Abstract]
Reorganization Activity	The Company’s reorganization activity was as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Reorganization liability, beginning balance $ 844 $ 2,982 $ 3,454 $ 1,143 Restructuring charges 2,428 1,953 2,428 16,292 Cash payments (852 ) (1,562 ) (3,462 ) (6,157 ) Non-cash payments — — — (7,905 ) Reorganization liability, ending balance $ 2,420 $ 3,373 $ 2,420 $ 3,373

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Schedule of Earnings (Loss) Per Share, Basic and Diluted	The following table sets forth the computation of basic and diluted earnings per share available to common shareholders for the three and nine months ended September 30, 2015 and 2014, respectively (in thousands, except share and per share data). Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 (unaudited) (unaudited) Net income (loss) $ (32,970 ) $ 9,553 $ (89,703 ) $ (61,969 ) Basic weighted-average common shares 97,230,069 95,775,597 96,358,342 95,750,887 Add: Effect of dilutive securities — 1,474,685 — — Diluted weighted average common shares 97,230,069 97,250,282 96,358,342 95,750,887 Net income (loss) per common share (basic) $ (0.34 ) $ 0.10 $ (0.93 ) $ (0.65 ) Net income (loss) per common share (diluted) $ (0.34 ) $ 0.10 $ (0.93 ) $ (0.65 )

Fair Value of Financial Instr26

Fair Value of Financial Instruments (Details) - Recurring - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total	$ 0	$ 137,802
Money Market Funds | Fair Value, Inputs, Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Money market funds with maturities of less than 90 days	$ 0	$ 137,802

Accounts Receivable and Allow27

Accounts Receivable and Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Allowance for Doubtful Accounts Receivable [Roll Forward]
Beginning balance	$ 112	$ 253	$ 314	$ 740
(Recoveries)/Provision	(34)	39	(79)	(455)
Write-offs	(12)	0	(169)	7
Ending balance	$ 66	$ 292	$ 66	$ 292

Property, Equipment, and Soft28

Property, Equipment, and Software (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 63,899	$ 45,742
Less: Accumulated depreciation and amortization	(37,320)	(31,148)
Property and equipment and software, net	26,579	14,594
Computer and other equipment
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	20,711	17,701
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	17,598	12,491
Software
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	20,687	12,398
Office furniture
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 4,903	$ 3,152

Property, Plant and Equipment -

Property, Plant and Equipment - Allocation of Depreciation and Amortization (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Property, Plant and Equipment [Line Items]
Depreciation and amortization	$ 2,738	$ 1,403	$ 6,556	$ 4,279
Cost of services
Property, Plant and Equipment [Line Items]
Depreciation and amortization	2,491	1,053	5,799	3,142
Selling, general and administration
Property, Plant and Equipment [Line Items]
Depreciation and amortization	$ 247	$ 350	$ 757	$ 1,137

Customer Liabilities (Details)

Customer Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Other Liabilities Disclosure [Abstract]
Deferred customer billings, current	$ 234,436	$ 132,063
Accrued service costs, current	96,237	68,077
Customer deposits, current	18,027	19,675
Deferred revenue, current	128	183
Current portion of customer liabilities	348,828	219,998
Deferred customer billings, non-current	323,293	317,065
Total customer liabilities	$ 672,121	$ 537,063

Share-Based Compensation - Addi

Share-Based Compensation - Additional Information (Details) $ / shares in Units, $ in Thousands	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2015USD ($)$ / sharesshares	Sep. 30, 2014USD ($)	Jun. 30, 2014employee	Mar. 31, 2014	Sep. 30, 2015USD ($)$ / sharesshares	Sep. 30, 2014USD ($)shares	Dec. 31, 2013employee	Aug. 07, 2015$ / shares	Jun. 30, 2015$ / shares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-based compensation expense	$ 12,315	$ 5,368			$ 25,318	$ 23,740
Stock-based compensation expense, related tax benefits	4,500	1,900			$ 9,600	$ 8,500
Shares paid for tax withholding for share-based compensation (in shares) | shares					288,490	33,403
Shares paid for tax withholding for share-based compensation, cost					$ 1,400	$ 300
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares granted | shares					4,553,429
Share-based Compensation Plan Modification Due to Resignation of a Board Member and Former Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Net increase in share-based compensation as a result of stock awards modification					$ 3,100
2014 Bonus Plan RSA
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Net increase in share-based compensation as a result of stock awards modification	$ 1,800				$ 1,800
2014 Bonus Plan RSA | Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares granted | shares	683,401
Amount per share of bonus paid | $ / shares	$ 2.66				$ 2.66
Closing Trading Price (dollars per share) | $ / shares								$ 2.72	$ 5.38
Share-based Compensation Plan Modification Due to Retention Equity Awards Granted to COO
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Net increase in share-based compensation as a result of stock awards modification	$ 100	$ 300			$ 500	600
Share-based Compensation Plan Modification Due to Modification of Award Terms Granted to COO
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Net increase in share-based compensation as a result of stock awards modification						200
Share-based Compensation Plan Modification Due to Modification of Award Terms Granted to COO | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Extension of the exercise period for vested options before plan modification			60 days
Extension of the exercise period for vested options after plan modification			2 years
Share-based Compensation Plan Modification Due to Restructuring Plans | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Net increase in share-based compensation as a result of stock awards modification						2,300
Number of employees affected by modification of share-based awards | employee			39				13
Extension of the exercise period for vested options, after the effective period of registration statement			60 days
Board of Directors Chairman | Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares granted | shares	500,000
Senior Executive
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Net increase in share-based compensation as a result of stock awards modification						$ 5,600
Extension of the exercise period for vested options before plan modification				60 days
Extension of the exercise period for vested options, after the effective period of registration statement				60 days

Share-Based Compensation - Allo

Share-Based Compensation - Allocation of Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation expense	$ 12,315	$ 5,368	$ 25,318	$ 23,740
Share-based compensation expense, paid in cash	1,900	300	2,300	600
Cost of services
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation expense	3,152	1,736	5,756	5,614
Selling, general and administration
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation expense	9,163	3,488	19,562	10,077
Restatement and other
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation expense	$ 0	$ 144	$ 0	$ 8,049

Share-Based Compensation - Blac

Share-Based Compensation - Black Scholes Assumptions (Details)	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Future dividends	0.00%	0.00%
Risk-free interest rate, minimum	1.50%	1.90%
Risk-free interest rate, maximum	2.00%	2.20%
Expected volatility		50.00%
Expected life	6 years 3 months
Forfeitures	5.68%	5.68%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected volatility	50.00%
Expected life		6 years 3 months
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected volatility	68.00%
Expected life		7 years

Share-Based Compensation - Stoc

Share-Based Compensation - Stock Option Activity (Details) - $ / shares	9 Months Ended
	Sep. 30, 2015	Dec. 31, 2014
Shares
Outstanding at Januray 1, 2015 (in shares)	19,924,405
Granted (in shares)	2,201,189
Exercised (in shares)	(1,230,281)
Canceled (in shares)	(3,889,964)
Forfeited (in shares)	(983,712)
Outstanding at September 30, 2015 (in shares)	16,021,637
Outstanding and vested at end of period (in shares)	9,052,988	11,879,209
Weighted- Average Exercise Price
Outstanding at January 1, 2015 (in dollars per share)	$ 10.91
Granted (in dollars per share)	5.64
Exercised (in dollars per share)	1.08
Canceled (in dollars per share)	14.25
Forfeited (in dollars per share)	8.43
Outstanding at September 30, 2015 (in dollars per share)	10.28
Outstanding and vested at end of period (in dollars per share)	$ 11.69	$ 11.73

Share-Based Compensation - Rest

Share-Based Compensation - Restricted Stock Award Activity (Details) - Restricted Stock Awards	9 Months Ended
	Sep. 30, 2015$ / sharesshares
Shares
Outstanding at January 1, 2015 (in shares) | shares	2,477,465
Granted (in shares) | shares	4,553,429
Vested (in shares) | shares	(842,183)
Forfeited (in shares) | shares	(219,286)
Outstanding at September 30, 2015 (in shares) | shares	5,969,425
Weighted- Average Grant Date Fair Value
Outstanding at January 1, 2015 (in dollars per share)	$ 8.71
Granted (in dollars per share)	3.48
Vested (in dollars per share)	7.29
Forfeited (in dollars per share)	8.22
Outstanding at September 30, 2015 (in dollars per share)	$ 4.94

Restatement and Other - Reorgan

Restatement and Other - Reorganization-related, Narrative (Details) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2015USD ($)	Sep. 30, 2014USD ($)	Sep. 30, 2015USD ($)	Sep. 30, 2014USD ($)	Dec. 31, 2013event
Restructuring and Related Activities [Abstract]
Restatement expenses and certain other costs	$ 3,964	$ 13,846	$ 5,850	$ 67,907
Number of positions eliminated (in events) | event					2
Restructuring charges	2,428	1,953	2,428	16,292
Severance and employee benefits	800	$ 2,000	800	8,400
Non-cash share-based compensation expense, option modification				$ 7,900
Facilities related expenses	$ 1,600		$ 1,600

Restatement and Other - Reorg37

Restatement and Other - Reorganization Liability Activity (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Restructuring Reserve [Roll Forward]
Reorganization liability, beginning balance	$ 844	$ 2,982	$ 3,454	$ 1,143
Restructuring charges	2,428	1,953	2,428	16,292
Cash payments	(852)	(1,562)	(3,462)	(6,157)
Non-cash payments	0	0	0	(7,905)
Reorganization liability, ending balance	$ 2,420	$ 3,373	$ 2,420	$ 3,373

Restatement and Other - Restate

Restatement and Other - Restatement and Other (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Jun. 30, 2015	Sep. 30, 2015	Sep. 30, 2014
Restructuring and Related Activities [Abstract]
Restatement-related costs	$ 0.2	$ 6.8		$ 2.4	$ 45.5
Other costs related to exploration of potential strategic alternatives	$ 1.4			1.1
Exploration of potential strategic alternatives				$ 1.4
Decrease in employment tax expense			$ 0.3
Other cost associated with Transformation Office		$ 5			$ 6.1

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Income Tax Disclosure [Abstract]
Federal statutory tax rate			35.00%	35.00%
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax expense	$ (21,800)	$ 5,291	$ (57,112)	$ (34,862)
Write off of deferred tax asset due to the expiration and exercise of share-based awards			13,800
Domestic Tax Authority
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Net deferred tax asset	307,400		307,400
Net Deferred tax asset, related to deferred customer billings	$ 222,300		$ 222,300
Restatement Adjustment | Corrected State Statutory Rate
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax expense				$ 2,400

Earnings Per Share - Computatio

Earnings Per Share - Computation of Basic Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Earnings Per Share Reconciliation [Abstract]
Net income (loss)	$ (32,970)	$ 9,553	$ (89,703)	$ (61,969)
Basic weighted-average common shares	97,230,069	95,775,597	96,358,342	95,750,887
Add: Effect of dilutive securities (in shares)	0	1,474,685	0	0
Diluted weighted average common shares	97,230,069	97,250,282	96,358,342	95,750,887
Net income (loss) per common share (basic) (in dollars per share)	$ (0.34)	$ 0.10	$ (0.93)	$ (0.65)
Net income (loss) per common share (diluted) (in dollars per share)	$ (0.34)	$ 0.10	$ (0.93)	$ (0.65)

Earnings Per Share - Additional

Earnings Per Share - Additional Information (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Earnings Per Share [Abstract]
Antidilutive securities excluded from computation of earnings per share (in shares)	21,991,062	19,345,399	21,992,062	23,346,213

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details)	Jun. 17, 2015USD ($)	Mar. 31, 2015USD ($)	Feb. 25, 2015USD ($)	Sep. 26, 2013USD ($)	Jul. 30, 2012USD ($)	May. 01, 2012lawsuit	Sep. 30, 2015USD ($)	Jul. 31, 2015USD ($)	Feb. 15, 2015USD ($)	Dec. 31, 2014USD ($)
Loss Contingencies [Line Items]
Line of credit facility, maximum borrowing capacity									$ 3,000,000
Restricted cash							$ 0		$ 5,000,000	$ 5,000,000
Amount reclassified from restricted cash into cash and cash equivalents		$ 5,000,000
Against Salem Hospital
Loss Contingencies [Line Items]
Confidential arbitration demand in an aggregate amount	$ 9,300,000
Asserted counterclaim value								$ 2,700,000
Settled Litigation | Minnesota
Loss Contingencies [Line Items]
Litigation settlement sum					$ 2,500,000
Settled Litigation | Wong Litigation Case
Loss Contingencies [Line Items]
Litigation settlement sum				$ 14,000,000
Number of lawsuits | lawsuit						2
Settled Litigation | U.S. District Court for the Northern District of Illinois
Loss Contingencies [Line Items]
Litigation settlement sum			$ 600,000

Segments and Customer Concent43

Segments and Customer Concentrations - Additional Information (Details)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2015customer	Sep. 30, 2014customer	Sep. 30, 2015segmentcustomer	Sep. 30, 2014customer	Dec. 31, 2014customer
Segment Reporting [Abstract]
Number of reportable segments | segment			1
Sales | Customer Concentration Risk | Three Customers Unaffiliated with Ascension Health
Segment Reporting Information [Line Items]
Number of individual customers	3		3
Concentration percentage	59.00%		54.00%
Sales | Customer Concentration Risk | Three Major Individual Customers
Segment Reporting Information [Line Items]
Number of individual customers		3		3
Concentration percentage		93.00%		84.00%
Sales | Customer Concentration Risk | Major Individual Customer Affiliated with Ascension Health [Member]
Segment Reporting Information [Line Items]
Number of individual customers		1
Deferred customer billings | Customer Concentration Risk | Three Major Individual Customers
Segment Reporting Information [Line Items]
Number of individual customers			3		3
Concentration percentage			47.00%		48.00%
Deferred customer billings | Customer Concentration Risk | Ascension Health
Segment Reporting Information [Line Items]
Concentration percentage			78.00%		76.00%
Deferred customer billings | Customer Concentration Risk | Two Major Individual Customers Affiliated with Ascension Health [Member]
Segment Reporting Information [Line Items]
Number of individual customers			2		2