R1 RCM 10-Q 3 Nov 20 2020 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2020	Oct. 27, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2020
Document Transition Report	false
Entity File Number	001-34746
Entity Registrant Name	R1 RCM INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	02-0698101
Entity Address, Address Line One	401 North Michigan Avenue
Entity Address, Address Line Two	Suite 2700
Entity Address, City or Town	Chicago
Entity Address, State or Province	IL
Entity Address, Postal Zip Code	60611
City Area Code	312
Local Phone Number	324-7820
Title of 12(b) Security	Common stock, par value $0.01 per share
Trading Symbol	RCM
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filter Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		116,662,422
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
Entity Central Index Key	0001472595
Current Fiscal Year End Date	--12-31

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 106.3	$ 92
Accounts receivable, net of $3.6 million and $2.8 million allowance	76.7	52.3
Accounts receivable, net of $0.1 million and $0.0 million allowance - related party	35.5	30.8
Prepaid expenses and other current assets	62.4	41.6
Assets held for sale	101.5	0
Total current assets	382.4	216.7
Property, equipment and software, net	102.8	116.9
Operating lease right-of-use assets	63.5	77.9
Intangible assets, net	175.7	164.7
Goodwill	375.3	253.2
Non-current deferred tax assets	54.5	64.2
Non-current portion of restricted cash equivalents	1	0.5
Other assets	49.3	35
Total assets	1,204.5	929.1
Current liabilities:
Accounts payable	21.8	20.2
Current portion of customer liabilities	18.8	14
Current portion of customer liabilities - related party	22.6	34.1
Accrued compensation and benefits	54.5	95.1
Current portion of operating lease liabilities	12.9	12.8
Current portion of long-term debt	29	16.3
Other accrued expenses	55.6	40
Liabilities held for sale	25.3	0
Total current liabilities	240.5	232.5
Non-current portion of customer liabilities - related party	17.2	18.6
Non-current portion of operating lease liabilities	73.6	82.7
Long-term debt	529.2	337.7
Other non-current liabilities	35.8	10.4
Total liabilities	896.3	681.9
8.00% Series A convertible preferred stock, par value $0.01, 370,000 shares authorized, 282,841 shares issued and outstanding as of September 30, 2020 (aggregate liquidation value of $288.5); 370,000 shares authorized, 266,529 shares issued and outstanding as of December 31, 2019 (aggregate liquidation value of $271.9)	245.7	229.1
Stockholders’ equity:
Common stock, $0.01 par value, 500,000,000 shares authorized, 130,412,966 shares issued and 116,493,027 shares outstanding at September 30, 2020; 127,807,546 shares issued and 114,021,280 shares outstanding at December 31, 2019	1.3	1.3
Additional paid-in capital	384	372.7
Accumulated deficit	(240.1)	(277.8)
Accumulated other comprehensive loss	(7.9)	(4.5)
Treasury stock, at cost, 13,919,939 shares as of September 30, 2020; 13,786,266 shares as of December 31, 2019	(74.8)	(73.6)
Total stockholders’ equity	62.5	18.1
Total liabilities and stockholders’ equity	$ 1,204.5	$ 929.1

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Accounts receivable, allowance	$ 3.6	$ 2.8
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	500,000,000	500,000,000
Common stock, shares issued (in shares)	130,412,966	127,807,546
Common stock, shares outstanding (in shares)	116,493,027	114,021,280
Treasury stock, shares (in shares)	13,919,939	13,786,266
Related Party
Accounts receivable, allowance	$ 0.1	$ 0
Redeemable Convertible Preferred Stock
Preferred stock, dividend rate (percentage)	8.00%	8.00%
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	370,000	370,000
Preferred stock, shares issued (in shares)	282,841	266,529
Preferred stock, shares outstanding (in shares)	282,841	266,529
Preferred stock, aggregate liquidation value	$ 288.5	$ 271.9

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Net services revenue ($193.4 million and $608.2 million for the three and nine months ended September 30, 2020, respectively, and $204.5 million and $583.7 million for the three and nine months ended September 30, 2019, respectively, from related party)	$ 307.2	$ 301.2	$ 942.4	$ 872.1
Operating expenses:
Cost of services	255.2	241.9	757.4	725.2
Selling, general and administrative	25.7	28.3	74.5	76.6
Other expenses	15.7	7.4	42.4	26.9
Total operating expenses	296.6	277.6	874.3	828.7
Income from operations	10.6	23.6	68.1	43.4
Loss on debt extinguishment	0	0	0	18.8
Net interest expense	4.4	5	13	25.1
Income (loss) before income tax provision (benefit)	6.2	18.6	55.1	(0.5)
Income tax provision (benefit)	1	9.4	16.6	(4.7)
Net income	$ 5.2	$ 9.2	$ 38.5	$ 4.2
Net income (loss) per common share:
Basic (in dollars per share)	$ 0	$ 0.02	$ 0.10	$ (0.10)
Diluted (in dollars per share)	$ 0	$ 0.01	$ 0.08	$ (0.10)
Weighted average shares used in calculating net income (loss) per common share:
Basic (in shares)	115,976,377	112,230,439	115,164,631	111,005,255
Diluted (in shares)	115,976,377	165,622,407	171,178,086	111,005,255
Consolidated statements of comprehensive income
Net income	$ 5.2	$ 9.2	$ 38.5	$ 4.2
Other comprehensive income (loss):
Net change on derivatives designated as cash flow hedges, net of tax	1.1	(0.5)	(2.5)	(0.2)
Foreign currency translation adjustments	1.4	(1.2)	(0.9)	(0.7)
Comprehensive income	7.7	7.5	35.1	3.3
Basic:
Net income	5.2	9.2	38.5	4.2
Less dividends on preferred shares	(5.6)	(5.3)	(16.6)	(15.4)
Less income allocated to preferred shareholders	0	(1.9)	(10.9)	0
Net income (loss) available/allocated to common shareholders - basic	(0.4)	2	11	(11.2)
Diluted:
Net income	5.2	9.2	38.5	4.2
Less dividends on preferred shares	(5.6)	(5.3)	(16.6)	(15.4)
Less income allocated to preferred shareholders	0	(1.5)	(8.7)	0
Net income (loss) available/allocated to common shareholders - diluted	$ (0.4)	$ 2.4	$ 13.2	$ (11.2)

Consolidated Statements of Op_2

Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Revenue from related parties	$ 193.4	$ 204.5	$ 608.2	$ 583.7

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity (Deficit) (unaudited) - USD ($) $ in Millions	Total	Previously Reported	Revision Of Prior Period, Accounting Standards Update, Adjustment	Revision Of Prior Period, Accounting Standards Update, Adjusted Balance	Common Stock	Common StockPreviously Reported	Common StockRevision Of Prior Period, Accounting Standards Update, Adjusted Balance	Treasury Stock	Treasury StockPreviously Reported	Treasury StockRevision Of Prior Period, Accounting Standards Update, Adjusted Balance	Additional Paid-In Capital	Additional Paid-In CapitalPreviously Reported	Additional Paid-In CapitalRevision Of Prior Period, Accounting Standards Update, Adjusted Balance	Accumulated Deficit	Accumulated DeficitPreviously Reported	Accumulated DeficitRevision Of Prior Period, Accounting Standards Update, Adjustment	Accumulated DeficitRevision Of Prior Period, Accounting Standards Update, Adjusted Balance	Accumulated Other Comprehensive Loss	Accumulated Other Comprehensive LossPreviously Reported	Accumulated Other Comprehensive LossRevision Of Prior Period, Accounting Standards Update, Adjusted Balance
Beginning Balance (in shares) at Dec. 31, 2018					123,353,656			12,811,755
Beginning Balance at Dec. 31, 2018	$ 6.3				$ 1.2			$ (62.6)			$ 361			$ (289.8)				$ (3.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	4.5										4.5
Issuance of common stock related to share-based compensation plans (in shares)					2,613
Exercise of vested stock options (in shares)					145,235
Exercise of vested stock options	0.4										0.4
Dividends paid/accrued	(5)										(5)
Acquisition of treasury stock related to share-based compensation plans (in shares)								(342,998)
Acquisition of treasury stock related to share-based compensation plans	(3.3)							$ (3.3)
Forfeitures (in shares)								(1,208)
Net change on derivatives designated as cash flow hedges, net of tax	0.2																	0.2
Foreign currency translation adjustments	0.5																	0.5
Net income	0.2													0.2
Ending Balance (in shares) at Mar. 31, 2019					123,501,504			13,155,961
Ending Balance at Mar. 31, 2019	3.8				$ 1.2			$ (65.9)			360.9			(289.6)				(2.8)
Beginning Balance (in shares) at Dec. 31, 2018					123,353,656			12,811,755
Beginning Balance at Dec. 31, 2018	6.3				$ 1.2			$ (62.6)			361			(289.8)				(3.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net change on derivatives designated as cash flow hedges, net of tax	(0.2)
Foreign currency translation adjustments	(0.7)
Net income	4.2
Ending Balance (in shares) at Sep. 30, 2019					126,166,326			13,301,751
Ending Balance at Sep. 30, 2019	14.8				$ 1.3			$ (67.3)			370.8			(285.6)				(4.4)
Beginning Balance (in shares) at Dec. 31, 2018					123,353,656			12,811,755
Beginning Balance at Dec. 31, 2018	6.3				$ 1.2			$ (62.6)			361			(289.8)				(3.5)
Ending Balance (in shares) at Dec. 31, 2019						127,807,546	127,807,546		13,786,266	13,786,266
Ending Balance at Dec. 31, 2019	$ 18.1	$ 18.1	$ (0.8)	$ 17.3		$ 1.3	$ 1.3		$ (73.6)	$ (73.6)		$ 372.7	$ 372.7		$ (277.8)	$ (0.8)	$ (278.6)		$ (4.5)	$ (4.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Beginning Balance (in shares) at Mar. 31, 2019					123,501,504			13,155,961
Beginning Balance at Mar. 31, 2019	$ 3.8				$ 1.2			$ (65.9)			360.9			(289.6)				(2.8)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	4.8										4.8
Issuance of common stock related to share-based compensation plans (in shares)					359,488
Exercise of vested stock options (in shares)					1,329,175
Exercise of vested stock options	7.4				$ 0.1						7.3
Dividends paid/accrued	(5.1)										(5.1)
Acquisition of treasury stock related to share-based compensation plans (in shares)								(143,739)
Acquisition of treasury stock related to share-based compensation plans	(1.4)							$ (1.4)
Net change on derivatives designated as cash flow hedges, net of tax	0.1																	0.1
Net income	(5.2)													(5.2)
Ending Balance (in shares) at Jun. 30, 2019					125,190,167			13,299,700
Ending Balance at Jun. 30, 2019	4.4				$ 1.3			$ (67.3)			367.9			(294.8)				(2.7)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	3.8										3.8
Issuance of common stock related to share-based compensation plans (in shares)					57,555
Issuance of common stock related to share-based compensation plans	0										0
Exercise of vested stock options (in shares)					918,604
Exercise of vested stock options	4.3										4.3
Dividends paid/accrued	(5.2)										(5.2)
Acquisition of treasury stock related to share-based compensation plans (in shares)								(2,051)
Net change on derivatives designated as cash flow hedges, net of tax	(0.5)																	(0.5)
Foreign currency translation adjustments	(1.2)																	(1.2)
Net income	9.2													9.2
Ending Balance (in shares) at Sep. 30, 2019					126,166,326			13,301,751
Ending Balance at Sep. 30, 2019	14.8				$ 1.3			$ (67.3)			370.8			(285.6)				(4.4)
Beginning Balance (in shares) at Dec. 31, 2019						127,807,546	127,807,546		13,786,266	13,786,266
Beginning Balance at Dec. 31, 2019	18.1	18.1	(0.8)	17.3		$ 1.3	$ 1.3		$ (73.6)	$ (73.6)		372.7	372.7		(277.8)	(0.8)	(278.6)		(4.5)	(4.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	4.8										4.8
Issuance of common stock related to share-based compensation plans (in shares)					1,720
Exercise of vested stock options (in shares)					553,520
Exercise of vested stock options	3.1										3.1
Dividends paid/accrued	(5.4)										(5.4)
Acquisition of treasury stock related to share-based compensation plans (in shares)								(545)
Net change on derivatives designated as cash flow hedges, net of tax	(4.4)																	(4.4)
Foreign currency translation adjustments	(2.1)																	(2.1)
Net income	18.2													18.2
Ending Balance (in shares) at Mar. 31, 2020					128,362,786			13,786,811
Ending Balance at Mar. 31, 2020	31.5				$ 1.3			$ (73.6)			375.2			(260.4)				(11)
Beginning Balance (in shares) at Dec. 31, 2019						127,807,546	127,807,546		13,786,266	13,786,266
Beginning Balance at Dec. 31, 2019	$ 18.1	$ 18.1	$ (0.8)	$ 17.3		$ 1.3	$ 1.3		$ (73.6)	$ (73.6)		$ 372.7	$ 372.7		$ (277.8)	$ (0.8)	$ (278.6)		$ (4.5)	$ (4.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of vested stock options (in shares)	2,126,647
Net change on derivatives designated as cash flow hedges, net of tax	$ (2.5)
Foreign currency translation adjustments	(0.9)
Net income	38.5
Ending Balance (in shares) at Sep. 30, 2020					130,412,966			13,919,939
Ending Balance at Sep. 30, 2020	$ 62.5				$ 1.3			$ (74.8)			384			(240.1)				(7.9)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Beginning Balance (in shares) at Mar. 31, 2020					128,362,786			13,786,811
Beginning Balance at Mar. 31, 2020	$ 31.5				$ 1.3			$ (73.6)			375.2			(260.4)				(11)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	4.4										4.4
Issuance of common stock related to share-based compensation plans (in shares)					463,038
Exercise of vested stock options (in shares)					464,136
Exercise of vested stock options	1.2										1.2
Dividends paid/accrued	(5.6)										(5.6)
Acquisition of treasury stock related to share-based compensation plans (in shares)								(128,361)
Acquisition of treasury stock related to share-based compensation plans	(1.1)							$ (1.1)
Net change on derivatives designated as cash flow hedges, net of tax	0.8																	0.8
Foreign currency translation adjustments	(0.2)																	(0.2)
Net income	15.1													15.1
Ending Balance (in shares) at Jun. 30, 2020					129,289,960			13,915,172
Ending Balance at Jun. 30, 2020	46.1				$ 1.3			$ (74.7)			375.2			(245.3)				(10.4)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	6.8										6.8
Issuance of common stock related to share-based compensation plans (in shares)					14,015
Exercise of vested stock options (in shares)					1,108,991
Exercise of vested stock options	7.6										7.6
Dividends paid/accrued	(5.6)										(5.6)
Acquisition of treasury stock related to share-based compensation plans (in shares)								(4,767)
Acquisition of treasury stock related to share-based compensation plans	(0.1)							$ (0.1)
Net change on derivatives designated as cash flow hedges, net of tax	1.1																	1.1
Foreign currency translation adjustments	1.4																	1.4
Net income	5.2													5.2
Ending Balance (in shares) at Sep. 30, 2020					130,412,966			13,919,939
Ending Balance at Sep. 30, 2020	$ 62.5				$ 1.3			$ (74.8)			$ 384			$ (240.1)				$ (7.9)

Consolidated Statements of St_2

Consolidated Statements of Stockholders' Equity (Deficit) (unaudited) (Parenthetical) - USD ($) $ in Millions	Dec. 31, 2019	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019
Accumulated Other Comprehensive Loss
Net change on derivatives designated as cash flow hedges, tax		$ 0.4	$ 0.3	$ 1.5	$ 0.2	$ 0	$ 0.1
Revision Of Prior Period, Accounting Standards Update, Adjustment
Impact of credit-loss standard adoption, tax	$ 0.3

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Operating activities
Net income	$ 38.5	$ 4.2
Adjustments to reconcile net income to net cash provided by operations:
Depreciation and amortization	50.9	39.9
Amortization of debt issuance costs	0.8	1.4
Share-based compensation	15.9	12.8
Loss on disposal and right-of-use asset write-downs	5.1	0
Loss on debt extinguishment	0	18.8
Provision for credit losses	1.3	2.3
Deferred income taxes	16.2	(9.4)
Non-cash lease expense	8.7	8.5
Change in value of contingent consideration	1.6	0
Changes in operating assets and liabilities:
Accounts receivable and related party accounts receivable	(47.2)	9.8
Prepaid expenses and other assets	(11.8)	(20.1)
Accounts payable	1.9	10.5
Accrued compensation and benefits	(36.1)	(7.3)
Lease liabilities	(7.8)	(8.9)
Other liabilities	22.5	1
Customer liabilities and customer liabilities - related party	(10)	(20.2)
Net cash provided by operating activities	50.5	43.3
Investing activities
Purchases of property, equipment, and software	(42.3)	(43.1)
Acquisition of SCI, net of cash acquired and earn-out provision	(189)	0
Acquisition of RevWorks, net of contingent consideration	(5)	0
Net cash used in investing activities	(236.3)	(43.1)
Financing activities
Repayment of senior secured debt	(17)	(272.7)
Repayment of subordinated notes and prepayment penalty	0	(112.2)
Repayments on revolver	(17)	(272.7)
Exercise of vested stock options	11	9.5
Shares withheld for taxes	(7.5)	(4.7)
Finance lease payments	(0.8)	(0.6)
Other	(5)	0
Net cash provided by (used in) financing activities	201.3	(8.9)
Effect of exchange rate changes in cash, cash equivalents and restricted cash	(0.7)	(0.3)
Net increase (decrease) in cash, cash equivalents and restricted cash	14.8	(9)
Cash, cash equivalents and restricted cash, at beginning of period	92.5	65.1
Cash, cash equivalents and restricted cash, at end of period	107.3	56.1
Supplemental disclosures of cash flow information
Accrued dividends payable to preferred stockholders	5.6	5.2
Accrued and other liabilities related to purchases of property, equipment and software	8.8	20.1
Accounts payable related to purchases of property, equipment and software	2.1	5.2
Interest paid	11.8	22.6
Income taxes paid	3.4	3.5
Income taxes refunded	0.2	0.1
Senior Term Loan
Financing activities
Issuance of senior secured debt, net of discount and issuance costs	190.6	321.8
Borrowings on revolver	190.6	321.8
Senior Revolver
Financing activities
Issuance of senior secured debt, net of discount and issuance costs	50	60
Borrowings on revolver	50	60
Repayment of senior secured debt	(20)	(10)
Repayments on revolver	$ (20)	$ (10)

Business Description and Basis

Business Description and Basis of Presentation	9 Months Ended
	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Basis of Presentation	Business Description and Basis of Presentation Business Description R1 RCM Inc. (the “Company”) is a leading provider of technology-enabled revenue cycle management (“RCM”) services to healthcare providers, including health systems, hospitals, and physician groups. The Company helps healthcare providers generate sustainable improvements in their operating margins and cash flows while also enhancing patient, physician, and staff satisfaction for its customers. For further information regarding the Company's business, including relationships with Ascension Health (“Ascension”), TowerBrook Capital Partners (“TowerBrook”), and IHC Health Services, Inc. (“Intermountain”), and its prior acquisition of Intermedix Holdings, Inc. (“Intermedix”), refer to Note 1 of the Company's Annual Report on Form 10-K for the fiscal year ended December 31, 2019 (the “2019 Form 10-K”). SCI Solutions, Inc. Acquisition On April 1, 2020, the Company completed the acquisition of scheduling.com, Inc. d/b/a SCI Solutions, Inc. (“SCI”) pursuant to a stock purchase agreement dated as of January 9, 2020 (the “Stock Purchase Agreement”), by and among the Company, Clearsight Intermediate Holdings, Inc. (“Clearsight Holdings”) and Clearsight Group Holdings, LLC (the “Seller”) (the “SCI Acquisition”). At the closing of the transaction, the Company purchased from the Seller all of the issued and outstanding equity interests of Clearsight Holdings, which owns all of the issued and outstanding equity interests of SCI. SCI is a leading provider of software-as-a-service (“SaaS”)-based scheduling and patient access solutions. SCI’s platform streamlines the patient and provider experience, creating efficient care networks where health systems’ capacity is digitally and conveniently accessible to all market constituents. The combination of R1 and SCI is expected to deliver enhanced value for healthcare providers by enabling them to expand digital front door strategies for their patients, improve operating efficiency, and increase capacity utilization, among other benefits. Refer to Note 4, Acquisitions for additional details. RevWorks Acquisition On August 3, 2020, the Company completed the acquisition of the RevWorks services business pursuant to an asset purchase agreement dated as of June 2, 2020 (the “RevWorks Purchase Agreement”) by and among the Company and Cerner Corporation (the “RevWorks Acquisition”). At the closing of the transaction, the Company purchased certain assets relating to the RevWorks services business, as specified in the RevWorks Purchase Agreement. The combination of R1 and RevWorks is expected to provide enhanced revenue cycle capabilities and expertise to RevWorks clients, helping drive sustainable financial improvements for providers while improving their patients’ overall experience. Refer to Note 4, Acquisitions for additional details. Emergency Medical Services Disposition On July 19, 2020, the Company entered into a definitive agreement to dispose of its emergency medical services (“EMS”) business, including EMS Revenue Cycle Management and Electronic Patient Care Reporting (the “EMS Disposition”) for $140 million, inclusive of a $5 million hold-back amount subject to the completion of certain transition services, to be paid approximately one year from the date of the disposition. As of September 30, 2020, the assets and liabilities of the EMS business of approximately $101.5 million and $25.3 million, respectively, were classified as held for sale. Refer to Note 5, Assets and Liabilities of Business Held for Sale for additional details. On October 30, 2020, the Company completed the sale of the EMS business. The Company expects to recognize a gain on the sale of between $45 million and $60 million, subject to completion of customary working capital adjustments and the goodwill allocation. Refer to Note 5, Assets and Liabilities of Business Held for Sale for additional details. Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of September 30, 2020, the results of operations of the Company for the three and nine months ended September 30, 2020 and 2019, and the cash flows of the Company for the nine months ended September 30, 2020 and 2019. These financial statements include the accounts of R1 RCM Inc. and its wholly-owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with United States generally accepted accounting principles (“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, 2020 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2020.

Recent Accounting Pronouncement

Recent Accounting Pronouncements	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
Recent Accounting Pronouncements	Recent Accounting Pronouncements Recently Issued Accounting Standards and Disclosures In June 2016, the FASB issued ASU 2016-13

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2020
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Fair Value of Financial Instruments The Company's accounting policy for fair values, including details of the fair value hierarchy levels, are outlined in Note 4 of the Company's 2019 Form 10-K. The carrying amounts of the Company’s financial instruments, which include financial assets such as cash and cash equivalents, restricted cash equivalents, accounts receivable, net, and certain other current assets, as well as financial liabilities such as accounts payable, accrued service costs, accrued compensation and benefits, and certain other current liabilities, approximate their fair values, due to the short-term nature of these instruments. See Note 22, Derivative Financial Instruments, for a discussion of the fair value of the Company's forward currency derivative contracts and interest rate swaps.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
Acquisitions	Acquisitions SCI On April 1, 2020, the Company completed the acquisition of SCI. The SCI Acquisition has been accounted for under ASC 805, Business Combinations. Accordingly, the accounts of the acquired company, after adjustments to reflect fair values assigned to assets and liabilities, have been included in the Company’s consolidated financial statements since the date of the SCI Acquisition. The purchase price for the SCI Acquisition was $190.0 million, subject to customary adjustments for cash, transaction expenses, earn-out consideration, and normalized working capital. The Company funded the purchase price for the SCI Acquisition and the Company’s associated transaction expenses with a combination of cash on hand and the incurrence of additional indebtedness (see Note 12, Debt). The purchase price has been provisionally allocated, on a preliminary basis, to assets acquired and liabilities assumed based on their preliminary estimated fair values as of the completion of the SCI Acquisition. At the effective date of the SCI Acquisition, the assets acquired and liabilities assumed are generally required to be measured at fair value. The fair value estimate of assets acquired and liabilities assumed are pending completion of certain elements, including gathering further information about the identification and completeness of all assets and liabilities acquired, the finalization of an independent appraisal and valuations of fair value of the assets acquired and liabilities assumed, and final review by the Company's management. The Company expects to finalize these amounts in the fourth quarter of 2020. Accordingly, management considers the balances shown in the following table to be preliminary. Some of the more significant amounts that are not yet finalized relate to the fair value of intangible assets, contingent liabilities, and income and non-income related taxes. Accordingly, there could be adjustments to the consolidated financial statements, including changes in our amortization expense related to the valuation of intangible assets acquired and their respective useful lives among other adjustments. This measurement period will not exceed one year from the acquisition date. The final determination of the assets acquired and liabilities assumed will be based on the established fair value of the assets acquired and the liabilities assumed as of the acquisition date. The excess of the purchase price over the fair value of net assets acquired is allocated to goodwill. The final determination of the purchase price, fair values, and resulting goodwill may differ from what is reflected in these consolidated financial statements. The preliminary fair value of assets acquired and liabilities assumed is (in millions): Purchase Price Allocation Total purchase consideration $ 196.7 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 2.9 Accounts receivable 2.8 Prepaid expenses and other current assets 1.1 Property, equipment and software 0.3 Operating lease right-of-use assets 1.2 Intangible assets 86.1 Goodwill 126.3 Accounts payable (0.2) Current portion of customer liabilities (4.0) Accrued compensation and benefits (1.9) Current portion of operating lease liabilities (0.5) Other accrued expenses (0.3) Non-current portion of operating lease liabilities (0.7) Other non-current liabilities (5.0) Deferred income tax liabilities (11.4) Net assets acquired $ 196.7 Other non-current liabilities contained a note payable for $5 million. The Company repaid this note in the second quarter of 2020. The goodwill recognized is primarily attributable to synergies that are expected to be achieved from the integration of SCI. None of the goodwill is expected to be deductible for income tax purposes. The purchase price includes an earn-out provision, which is dependent on achieving certain revenue and operational targets in the year following the acquisition. The earn-out is binary, with the potential payment being either $10 million or $0. Based on projections at the time of acquisition, the earn-out was valued at $4.8 million. Adjustments to the earn-out based on information obtained subsequent to the acquisition are recorded through the income statement. In the third quarter of 2020, the Company updated the earn-out value to $6.4 million and recorded a change to income of $1.6 million as a component of other expenses in the quarter. Included in the Consolidated Statements of Operations and Comprehensive Income (Loss) for the three and nine months ended September 30, 2020 are net sales of $7.4 million and $14.0 million, respectively, and net loss before income taxes of $1.6 million and $3.9 million related to the operations of SCI since the acquisition date of April 1, 2020. Measurement period adjustments The Company had various measurement period adjustments due to updated valuation reports and additional knowledge gained since the acquisition. The significant adjustments included an increase to intangible assets of $1.8 million related to updated assumptions and information included in the valuations, an increase to the deferred tax liability of $1.3 million, and an offset of these changes to goodwill. In conjunction with the adjustments, the Company adjusted amortization expense in the quarter ended September 30, 2020. RevWorks On August 3, 2020, the Company completed the acquisition of RevWorks. The RevWorks Acquisition has been accounted for under ASC 805, Business Combinations. Accordingly, the accounts of the acquired company, after adjustments to reflect estimated fair values assigned to assets and liabilities, have been included in the Company’s consolidated financial statements since the date of the RevWorks Acquisition. The $30.0 million purchase consideration for the RevWorks Acquisition (inclusive of working capital) consisted of a $5.0 million payment at closing and two deferred payments, each of $12.5 million and totaling $25.0 million, which are due and payable on the first and second anniversary of the closing date. The two deferred payments are contractual obligations of the Company; however, they are potentially effectively refundable to the Company contingent on the achievement of certain pre-existing customer revenue targets for the RevWorks business that were agreed in the purchase agreement. If such targets are not achieved, this will result in Cerner Corporation (“Cerner”) returning to the Company up to $25.0 million. At the time of the acquisition, the Company recorded a present value liability for the contractual deferred payments of $24.3 million, and recorded an asset for the contingently returnable consideration of $22.3 million which is measured at fair value. The assets acquired in the RevWorks Acquisition consist primarily of customer relationships and fixed assets. There were no significant pre-closing liabilities of the RevWorks business included in the RevWorks Acquisition. The fair value estimate of assets acquired and liabilities assumed are pending completion of multiple elements, including gathering further information about the identification and completeness of all assets and liabilities acquired. The goodwill recognized is primarily attributable to synergies that are expected to be achieved from the integration of RevWorks. Included in the Consolidated Statements of Operations and Comprehensive Income (Loss) for the three and nine months ended September 30, 2020 are net sales of $8.3 million and net loss before income taxes of $0.3 million related to the operations of RevWorks since the acquisition date of August 3, 2020. Pro Forma Results The following table summarizes, on a pro forma basis, the combined results of the Company as though the SCI and RevWorks acquisitions had occurred as of January 1, 2019. These pro forma results are not necessarily indicative of either the actual consolidated results had the acquisitions occurred as of January 1, 2019 or of the future consolidated operating results for any period. Pro forma results are (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net services revenue $ 308.2 $ 325.1 $ 992.3 $ 954.2 Net income (loss) $ 0.3 $ 3.3 $ 51.5 $ (9.5) Supplemental pro-forma earnings were adjusted to exclude $6.0 million of acquisition-related costs incurred by the Company in 2020 and include those costs in 2019. Adjustments were also made to earnings to adjust depreciation and amortization to reflect fair value of identified assets acquired, to record the effects of extinguishing the debt of SCI and replacing it with the debt of the Company, and to record the income tax effect of these adjustments.

Assets and Liabilities of Busin

Assets and Liabilities of Business Held for Sale	9 Months Ended
	Sep. 30, 2020
Discontinued Operations and Disposal Groups [Abstract]
Assets and Liabilities of Business Held for Sale	Assets and Liabilities of Business Held for Sale As part of our portfolio analysis and strategic initiatives, the Company entered into a definitive agreement to dispose of its EMS business on July 19, 2020 for $140 million, inclusive of a $5 million hold-back amount subject to the completion of certain transition services, to be paid approximately one year from the date of the disposition. The disposition price is subject to customary adjustments for working capital, cash, and transaction expenses. The EMS Disposition closed on October 30, 2020. As of September 30, 2020, the assets and liabilities of the EMS business were classified as held-for-sale. The following table presents a summary of the EMS business assets and liabilities held for sale included in the consolidated balance sheet as of September 30, 2020 (in millions): September 30, 2020 Assets Accounts receivable, net $ 18.9 Prepaid expenses and other current assets 1.5 Property, equipment and software, net 5.9 Operating lease right-of-use assets 0.9 Intangible assets, net 66.5 Goodwill 7.6 Other assets 0.2 Total assets held for sale $ 101.5 Liabilities Accounts payable $ 1.4 Current portion of customer liabilities 2.1 Operating lease liabilities 0.9 Other accrued expenses 2.6 Deferred tax liabilities (1) 18.1 Other non-current liabilities 0.2 Total liabilities held for sale $ 25.3 (1) On a consolidated basis, the Company has a net deferred tax asset; however, the EMS business on a standalone basis is in a deferred tax liability position. For purposes of the EMS held for sale assets and liabilities, the deferred tax liability sits in the held for sale liability line. The EMS business did not meet the criteria to be classified as a discontinued operation as the EMS Disposition will not have a major effect on the Company’s operations and financial results.

Accounts Receivable and Allowan

Accounts Receivable and Allowance for Credit Losses	9 Months Ended
	Sep. 30, 2020
Receivables [Abstract]
Accounts Receivable and Allowance for Credit Losses	Accounts Receivable and Allowance for Credit LossesAccounts receivable is comprised of unpaid balances pertaining to modular services and end-to-end RCM customers, net receivable balances for end-to-end RCM customers after considering cost reimbursements owed to such customers, including related accrued balances, and amounts due from physician RCM and practice management customers. On January 1, 2020 (the "adoption date"), the Company replaced its previous incurred loss impairment model for estimating credit losses on accounts receivables with an expected loss model prepared in accordance with ASC 326. While the incurred loss impairment model had the Company recognize credit losses when it was probable that a loss had been incurred, ASC 326 The Company evaluates its accounts receivable for expected credit losses quarterly. The Company maintains an estimated allowance for credit losses 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 Company resources assigned to each customer, the status of any ongoing operations with each applicable customer, and environmental factors such as significant shifts in the healthcare environment which the Company believes may have impacted or will impact its customers’ financial health and ability to pay. The full effects of COVID-19 on the Company’s customers are uncertain and cannot be predicted. As a result, the Company’s future collection experience may differ from historical collection trends. The Company has presented the rollforward below on a consolidated basis as the currently expected credit losses for its large Integrated Delivery Network customers are not anticipated to be material. Movements in the allowance for credit losses are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Beginning balance $ 5.2 $ 2.1 $ 2.8 $ 1.1 Cumulative effect of ASC 326 — — 1.1 — Provision (recoveries) (0.8) 1.3 0.5 2.5 Amounts reclassified to held for sale (0.6) — (0.6) — Write-offs (0.1) (0.6) (0.1) (0.8) Ending balance $ 3.7 $ 2.8 $ 3.7 $ 2.8

Property, Equipment and Softwar

Property, Equipment and Software	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Property, Equipment and Software	Property, Equipment and Software Property, equipment and software consist of the following (in millions): September 30, 2020 December 31, 2019 Buildings and land $ 4.6 $ 4.6 Computer and other equipment 53.2 50.7 Leasehold improvements 28.3 31.1 Software 132.1 123.0 Office furniture 8.0 9.4 Property, equipment and software, gross 226.2 218.8 Less accumulated depreciation and amortization (123.4) (101.9) Property, equipment and software, net $ 102.8 $ 116.9 The following table summarizes the allocation of depreciation and amortization expense between cost of services and selling, general and administrative expenses (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Cost of services $ 11.8 $ 9.2 $ 34.1 $ 26.7 Selling, general and administrative 1.0 1.4 3.2 2.7 Total depreciation and amortization $ 12.8 $ 10.6 $ 37.3 $ 29.4

Leases

Leases	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Leases	Leases The Company's accounting policy for leases, including the elections made as part of the adoption of ASC 842 effective January 1, 2019, are outlined in Note 8 of the Company's 2019 Form 10-K. The components of lease costs are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Operating lease cost $ 4.3 $ 4.9 $ 14.1 $ 14.3 Finance lease cost: Amortization of right-of-use (“ROU”) assets 0.1 0.2 0.4 0.6 Interest on lease liabilities — — 0.1 0.1 Sublease income (0.6) (0.6) (1.7) (1.7) Total lease cost $ 3.8 $ 4.5 $ 12.9 $ 13.3 Supplemental cash flow information related to leases are as follows (in millions): Nine Months Ended September 30, 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 15.2 $ 13.8 Operating cash flows for finance leases 0.1 0.1 Financing cash flows for finance leases 0.8 0.6 ROU assets obtained in exchange for lease obligations: Operating leases 3.4 11.6 Finance leases — 0.5 The Company presents all non-cash transactions related to adjustments to the lease liability or right-of-use asset as non-cash transactions. This includes all non-cash charges related to any modification or reassessment events triggering remeasurement. Supplemental balance sheet information related to leases are as follows: September 30, 2020 December 31, 2019 Weighted average remaining lease term: Operating leases 7 years 8 years Finance leases 2 years 2 years Weighted average incremental borrowing rate: Operating leases 8.87 % 8.84 % Finance leases 6.62 % 6.45 % Maturities of lease liabilities as of September 30, 2020 are as follows (in millions): Operating Leases Finance Leases Remainder of 2020 $ 5.5 $ — 2021 19.1 0.5 2022 16.4 0.1 2023 15.2 — 2024 15.0 — 2025 14.8 — Thereafter 33.9 — Total 119.9 0.6 Less: Amounts included in held for sale liabilities 0.9 — Imputed interest 32.5 — Present value of lease liabilities $ 86.5 $ 0.6
Leases	Leases The Company's accounting policy for leases, including the elections made as part of the adoption of ASC 842 effective January 1, 2019, are outlined in Note 8 of the Company's 2019 Form 10-K. The components of lease costs are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Operating lease cost $ 4.3 $ 4.9 $ 14.1 $ 14.3 Finance lease cost: Amortization of right-of-use (“ROU”) assets 0.1 0.2 0.4 0.6 Interest on lease liabilities — — 0.1 0.1 Sublease income (0.6) (0.6) (1.7) (1.7) Total lease cost $ 3.8 $ 4.5 $ 12.9 $ 13.3 Supplemental cash flow information related to leases are as follows (in millions): Nine Months Ended September 30, 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 15.2 $ 13.8 Operating cash flows for finance leases 0.1 0.1 Financing cash flows for finance leases 0.8 0.6 ROU assets obtained in exchange for lease obligations: Operating leases 3.4 11.6 Finance leases — 0.5 The Company presents all non-cash transactions related to adjustments to the lease liability or right-of-use asset as non-cash transactions. This includes all non-cash charges related to any modification or reassessment events triggering remeasurement. Supplemental balance sheet information related to leases are as follows: September 30, 2020 December 31, 2019 Weighted average remaining lease term: Operating leases 7 years 8 years Finance leases 2 years 2 years Weighted average incremental borrowing rate: Operating leases 8.87 % 8.84 % Finance leases 6.62 % 6.45 % Maturities of lease liabilities as of September 30, 2020 are as follows (in millions): Operating Leases Finance Leases Remainder of 2020 $ 5.5 $ — 2021 19.1 0.5 2022 16.4 0.1 2023 15.2 — 2024 15.0 — 2025 14.8 — Thereafter 33.9 — Total 119.9 0.6 Less: Amounts included in held for sale liabilities 0.9 — Imputed interest 32.5 — Present value of lease liabilities $ 86.5 $ 0.6

Intangible Assets

Intangible Assets	9 Months Ended
	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets The following table provides the gross carrying value and accumulated amortization for each major class of intangible asset at September 30, 2020 and December 31, 2019 (in millions): September 30, 2020 December 31, 2019 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 97.9 $ (13.1) $ 84.8 $ 160.9 $ (15.6) $ 145.3 Technology 101.7 (10.8) 90.9 26.8 (7.4) 19.4 Total intangible assets $ 199.6 $ (23.9) $ 175.7 $ 187.7 $ (23.0) $ 164.7 Through the SCI and RevWorks acquisitions, the Company acquired the following intangible assets in 2020 (in millions, except weighted average useful life): Weighted Average Useful Life Gross Carrying Value Customer relationships 10 years $ 5.8 Technology 10 years $ 85.3 Intangible asset amortization expense was $4.5 million and $13.6 million for the three and nine months ended September 30, 2020, and $3.5 million and $10.5 million for the three and nine months ended September 30, 2019. Estimated annual amortization expense related to intangible assets with definite lives as of September 30, 2020 is as follows (in millions): Remainder of 2020 $ 4.3 2021 17.3 2022 17.3 2023 17.3 2024 15.5 2025 14.5 Thereafter 89.5 Total $ 175.7

Goodwill

Goodwill	9 Months Ended
	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Unless otherwise required, goodwill is tested for impairment annually in the fourth quarter. Changes in the carrying amount of goodwill for the nine months ended September 30, 2020 were (in millions): Goodwill Balance as of December 31, 2019 $ 253.2 Acquisitions 129.7 Amounts reclassified to held for sale (7.6) Balance as of September 30, 2020 $ 375.3

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition The Company follows the guidance under Topic 606, Revenue from Contracts with Customers (“Topic 606”). Revenue is measured based on consideration specified in a contract with a customer, and excludes any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contact term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. Disaggregation of Revenue In the following table, revenue is disaggregated by source (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net operating fees $ 253.7 $ 266.6 $ 822.4 $ 760.8 Incentive fees 25.1 12.3 43.2 41.9 Other 28.4 22.3 76.8 69.4 Net services revenue $ 307.2 $ 301.2 $ 942.4 $ 872.1 Contract Balances The following table provides information about receivables, contract assets, and contract liabilities from contracts with customers (in millions): September 30, 2020 December 31, 2019 Receivables (1) $ 112.2 $ 83.1 Contract assets (2) 1.7 2.0 Contract liabilities (2) 26.7 25.3 (1) Receivables are included in accounts receivable, net. The balance includes accounts receivable, net - related party. (2) Contract assets and contract liabilities are included in other current assets and customer liabilities, respectively. The contract liabilities balance contains related party amounts, including $4.1 million and $4.2 million of current customer liabilities and $17.2 million and $18.6 million of non-current customer liabilities for the nine months ended September 30, 2020 and year ended December 31, 2019, respectively. A receivable is recognized in the period the Company provides services when the Company’s right to consideration is unconditional. Payment terms on invoiced amounts are typically 30-60 days. The Company recognized revenue of $88.0 million and $69.0 million during the nine months ended September 30, 2020 and 2019, which amounts were included in contract liabilities at the beginning of the respective periods. These revenue amounts include $85.0 million and $66.7 million for the nine months ended September 30, 2020 and 2019, respectively, related to advanced billings which become accounts receivable and contract liabilities on the first day of the respective service period. Transaction Price Allocated to the Remaining Performance Obligation The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period (in millions). The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Other 2020 $ 25.0 $ 16.2 $ — 2021 33.8 27.2 3.9 2022 14.1 — 5.7 2023 9.8 — 5.7 2024 4.1 — 5.7 2025 4.1 — 2.9 Thereafter 0.5 — — Total $ 91.4 $ 43.4 $ 23.9 The amounts presented in the table above include variable fee estimates for the non-cancellable term of the Company's physician groups RCM services contracts, fixed fees which are typically recognized ratably as the performance obligation is satisfied, and incentive fees which are measured cumulatively over the contractually defined performance period. September 30, 2020 December 31, 2019 Prepaid expenses and other current assets $ 4.5 $ 4.0 Other assets 20.6 20.8 Total deferred contract costs $ 25.1 $ 24.8

Debt

Debt	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Debt	DebtThe carrying amounts of debt consist of the following (in millions): September 30, 2020 December 31, 2019 Senior Revolver $ 70.0 $ 40.0 Senior Term Loan 491.0 316.9 Unamortized discount and issuance costs (2.8) (2.9) Total debt 558.2 354.0 Less: Current maturities (29.0) (16.3) Total long-term debt $ 529.2 $ 337.7 Senior Secured Credit Facilities On June 26, 2019, the Company and certain of its subsidiaries entered into a senior credit agreement (the “Credit Agreement”) with Bank of America, N.A., as administrative agent, and the lenders named therein, for senior secured credit facilities (the “Senior Secured Credit Facilities”), consisting of a $325.0 million senior secured term loan facility (the “Senior Term Loan”) issued at 99.66% of par and a $100.0 million senior secured revolving credit facility (the “Senior Revolver”). On March 20, 2020, the Company entered into Amendment No. 1 to the Credit Agreement (the “Amendment”), pursuant to which the lenders named in the Amendment agreed to provide an additional $191.1 million incremental delayed-draw term loan facility (the “Incremental Term Loan”) on the same terms as its existing Senior Term Loan provided under the Credit Agreement. The Incremental Term Loan was drawn substantially concurrently with the closing of the SCI Acquisition on April 1, 2020. The proceeds of the Incremental Term Loan were used to fund the purchase price for the SCI Acquisition and related expenses. For further details on the closing, refer to Note 4, Acquisitions. The Incremental Term Loan has terms consistent with those of the Senior Term Loan, including with respect to interest, maturity, amortization, and prepayments and has the same affirmative and negative covenants and events of default as those applicable to the Senior Term Loan under the Credit Agreement. The drawing of the Incremental Term Loan increased the balance of the obligation due under the Senior Term Loan, and therefore is shown as one consolidated obligation. In accordance with ASC 470-50, the Amendment was treated as a loan modification in the financial statements. The Senior Revolver includes borrowing capacity available for letters of credit and for borrowings on same-day notice, referred to as the “swing loans.” Any issuance of letters of credit or making of a swing loan will reduce the amount available under the revolving credit facility. As of September 30, 2020, the Company had $70.0 million in borrowings, no letters of credit outstanding, and $30.0 million of availability under the Senior Revolver. Borrowings under the Senior Secured Credit Facilities bear interest, at the Company’s option, at: (i) an Alternate Base Rate (“ABR”) equal to the greater of (a) the prime rate of Bank of America, N.A., (b) the federal funds rate plus 0.50% per annum , and (c) the Eurodollar rate for an interest period of one-month beginning on such day plus 100 basis points, plus between 0.75% and 1.75% dependent on the Company's Net Leverage Ratio (provided that the Eurodollar rate applicable to the Term Loan Facility shall not be less than 0.00% per annum); or (ii) the Eurodollar rate (provided that the Eurodollar rate applicable to the Term Loan Facility shall not be less than 0.00% per annum), plus between 1.75% and 2.75%, dependent on the Company's Net Leverage Ratio. The interest rate as of September 30, 2020 was 2.40%. The Company is also required to pay an unused commitment fee to the lenders under the Senior Revolver at a rate between 0.30% and 0.50% of the average daily unutilized commitments thereunder dependent on the Company's net leverage ratio. The Credit Agreement contains a number of covenants that, among other things, restrict, subject to certain exceptions, the Company’s ability and the ability of its subsidiaries to: (i) incur additional indebtedness; (ii) create liens on assets; (iii) engage in mergers or consolidations; (iv) sell assets; (v) pay dividends and distributions or repurchase the Company’s capital stock; (vi) make investments, loans or advances; (vii) repay certain junior indebtedness; (viii) engage in certain transactions with affiliates; (ix) enter into sale and leaseback transactions; (x) amend material agreements governing certain of the Company’s junior indebtedness; (xi) change the Company’s lines of business; (xii) make certain acquisitions; and (xiii) limitations on the letter of credit cash collateral account. The Credit Agreement contains customary affirmative covenants and events of default. In addition, the Company is required to maintain minimum consolidated total net leverage and consolidated interest coverage ratios. The Company was in compliance with all of the covenants in the Credit Agreement as of September 30, 2020. Debt Maturities Scheduled maturities of the Company’s long-term debt are summarized as follows (in millions): Scheduled Maturities 2020 $ 6.4 2021 32.3 2022 38.7 2023 45.2 2024 438.4 Total $ 561.0 For further details on the Company's debt, refer to Note 13 of the Company's 2019 Form 10-K.

Share-Based Compensation

Share-Based Compensation	9 Months Ended
	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
Share-Based Compensation	Share-Based Compensation The share-based compensation expense relating to the Company’s stock options, restricted stock awards (“RSAs”), restricted stock units (“RSUs”), and performance-based restricted stock units (“PBRSUs”) for the three months ended September 30, 2020 and 2019 was $6.8 million and $3.8 million, respectively, with related tax benefits of approximately $1.2 million and $0.9 million, respectively. The share-based compensation expense relating to the Company’s stock options, RSAs, RSUs, and PBRSUs for the nine months ended September 30, 2020 and 2019 was $15.9 million and $12.8 million, respectively, with related tax benefits of approximately $2.6 million and $2.3 million, respectively. The Company accounts for forfeitures as they occur. Excess tax benefits and shortfalls for share-based payments are recognized in income tax expense (benefit) and included in operating activities. The Company recognized $1.2 million and $0.7 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the three months ended September 30, 2020 and 2019, respectively. The Company recognized $2.9 million and $4.1 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the nine months ended September 30, 2020 and 2019, respectively. Total share-based compensation costs that have been included in the Company’s consolidated statements of operations were as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Share-Based Compensation Expense Allocation Details: Cost of services $ 2.7 $ 1.5 $ 6.1 $ 4.3 Selling, general and administrative 4.1 2.3 9.8 8.4 Other — — — 0.1 Total share-based compensation expense $ 6.8 $ 3.8 $ 15.9 $ 12.8 The Company uses the Black-Scholes option pricing model to estimate the fair value of its service-based options as of their grant dates. Monte Carlo simulations are used to estimate the fair value of its market-based PBRSUs. The market-based PBRSUs vest upon satisfaction of both time-based requirements and market targets based on share price. 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, 2020 and 2019: Nine Months Ended September 30, 2020 2019 Expected dividend yield —% —% Risk-free interest rate 0.4% to 1.7% 1.8% to 2.5% Expected volatility 43% 40% to 45% Expected term (in years) 5.5 2.00 to 5.50 The risk-free interest rate input is based on U.S. Treasury instruments, and the expected volatility of the share price is based on 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. 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, 2020 is shown below: Options Weighted- Outstanding at December 31, 2019 10,680,340 $ 5.59 Granted 74,596 10.69 Exercised (2,126,647) 5.64 Canceled/forfeited (103,349) 2.67 Expired (1,214,220) 14.62 Outstanding at September 30, 2020 7,310,720 $ 4.16 Outstanding, vested and exercisable at September 30, 2020 6,218,553 $ 4.29 Outstanding, vested and exercisable at December 31, 2019 7,868,280 $ 6.57 Restricted stock awards, restricted stock units, and performance-based restricted stock units A summary of the RSA, RSU, and PBRSU activity during the nine months ended September 30, 2020 is shown below: Weighted- RSAs RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2019 — 1,373,356 4,119,436 $ 8.03 $ 6.37 Granted — 1,519,970 1,616,081 9.96 13.18 Vested — (478,773) — 6.63 — Forfeited — (163,397) (304,896) 8.25 6.06 Outstanding and unvested at September 30, 2020 — 2,251,156 5,430,621 $ 9.62 $ 8.41 Shares surrendered for taxes for the nine months ended September 30, 2020 — 133,673 — Cost of shares surrendered for taxes for the nine months ended September 30, 2020 (in millions) $ — $ 1.2 $ — Shares surrendered for taxes for the nine months ended September 30, 2019 380,564 108,224 — Cost of shares surrendered for taxes for the nine months ended September 30, 2019 (in millions) $ 3.7 $ 1.0 $ — Outstanding PBRSUs issued prior to April 2019 vest upon satisfaction of both time-based requirements and market targets based on share price with certain awards vesting between December 31, 2020 and December 31, 2022. Depending on the percentage level at which the market-based condition is satisfied, the number of shares vesting could be between 0% and 350% of the number of PBRSUs originally granted. PBRSUs issued subsequent to April 2019 vest either in December 2021 or December 2022 upon satisfaction of both time-based and performance-based conditions. Depending on the award, performance condition targets may include cumulative adjusted EBITDA, end-to-end RCM agreement growth, scored revenue growth, or other specific performance factors. Depending on the percentage level at which the performance-based conditions are satisfied, the number of shares vesting could be between 0% and 200% of the number of PBRSUs originally granted. Based on the established targets, the maximum number of shares that could vest for all outstanding PBRSUs is 11,788,879.

Other Expenses

Other Expenses	9 Months Ended
	Sep. 30, 2020
Other Income and Expenses [Abstract]
Other Expenses	Other Expenses Other expenses (income) consist of the following (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Severance and related employee benefits $ 2.5 $ 1.3 $ 5.5 $ 1.7 Strategic initiatives (1) 6.5 3.9 18.2 15.0 Transitioned employees restructuring expense (2) — 0.9 (0.2) 3.8 Digital Transformation Office (3) — 1.3 — 5.7 Facility-exit charges (4) 2.5 (0.1) 7.4 (0.2) Other (5) 4.2 0.1 11.5 0.9 Total other expenses $ 15.7 $ 7.4 $ 42.4 $ 26.9 (1) Costs related to evaluating, pursuing, and integrating acquisitions, performing portfolio analyses, and other inorganic business projects as part of the Company’s growth strategy. Costs include vendor spend, employee time and expenses spent on activities, severance and retention amounts associated with integration activities, and changes to contingent consideration related to acquisitions. (2) As part of the transition of personnel to the Company under certain operating partner model contracts, the Company has agreed to reimburse, or directly pay the affected employees, for certain severance and retention costs related to certain employees who will not be transitioned to the Company, or whose jobs will be relocated after the employee transitions to the Company. (3) Project costs related to the Company's initial efforts to automate its transactional environment. (4) Costs include asset impairment charges and other costs related to exited leased facilities. (5) For the three and nine months ended September 30, 2020, includes $2.6 million and $7.9 million, respectively, of expenses related to the COVID-19 pandemic, inclusive of appreciation bonuses for the Company’s front-line employees, pandemic response mobilization efforts, and other costs.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2020
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 and infrequent or unusual items which are required to be discretely recognized within the current interim period. 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 Tax Cut and Jobs Act (“Tax Act”) enacted on December 22, 2017 includes two sets of provisions aimed at preventing or decreasing U.S. tax base erosion - the global intangible low-taxed income (“GILTI”) provisions and the base erosion and anti-abuse tax (“BEAT”) provisions. The GILTI provisions impose taxes on foreign income in excess of a deemed return on tangible assets of foreign corporations. The Company elected to account for GILTI tax in the period in which it is incurred. The GILTI provisions require the Company to include in its U.S. income tax return foreign subsidiary earnings in excess of an allowable return on the foreign subsidiary’s tangible assets. The BEAT provisions eliminate the deduction of certain base-erosion payments made to related foreign corporations and impose a minimum tax if greater than regular tax. The Company included the current year impact of the GILTI tax and BEAT in the estimated annual effective tax rate calculation. The Company recognized income tax expense for the three months ended September 30, 2020 on the year-to-date pre-tax income. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for GILTI plus the geographical mix of earnings, permanent differences, and discrete items. The income tax expense for the nine months ended September 30, 2020 was higher than the amount derived by applying the federal statutory tax rate of 21% primarily due to GILTI and discrete items. The Company recognized income tax expense for the three months ended September 30, 2019 on the year-to-date pre-tax income. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions of BEAT and GILTI plus the geographical mix of earnings, permanent differences, and discrete items. The income tax benefit for the nine months ended September 30, 2019 was higher than the amount derived by applying the federal statutory tax rate of 21% primarily due to discrete items. The Company and its subsidiaries are subject to U.S. federal income tax as well as income tax of multiple state and foreign jurisdictions. U.S. federal income tax returns since 2016 are currently open for examination. State jurisdictions vary for open tax years. The statute of limitations for most states ranges from three At December 31, 2019, the Company had gross deferred tax assets of $135.0 million, of which $64.1 million related to net operating loss (“NOL”) carryforwards. The majority of the Company's carryforwards were generated in 2014 and 2016. The Company expects to be profitable, allowing the Company to utilize its NOL carryforward and other deferred tax assets.

8.00% Series A Convertible Pref

8.00% Series A Convertible Preferred Stock	9 Months Ended
	Sep. 30, 2020
Temporary Equity Disclosure [Abstract]
8.00% Series A Convertible Preferred Stock	8.00% Series A Convertible Preferred Stock The preferred stock is held by a related party, TCP-ASC ACHI Series LLLP, a limited liability limited partnership jointly owned by Ascension Health Alliance and investment funds affiliated with TowerBrook (the “Investor”). The following summarizes the preferred stock activity for the nine months ended September 30, 2020 (in millions, except per share data): Preferred Stock Shares Issued and Outstanding Carrying Value Balance at December 31, 2019 266,529 $ 229.1 Dividends paid/accrued dividends 16,312 16.6 Balance at September 30, 2020 282,841 $ 245.7

Earnings (Loss) Per Share

Earnings (Loss) Per Share	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	Earnings (Loss) Per Share Basic net income per share is computed by dividing net income, less any dividends, accretion or decretion, redemption or induced conversion on the preferred stock, by the weighted average number of common shares outstanding during the period. As the preferred stock participates in dividends alongside the Company’s common stock (per their participating dividends), the preferred stock would constitute participating securities under ASC 260-10 and are applied to earnings per share using the two-class method. Under this method, all earnings (distributed and undistributed) are allocated to common shares and participating securities based on their respective rights to receive dividends. Diluted net income per share is calculated using the more dilutive of the if-converted or the two-class method. For the three and nine months ended September 30, 2020 and 2019, the two-class method was more dilutive and was computed by adjusting the denominator used in the basic net income per share computation by potentially dilutive securities outstanding during the period plus, when their effect is dilutive, incremental shares consisting of shares subject to stock options, shares issuable upon vesting of RSAs, RSUs, PBRSUs and shares issuable upon conversion of preferred stock. Basic and diluted net income (loss) per common share are calculated as follows (in millions, except share and per share data): Three Months Ended Nine Months Ended 2020 2019 2020 2019 Basic EPS: Net income $ 5.2 $ 9.2 $ 38.5 $ 4.2 Less dividends on preferred shares (5.6) (5.3) (16.6) (15.4) Less income allocated to preferred shareholders — (1.9) (10.9) — Net income (loss) available/(allocated) to common shareholders - basic $ (0.4) $ 2.0 $ 11.0 $ (11.2) Diluted EPS: Net income $ 5.2 $ 9.2 $ 38.5 $ 4.2 Less dividends on preferred shares (5.6) (5.3) (16.6) (15.4) Less income allocated to preferred shareholders — (1.5) (8.7) — Net income (loss) available/(allocated) to common shareholders - diluted $ (0.4) $ 2.4 $ 13.2 $ (11.2) Basic weighted-average common shares 115,976,377 112,230,439 115,164,631 111,005,255 Add: Effect of dilutive equity awards — 10,465,800 12,293,285 — Add: Effect of dilutive warrants — 42,926,168 43,720,170 — Diluted weighted average common shares 115,976,377 165,622,407 171,178,086 111,005,255 Net income (loss) per common share (basic) $ — $ 0.02 $ 0.10 $ (0.10) Net income (loss) per common share (diluted) $ — $ 0.01 $ 0.08 $ (0.10) Because of their anti-dilutive effect, 21,350,755 and 95,210 common share equivalents comprised of stock options, PBRSUs, and RSUs have been excluded from the diluted earnings per share calculation for the three and nine months ended September 30, 2020.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings 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. In May 2016, the Company was served with a False Claims Act case brought by a former emergency department service associate who worked at a hospital of one of the Company’s customers, MedStar Inc.’s Washington Hospital Center (“WHC”), along with WHC and three other hospitals that were PAS customers and a place holder, John Doe hospital, representing all PAS customers ( U.S. ex rel. Graziosi vs. Accretive Health, Inc. et. al.) , and seeking money damages, False Claims Act penalties and plaintiff’s attorneys’ fees. The Third Amended Complaint alleges that the Company’s PAS business violates the federal False Claims Act. The case was originally filed under seal in 2013 in the federal district court in Chicago, was presented to the U.S. Attorney in Chicago, and the U.S. Attorney declined to intervene. The Company believes that it has meritorious defenses to all claims in the case and intends to vigorously defend itself against these claims. The Company and plaintiff have filed motions for summary judgment, which are fully briefed and pending the judge's decision. The outcome is not presently determinable.

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2020
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions This note encompasses transactions between Ascension and the Company pursuant to the amended and restated Master Professional Services Agreement (“A&R MPSA”), including all supplements, amendments and other documents entered into in connection therewith. For further details on the Company's agreements with Ascension, see Note 1 and Note 18 of the Company's 2019 Form 10-K. Net services revenue from services provided to Ascension included in the Company’s consolidated statements of operations were (in millions): Three Months Ended Nine Months Ended September 30, 2020 2019 2020 2019 Ascension $ 193.4 $ 204.5 $ 608.2 $ 583.7 Amounts included in the Company's consolidated balance sheets for Ascension, excluding debt, are (in millions): September 30, 2020 December 31, 2019 Accounts receivable, net of $0.1 million and $0.0 million allowance - related party $ 35.5 $ 30.8 Current portion of customer liabilities $ 22.6 $ 34.1 Non-current portion of customer liabilities $ 17.2 $ 18.6 Total customer liabilities $ 39.8 $ 52.7 Since Ascension is the Company's largest customer, a significant percentage of the Company's cost of services is associated with providing services to Ascension. However, due to the nature of the Company's global business services and information technology operations, it is impractical to assign the dollar amount associated with services provided to Ascension.

Deferred Contract Costs

Deferred Contract Costs	9 Months Ended
	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Deferred Contract Costs	Revenue Recognition The Company follows the guidance under Topic 606, Revenue from Contracts with Customers (“Topic 606”). Revenue is measured based on consideration specified in a contract with a customer, and excludes any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contact term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. Disaggregation of Revenue In the following table, revenue is disaggregated by source (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net operating fees $ 253.7 $ 266.6 $ 822.4 $ 760.8 Incentive fees 25.1 12.3 43.2 41.9 Other 28.4 22.3 76.8 69.4 Net services revenue $ 307.2 $ 301.2 $ 942.4 $ 872.1 Contract Balances The following table provides information about receivables, contract assets, and contract liabilities from contracts with customers (in millions): September 30, 2020 December 31, 2019 Receivables (1) $ 112.2 $ 83.1 Contract assets (2) 1.7 2.0 Contract liabilities (2) 26.7 25.3 (1) Receivables are included in accounts receivable, net. The balance includes accounts receivable, net - related party. (2) Contract assets and contract liabilities are included in other current assets and customer liabilities, respectively. The contract liabilities balance contains related party amounts, including $4.1 million and $4.2 million of current customer liabilities and $17.2 million and $18.6 million of non-current customer liabilities for the nine months ended September 30, 2020 and year ended December 31, 2019, respectively. A receivable is recognized in the period the Company provides services when the Company’s right to consideration is unconditional. Payment terms on invoiced amounts are typically 30-60 days. The Company recognized revenue of $88.0 million and $69.0 million during the nine months ended September 30, 2020 and 2019, which amounts were included in contract liabilities at the beginning of the respective periods. These revenue amounts include $85.0 million and $66.7 million for the nine months ended September 30, 2020 and 2019, respectively, related to advanced billings which become accounts receivable and contract liabilities on the first day of the respective service period. Transaction Price Allocated to the Remaining Performance Obligation The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period (in millions). The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Other 2020 $ 25.0 $ 16.2 $ — 2021 33.8 27.2 3.9 2022 14.1 — 5.7 2023 9.8 — 5.7 2024 4.1 — 5.7 2025 4.1 — 2.9 Thereafter 0.5 — — Total $ 91.4 $ 43.4 $ 23.9 The amounts presented in the table above include variable fee estimates for the non-cancellable term of the Company's physician groups RCM services contracts, fixed fees which are typically recognized ratably as the performance obligation is satisfied, and incentive fees which are measured cumulatively over the contractually defined performance period. September 30, 2020 December 31, 2019 Prepaid expenses and other current assets $ 4.5 $ 4.0 Other assets 20.6 20.8 Total deferred contract costs $ 25.1 $ 24.8

Segments and Customer Concentra

Segments and Customer Concentrations	9 Months Ended
	Sep. 30, 2020
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 healthcare providers. Accordingly, for purposes of segment disclosures, the Company has only one reportable segment. Healthcare providers affiliated with Ascension have accounted for a significant portion of the Company’s net services revenue each year since the Company’s formation. For the three months ended September 30, 2020 and 2019, net services revenue from healthcare organizations affiliated with Ascension accounted for 63% and 68% of the Company's total net services revenue, respectively. For the nine months ended September 30, 2020 and 2019, net services revenue from Ascension accounted for 65% and 67%, respectively. The loss of customers within the Ascension health system could have a material adverse impact on the Company’s operations. For the three months ended September 30, 2020 and 2019, Intermountain Healthcare accounted for 12% and 15% of the Company's total net services revenue, respectively. For the nine months ended September 30, 2020 and 2019, Intermountain Healthcare accounted for 14% and 15% of the Company’s total net services revenue, respectively. As of September 30, 2020 and December 31, 2019, the Company had a concentration of credit risk with Ascension accounting for 32% and 37% of accounts receivable, respectively.

Derivative Financial Instrument

Derivative Financial Instruments	9 Months Ended
	Sep. 30, 2020
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments	Derivative Financial Instruments The Company utilizes cash flow hedges to mitigate its currency risk arising from its global delivery resources and to reduce variability in interest cash flows from its outstanding debt. As of September 30, 2020, the Company has recorded no existing gains or losses and $2.9 million of existing losses in accumulated other comprehensive income for the foreign currency hedges and interest rate swaps, respectively. The Company estimates that $1.7 million of losses reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next 12 months for interest rate swaps. The amounts related to foreign currency hedges that were reclassified into cost of services were a net loss of $0.1 million and $0.8 million during the three and nine month period ended September 30, 2020, and a net gain of $0.4 million and $0.9 million during the three and nine month period ended September 30, 2019. The amounts related to the interest rate swaps that were reclassified into interest expense were a net loss of $0.5 million and $0.8 million during the three and nine month period ended September 30, 2020, and no net gain or loss during the three and nine month periods ended September 30, 2019. The Company classifies cash flows from its derivative programs as cash flows from operating activities in the consolidated statements of cash flows. As of September 30, 2020, the Company’s currency forward contracts have maturities extending no later than December 31, 2020. The Company's interest rate swaps extend no later than August of 2022.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2020
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Emergency Medical Services Sale On October 30, 2020, the Company completed the EMS Disposition. Refer to Note 5 for additional information.

Recent Accounting Pronounceme_2

Recent Accounting Pronouncements (Policies)	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of September 30, 2020, the results of operations of the Company for the three and nine months ended September 30, 2020 and 2019, and the cash flows of the Company for the nine months ended September 30, 2020 and 2019. These financial statements include the accounts of R1 RCM Inc. and its wholly-owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with United States generally accepted accounting principles (“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, 2020 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2020.
Recently Issued Accounting Standards and Disclosures	Recently Issued Accounting Standards and Disclosures In June 2016, the FASB issued ASU 2016-13
Accounts Receivable and Allowance for Credit Losses	Accounts Receivable and Allowance for Credit LossesAccounts receivable is comprised of unpaid balances pertaining to modular services and end-to-end RCM customers, net receivable balances for end-to-end RCM customers after considering cost reimbursements owed to such customers, including related accrued balances, and amounts due from physician RCM and practice management customers.
Revenue Recognition	Revenue RecognitionThe Company follows the guidance under Topic 606, Revenue from Contracts with Customers (“Topic 606”). Revenue is measured based on consideration specified in a contract with a customer, and excludes any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contact term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved.

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
Schedule of Assets Acquired and Liabilities Assumed	The preliminary fair value of assets acquired and liabilities assumed is (in millions): Purchase Price Allocation Total purchase consideration $ 196.7 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 2.9 Accounts receivable 2.8 Prepaid expenses and other current assets 1.1 Property, equipment and software 0.3 Operating lease right-of-use assets 1.2 Intangible assets 86.1 Goodwill 126.3 Accounts payable (0.2) Current portion of customer liabilities (4.0) Accrued compensation and benefits (1.9) Current portion of operating lease liabilities (0.5) Other accrued expenses (0.3) Non-current portion of operating lease liabilities (0.7) Other non-current liabilities (5.0) Deferred income tax liabilities (11.4) Net assets acquired $ 196.7
Schedule of Pro Forma Results	The following table summarizes, on a pro forma basis, the combined results of the Company as though the SCI and RevWorks acquisitions had occurred as of January 1, 2019. These pro forma results are not necessarily indicative of either the actual consolidated results had the acquisitions occurred as of January 1, 2019 or of the future consolidated operating results for any period. Pro forma results are (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net services revenue $ 308.2 $ 325.1 $ 992.3 $ 954.2 Net income (loss) $ 0.3 $ 3.3 $ 51.5 $ (9.5)

Assets and Liabilities of Bus_2

Assets and Liabilities of Business Held for Sale (Tables)	9 Months Ended
	Sep. 30, 2020
Discontinued Operations and Disposal Groups [Abstract]
Summary of Assets and Liabilities Held For Sale Included in the Balance Sheet	The following table presents a summary of the EMS business assets and liabilities held for sale included in the consolidated balance sheet as of September 30, 2020 (in millions): September 30, 2020 Assets Accounts receivable, net $ 18.9 Prepaid expenses and other current assets 1.5 Property, equipment and software, net 5.9 Operating lease right-of-use assets 0.9 Intangible assets, net 66.5 Goodwill 7.6 Other assets 0.2 Total assets held for sale $ 101.5 Liabilities Accounts payable $ 1.4 Current portion of customer liabilities 2.1 Operating lease liabilities 0.9 Other accrued expenses 2.6 Deferred tax liabilities (1) 18.1 Other non-current liabilities 0.2 Total liabilities held for sale $ 25.3

Accounts Receivable and Allow_2

Accounts Receivable and Allowance for Credit Losses (Tables)	9 Months Ended
	Sep. 30, 2020
Receivables [Abstract]
Schedule of Allowance for Credit Losses	Movements in the allowance for credit losses are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Beginning balance $ 5.2 $ 2.1 $ 2.8 $ 1.1 Cumulative effect of ASC 326 — — 1.1 — Provision (recoveries) (0.8) 1.3 0.5 2.5 Amounts reclassified to held for sale (0.6) — (0.6) — Write-offs (0.1) (0.6) (0.1) (0.8) Ending balance $ 3.7 $ 2.8 $ 3.7 $ 2.8

Property, Equipment, and Softwa

Property, Equipment, and Software (Tables)	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Schedule of Property, Equipment and Software	Property, equipment and software consist of the following (in millions): September 30, 2020 December 31, 2019 Buildings and land $ 4.6 $ 4.6 Computer and other equipment 53.2 50.7 Leasehold improvements 28.3 31.1 Software 132.1 123.0 Office furniture 8.0 9.4 Property, equipment and software, gross 226.2 218.8 Less accumulated depreciation and amortization (123.4) (101.9) Property, equipment and software, net $ 102.8 $ 116.9
Summary Depreciation and Amortization Expense	The following table summarizes the allocation of depreciation and amortization expense between cost of services and selling, general and administrative expenses (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Cost of services $ 11.8 $ 9.2 $ 34.1 $ 26.7 Selling, general and administrative 1.0 1.4 3.2 2.7 Total depreciation and amortization $ 12.8 $ 10.6 $ 37.3 $ 29.4

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Schedules of Components of Lease Costs and Supplemental Cash Flow Information	The components of lease costs are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Operating lease cost $ 4.3 $ 4.9 $ 14.1 $ 14.3 Finance lease cost: Amortization of right-of-use (“ROU”) assets 0.1 0.2 0.4 0.6 Interest on lease liabilities — — 0.1 0.1 Sublease income (0.6) (0.6) (1.7) (1.7) Total lease cost $ 3.8 $ 4.5 $ 12.9 $ 13.3 Supplemental cash flow information related to leases are as follows (in millions): Nine Months Ended September 30, 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 15.2 $ 13.8 Operating cash flows for finance leases 0.1 0.1 Financing cash flows for finance leases 0.8 0.6 ROU assets obtained in exchange for lease obligations: Operating leases 3.4 11.6 Finance leases — 0.5
Schedule of Supplemental Balance Sheet Information	Supplemental balance sheet information related to leases are as follows: September 30, 2020 December 31, 2019 Weighted average remaining lease term: Operating leases 7 years 8 years Finance leases 2 years 2 years Weighted average incremental borrowing rate: Operating leases 8.87 % 8.84 % Finance leases 6.62 % 6.45 %
Schedule of Operating Lease Maturity	Maturities of lease liabilities as of September 30, 2020 are as follows (in millions): Operating Leases Finance Leases Remainder of 2020 $ 5.5 $ — 2021 19.1 0.5 2022 16.4 0.1 2023 15.2 — 2024 15.0 — 2025 14.8 — Thereafter 33.9 — Total 119.9 0.6 Less: Amounts included in held for sale liabilities 0.9 — Imputed interest 32.5 — Present value of lease liabilities $ 86.5 $ 0.6
Schedule of Finance Lease Maturity	Maturities of lease liabilities as of September 30, 2020 are as follows (in millions): Operating Leases Finance Leases Remainder of 2020 $ 5.5 $ — 2021 19.1 0.5 2022 16.4 0.1 2023 15.2 — 2024 15.0 — 2025 14.8 — Thereafter 33.9 — Total 119.9 0.6 Less: Amounts included in held for sale liabilities 0.9 — Imputed interest 32.5 — Present value of lease liabilities $ 86.5 $ 0.6

Intangible Assets (Tables)

Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table provides the gross carrying value and accumulated amortization for each major class of intangible asset at September 30, 2020 and December 31, 2019 (in millions): September 30, 2020 December 31, 2019 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 97.9 $ (13.1) $ 84.8 $ 160.9 $ (15.6) $ 145.3 Technology 101.7 (10.8) 90.9 26.8 (7.4) 19.4 Total intangible assets $ 199.6 $ (23.9) $ 175.7 $ 187.7 $ (23.0) $ 164.7
Schedule of Acquired Intangible Assets	Through the SCI and RevWorks acquisitions, the Company acquired the following intangible assets in 2020 (in millions, except weighted average useful life): Weighted Average Useful Life Gross Carrying Value Customer relationships 10 years $ 5.8 Technology 10 years $ 85.3
Schedule of Estimated Annual Amortization Expense	Estimated annual amortization expense related to intangible assets with definite lives as of September 30, 2020 is as follows (in millions): Remainder of 2020 $ 4.3 2021 17.3 2022 17.3 2023 17.3 2024 15.5 2025 14.5 Thereafter 89.5 Total $ 175.7

Goodwill (Tables)

Goodwill (Tables)	9 Months Ended
	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in Carrying Value of Goodwill	Changes in the carrying amount of goodwill for the nine months ended September 30, 2020 were (in millions): Goodwill Balance as of December 31, 2019 $ 253.2 Acquisitions 129.7 Amounts reclassified to held for sale (7.6) Balance as of September 30, 2020 $ 375.3

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregated Revenue By Source	In the following table, revenue is disaggregated by source (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Net operating fees $ 253.7 $ 266.6 $ 822.4 $ 760.8 Incentive fees 25.1 12.3 43.2 41.9 Other 28.4 22.3 76.8 69.4 Net services revenue $ 307.2 $ 301.2 $ 942.4 $ 872.1
Schedule of Assets and Liabilities	The following table provides information about receivables, contract assets, and contract liabilities from contracts with customers (in millions): September 30, 2020 December 31, 2019 Receivables (1) $ 112.2 $ 83.1 Contract assets (2) 1.7 2.0 Contract liabilities (2) 26.7 25.3 (1) Receivables are included in accounts receivable, net. The balance includes accounts receivable, net - related party.
Schedule of Transaction Price Allocated to the Remaining Performance Obligation	The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period (in millions). The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Other 2020 $ 25.0 $ 16.2 $ — 2021 33.8 27.2 3.9 2022 14.1 — 5.7 2023 9.8 — 5.7 2024 4.1 — 5.7 2025 4.1 — 2.9 Thereafter 0.5 — — Total $ 91.4 $ 43.4 $ 23.9

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Schedule of Carrying Values Long-Term Debt	The carrying amounts of debt consist of the following (in millions): September 30, 2020 December 31, 2019 Senior Revolver $ 70.0 $ 40.0 Senior Term Loan 491.0 316.9 Unamortized discount and issuance costs (2.8) (2.9) Total debt 558.2 354.0 Less: Current maturities (29.0) (16.3) Total long-term debt $ 529.2 $ 337.7
Scheduled Maturities of Long-term Debt	Scheduled maturities of the Company’s long-term debt are summarized as follows (in millions): Scheduled Maturities 2020 $ 6.4 2021 32.3 2022 38.7 2023 45.2 2024 438.4 Total $ 561.0

Share-Based Compensation (Table

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
Schedule of Share-based Compensation Expense	Total share-based compensation costs that have been included in the Company’s consolidated statements of operations were as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Share-Based Compensation Expense Allocation Details: Cost of services $ 2.7 $ 1.5 $ 6.1 $ 4.3 Selling, general and administrative 4.1 2.3 9.8 8.4 Other — — — 0.1 Total share-based compensation expense $ 6.8 $ 3.8 $ 15.9 $ 12.8
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, 2020 and 2019: Nine Months Ended September 30, 2020 2019 Expected dividend yield —% —% Risk-free interest rate 0.4% to 1.7% 1.8% to 2.5% Expected volatility 43% 40% to 45% Expected term (in years) 5.5 2.00 to 5.50
Schedule of Stock Options Activity	A summary of the options activity during the nine months ended September 30, 2020 is shown below: Options Weighted- Outstanding at December 31, 2019 10,680,340 $ 5.59 Granted 74,596 10.69 Exercised (2,126,647) 5.64 Canceled/forfeited (103,349) 2.67 Expired (1,214,220) 14.62 Outstanding at September 30, 2020 7,310,720 $ 4.16 Outstanding, vested and exercisable at September 30, 2020 6,218,553 $ 4.29 Outstanding, vested and exercisable at December 31, 2019 7,868,280 $ 6.57
Schedule of Non-Options Awards Activity	A summary of the RSA, RSU, and PBRSU activity during the nine months ended September 30, 2020 is shown below: Weighted- RSAs RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2019 — 1,373,356 4,119,436 $ 8.03 $ 6.37 Granted — 1,519,970 1,616,081 9.96 13.18 Vested — (478,773) — 6.63 — Forfeited — (163,397) (304,896) 8.25 6.06 Outstanding and unvested at September 30, 2020 — 2,251,156 5,430,621 $ 9.62 $ 8.41 Shares surrendered for taxes for the nine months ended September 30, 2020 — 133,673 — Cost of shares surrendered for taxes for the nine months ended September 30, 2020 (in millions) $ — $ 1.2 $ — Shares surrendered for taxes for the nine months ended September 30, 2019 380,564 108,224 — Cost of shares surrendered for taxes for the nine months ended September 30, 2019 (in millions) $ 3.7 $ 1.0 $ —

Other Expenses (Tables)

Other Expenses (Tables)	9 Months Ended
	Sep. 30, 2020
Other Income and Expenses [Abstract]
Schedule of Other Expenses (Income)	Other expenses (income) consist of the following (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Severance and related employee benefits $ 2.5 $ 1.3 $ 5.5 $ 1.7 Strategic initiatives (1) 6.5 3.9 18.2 15.0 Transitioned employees restructuring expense (2) — 0.9 (0.2) 3.8 Digital Transformation Office (3) — 1.3 — 5.7 Facility-exit charges (4) 2.5 (0.1) 7.4 (0.2) Other (5) 4.2 0.1 11.5 0.9 Total other expenses $ 15.7 $ 7.4 $ 42.4 $ 26.9 (1) Costs related to evaluating, pursuing, and integrating acquisitions, performing portfolio analyses, and other inorganic business projects as part of the Company’s growth strategy. Costs include vendor spend, employee time and expenses spent on activities, severance and retention amounts associated with integration activities, and changes to contingent consideration related to acquisitions. (2) As part of the transition of personnel to the Company under certain operating partner model contracts, the Company has agreed to reimburse, or directly pay the affected employees, for certain severance and retention costs related to certain employees who will not be transitioned to the Company, or whose jobs will be relocated after the employee transitions to the Company. (3) Project costs related to the Company's initial efforts to automate its transactional environment. (4) Costs include asset impairment charges and other costs related to exited leased facilities. (5) For the three and nine months ended September 30, 2020, includes $2.6 million and $7.9 million, respectively, of expenses related to the COVID-19 pandemic, inclusive of appreciation bonuses for the Company’s front-line employees, pandemic response mobilization efforts, and other costs.

8.00% Series A Convertible Pr_2

8.00% Series A Convertible Preferred Stock (Tables)	9 Months Ended
	Sep. 30, 2020
Temporary Equity Disclosure [Abstract]
Summary of Preferred Stock Activity	The following summarizes the preferred stock activity for the nine months ended September 30, 2020 (in millions, except per share data): Preferred Stock Shares Issued and Outstanding Carrying Value Balance at December 31, 2019 266,529 $ 229.1 Dividends paid/accrued dividends 16,312 16.6 Balance at September 30, 2020 282,841 $ 245.7

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Schedule of Basic and Diluted Net Income (Loss) Per Common Share	Basic and diluted net income (loss) per common share are calculated as follows (in millions, except share and per share data): Three Months Ended Nine Months Ended 2020 2019 2020 2019 Basic EPS: Net income $ 5.2 $ 9.2 $ 38.5 $ 4.2 Less dividends on preferred shares (5.6) (5.3) (16.6) (15.4) Less income allocated to preferred shareholders — (1.9) (10.9) — Net income (loss) available/(allocated) to common shareholders - basic $ (0.4) $ 2.0 $ 11.0 $ (11.2) Diluted EPS: Net income $ 5.2 $ 9.2 $ 38.5 $ 4.2 Less dividends on preferred shares (5.6) (5.3) (16.6) (15.4) Less income allocated to preferred shareholders — (1.5) (8.7) — Net income (loss) available/(allocated) to common shareholders - diluted $ (0.4) $ 2.4 $ 13.2 $ (11.2) Basic weighted-average common shares 115,976,377 112,230,439 115,164,631 111,005,255 Add: Effect of dilutive equity awards — 10,465,800 12,293,285 — Add: Effect of dilutive warrants — 42,926,168 43,720,170 — Diluted weighted average common shares 115,976,377 165,622,407 171,178,086 111,005,255 Net income (loss) per common share (basic) $ — $ 0.02 $ 0.10 $ (0.10) Net income (loss) per common share (diluted) $ — $ 0.01 $ 0.08 $ (0.10)

Related Party Transactions (Tab

Related Party Transactions (Tables)	9 Months Ended
	Sep. 30, 2020
Related Party Transactions [Abstract]
Schedule of Related Party Transactions	Net services revenue from services provided to Ascension included in the Company’s consolidated statements of operations were (in millions): Three Months Ended Nine Months Ended September 30, 2020 2019 2020 2019 Ascension $ 193.4 $ 204.5 $ 608.2 $ 583.7 Amounts included in the Company's consolidated balance sheets for Ascension, excluding debt, are (in millions): September 30, 2020 December 31, 2019 Accounts receivable, net of $0.1 million and $0.0 million allowance - related party $ 35.5 $ 30.8 Current portion of customer liabilities $ 22.6 $ 34.1 Non-current portion of customer liabilities $ 17.2 $ 18.6 Total customer liabilities $ 39.8 $ 52.7

Deferred Contract Costs (Tables

Deferred Contract Costs (Tables)	9 Months Ended
	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Summary of Deferred Contract Costs	The following table summarizes the breakout of deferred contract costs (in millions): September 30, 2020 December 31, 2019 Prepaid expenses and other current assets $ 4.5 $ 4.0 Other assets 20.6 20.8 Total deferred contract costs $ 25.1 $ 24.8

Business Description and Basi_2

Business Description and Basis of Presentation - Narrative (Details) - USD ($) $ in Millions	Oct. 30, 2020	Sep. 30, 2020	Dec. 31, 2019
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Assets held for sale		$ 101.5	$ 0
Liabilities held for sale		25.3	$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | EMS Disposition | Subsequent Event
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of EMS business, disposition price	$ 140
Sale of EMS business, hold-back amount included in disposition price	$ 5
Sale of EMS business, hold-back amount, settlement period from date of the disposition	1 year
Disposal Group, Disposed of by Sale, Not Discontinued Operations | EMS Disposition | Subsequent Event | Minimum | Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Expected gain on sale of assets	$ 45
Disposal Group, Disposed of by Sale, Not Discontinued Operations | EMS Disposition | Subsequent Event | Maximum | Forecast
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Expected gain on sale of assets	$ 60
Disposal Group, Held-for-sale, Not Discontinued Operations | EMS Disposition
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Assets held for sale		101.5
Liabilities held for sale		$ 25.3

Recent Accounting Pronounceme_3

Recent Accounting Pronouncements - Narrative (Details) - USD ($) $ in Millions	Jan. 01, 2020	Sep. 30, 2020	Dec. 31, 2019
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Additional allowance for doubtful accounts	$ 1.1

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details)	Sep. 03, 2022USD ($)	Sep. 03, 2021USD ($)	Aug. 03, 2020USD ($)payment	Apr. 01, 2020USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 03, 2022USD ($)
Business Acquisition [Line Items]
Updated earn-out value to other expenses						$ 15,700,000	$ 7,400,000		$ 42,400,000	$ 26,900,000
Purchase price, payment									5,000,000	$ 0
SCI Acquisition
Business Acquisition [Line Items]
Purchase price				$ 190,000,000
Other non-current liabilities, note payable				5,000,000
Net sales, since acquisition date						7,400,000			14,000,000
Net loss, before income taxes, since acquisition date						1,600,000			3,900,000
Measurement period adjustment, intangible assets								$ 1,800,000
Measurement period adjustment, goodwill adjustment from intangible assets								1,800,000
Measurement period adjustment, deferred income taxes								1,300,000
Measurement period adjustment, goodwill adjustment from deferred income taxes								1,300,000
Purchase price for the acquisition				196,700,000
SCI Acquisition | Earn-out Provision
Business Acquisition [Line Items]
Earn-out provision, high-end estimate				10,000,000
Earn-out provision, low-end estimate				0
Earn-out provision, value				$ 4,800,000	$ 6,400,000	6,400,000		$ 6,400,000	6,400,000
Updated earn-out value to other expenses						$ 1,600,000
RevWorks
Business Acquisition [Line Items]
Net sales, since acquisition date					8,300,000
Purchase price for the acquisition			$ 30,000,000
Purchase price, payment			$ 5,000,000
Number of deferred payments | payment			2
Contractual deferred payments			$ 24,300,000
Net loss, before income taxes, since the acquisition date					$ 300,000
RevWorks | Subsequent Event | Forecast
Business Acquisition [Line Items]
Purchase price, payment	$ 12,500,000	$ 12,500,000									$ 25,000,000
RevWorks | Cerner
Business Acquisition [Line Items]
Asset, contingently returnable consideration			22,300,000
Contingent consideration asset, (up to)			$ 25,000,000
RevWorks | Acquisition-related Costs
Business Acquisition [Line Items]
Supplemental pro-forma earnings adjustment									$ 6,000,000

Acquisitions - Fair Value of As

Acquisitions - Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions	Apr. 01, 2020	Sep. 30, 2020	Dec. 31, 2019
Allocation of consideration to assets acquired and liabilities assumed:
Goodwill		$ 375.3	$ 253.2
SCI Acquisition
Business Acquisition [Line Items]
Total purchase consideration	$ 196.7
Allocation of consideration to assets acquired and liabilities assumed:
Cash and cash equivalents	2.9
Accounts receivable	2.8
Prepaid expenses and other current assets	1.1
Property, equipment and software	0.3
Operating lease right-of-use assets	1.2
Intangible assets	86.1
Goodwill	126.3
Accounts payable	(0.2)
Current portion of customer liabilities	(4)
Accrued compensation and benefits	(1.9)
Current portion of operating lease liabilities	(0.5)
Other accrued expenses	(0.3)
Non-current portion of operating lease liabilities	(0.7)
Other non-current liabilities	(5)
Deferred income tax liabilities	(11.4)	$ (11.4)
Net assets acquired	$ 196.7

Acquisitions - Pro Forma Result

Acquisitions - Pro Forma Results (Details) - RevWorks - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Business Acquisition [Line Items]
Net services revenue	$ 308.2	$ 325.1	$ 992.3	$ 954.2
Net income (loss)	$ 0.3	$ 3.3	$ 51.5	$ (9.5)

Assets and Liabilities of Bus_3

Assets and Liabilities of Business Held for Sale - Narrative (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - EMS Disposition - Subsequent Event $ in Millions	Oct. 30, 2020USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of EMS business, disposition price	$ 140
Sale of EMS business, hold-back amount included in disposition price	$ 5
Sale of EMS business, hold-back amount, settlement period from date of the disposition	1 year

Assets and Liabilities of Bus_4

Assets and Liabilities of Business Held for Sale - Summary of Assets and Liabilities Held For Sale (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Assets
Total assets held for sale	$ 101.5	$ 0
EMS Disposition | Disposal Group, Held-for-sale, Not Discontinued Operations
Assets
Accounts receivable, net	18.9
Prepaid expenses and other current assets	1.5
Property, equipment and software, net	5.9
Operating lease right-of-use assets	0.9
Intangible assets, net	66.5
Goodwill	7.6
Other assets	0.2
Total assets held for sale	101.5
Liabilities
Accounts payable	1.4
Current portion of customer liabilities	2.1
Operating lease liabilities	0.9
Other accrued expenses	2.6
Deferred tax liabilities	18.1
Other non-current liabilities	0.2
Total liabilities held for sale	$ 25.3

Accounts Receivable and Allow_3

Accounts Receivable and Allowance for Credit Losses - Narrative (Details) - USD ($) $ in Millions	Jan. 01, 2020	Sep. 30, 2020	Dec. 31, 2019
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member
Cumulative Effect, Period of Adoption, Adjustment
Accounts, Notes, Loans and Financing Receivable [Line Items]
Initial increase, allowance for credit losses	$ 1.1

Accounts Receivable and Allow_4

Accounts Receivable and Allowance for Credit Losses - Schedule of Allowance for Credit Losses (Details) - USD ($) $ in Millions	Jan. 01, 2020	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 2.8	$ 5.2	$ 2.1	$ 2.8	$ 1.1	$ 1.1
Cumulative effect of ASC 326 adoption	$ 2.8	3.7	2.8	3.7	2.8	1.1
Provision (recoveries)		(0.8)	1.3	0.5	2.5
Amounts reclassified to held for sale		(0.6)	0	(0.6)	0
Write-offs		(0.1)	(0.6)	(0.1)	(0.8)
Ending balance		$ 3.7	$ 2.8	$ 3.7	$ 2.8	$ 2.8
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member			us-gaap:AccountingStandardsUpdate201613Member		us-gaap:AccountingStandardsUpdate201613Member
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 1.1			$ 1.1
Cumulative effect of ASC 326 adoption	$ 1.1			$ 1.1		$ 1.1
Ending balance						$ 1.1

Property, Equipment, and Soft_2

Property, Equipment, and Software - Schedule of Property, Equipment and Software (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 226.2	$ 218.8
Less accumulated depreciation and amortization	(123.4)	(101.9)
Property, equipment and software, net	102.8	116.9
Buildings and land
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	4.6	4.6
Computer and other equipment
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	53.2	50.7
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	28.3	31.1
Software
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	132.1	123
Office furniture
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 8	$ 9.4

Property, Equipment, and Soft_3

Property, Equipment, and Software - Allocation of Depreciation and Amortization Expense between Cost of Services and Selling, General and Administrative Expenses (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 12.8	$ 10.6	$ 37.3	$ 29.4
Cost of services
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	11.8	9.2	34.1	26.7
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 1	$ 1.4	$ 3.2	$ 2.7

Leases - Schedule of Lease Cost

Leases - Schedule of Lease Costs (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Leases [Abstract]
Operating lease cost	$ 4.3	$ 4.9	$ 14.1	$ 14.3
Finance lease cost:
Amortization of right-of-use (“ROU”) assets	0.1	0.2	0.4	0.6
Interest on lease liabilities	0	0	0.1	0.1
Sublease income	(0.6)	(0.6)	(1.7)	(1.7)
Total lease cost	$ 3.8	$ 4.5	$ 12.9	$ 13.3

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$ 15.2	$ 13.8
Operating cash flows for finance leases	0.1	0.1
Financing cash flows for finance leases	0.8	0.6
ROU assets obtained in exchange for lease obligations:
Operating leases	3.4	11.6
Finance leases	$ 0	$ 0.5

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information (Details)	Sep. 30, 2020	Dec. 31, 2019
Weighted average remaining lease term:
Operating leases	7 years	8 years
Finance leases	2 years	2 years
Weighted average incremental borrowing rate:
Operating leases	8.87%	8.84%
Finance leases	6.62%	6.45%

Leases - Schedule of Operating

Leases - Schedule of Operating and Finance Lease Maturity (Details) $ in Millions	Sep. 30, 2020USD ($)
Operating Leases
Remainder of 2020	$ 5.5
2021	19.1
2022	16.4
2023	15.2
2024	15
2025	14.8
Thereafter	33.9
Total	119.9
Less:
Amounts included in held for sale liabilities	0.9
Imputed interest	32.5
Present value of lease liabilities	86.5
Finance Leases
Remainder of 2020	0
2021	0.5
2022	0.1
2023	0
2024	0
2025	0
Thereafter	0
Total	0.6
Less:
Amounts included in held for sale liabilities	0
Imputed interest	0
Present value of lease liabilities	$ 0.6

Intangible Assets - Components

Intangible Assets - Components of Intangible Assets (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 199.6	$ 187.7
Accumulated Amortization	(23.9)	(23)
Total	175.7	164.7
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	97.9	160.9
Accumulated Amortization	(13.1)	(15.6)
Total	84.8	145.3
Technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	101.7	26.8
Accumulated Amortization	(10.8)	(7.4)
Total	$ 90.9	$ 19.4

Intangible Assets - Acquired In

Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Millions	3 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 199.6	$ 187.7
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 97.9	160.9
Customer relationships | SCI And RevWorks Acquisitions
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life	10 years
Gross Carrying Value	$ 5.8
Technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 101.7	$ 26.8
Technology | SCI And RevWorks Acquisitions
Finite-Lived Intangible Assets [Line Items]
Weighted Average Useful Life	10 years
Gross Carrying Value	$ 85.3

Intangible Assets - Narrative (

Intangible Assets - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible asset amortization expense	$ 4.5	$ 3.5	$ 13.6	$ 10.5

Intangible Assets - Future Amor

Intangible Assets - Future Amortization (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
Remainder of 2020	$ 4.3
2021	17.3
2022	17.3
2023	17.3
2024	15.5
2025	14.5
Thereafter	89.5
Total	$ 175.7	$ 164.7

Goodwill - Schedule of Changes

Goodwill - Schedule of Changes in Carrying Value of Goodwill (Details) $ in Millions	9 Months Ended
	Sep. 30, 2020USD ($)
Goodwill [Roll Forward]
Balance as of December 31, 2019	$ 253.2
Acquisitions	129.7
Amounts reclassified to held for sale	(7.6)
Balance as of September 30, 2020	$ 375.3

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregated Revenue by Source (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Disaggregation of Revenue [Line Items]
Net services revenue	$ 307.2	$ 301.2	$ 942.4	$ 872.1
Net operating fees
Disaggregation of Revenue [Line Items]
Net services revenue	253.7	266.6	822.4	760.8
Incentive fees
Disaggregation of Revenue [Line Items]
Net services revenue	25.1	12.3	43.2	41.9
Other
Disaggregation of Revenue [Line Items]
Net services revenue	$ 28.4	$ 22.3	$ 76.8	$ 69.4

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Contract Balances (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Revenue from Contract with Customer [Abstract]
Receivables	$ 112.2	$ 83.1
Contract assets	1.7	2
Contract liabilities	26.7	25.3
Disaggregation of Revenue [Line Items]
Non-current customer liabilities, related party	17.2	18.6
Investor
Disaggregation of Revenue [Line Items]
Current customer liabilities, related party	$ 4.1	$ 4.2

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Revenue from Contract with Customer [Abstract]
Revenue recognized that was included in the contract liability balance at the beginning of the period	$ 88	$ 69
Revenue recognized, advance billings	$ 85	$ 66.7

Revenue Recognition - Transacti

Revenue Recognition - Transaction Price Allocated to the Remaining Performance Obligation (Details) $ in Millions	Sep. 30, 2020USD ($)
Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 91.4
Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	43.4
Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 23.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-10-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	3 months
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-10-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 25
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-10-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	16.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-10-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 33.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	27.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 3.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 14.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 5.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 9.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 5.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 4.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 5.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 4.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 2.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0

Debt - Carrying Amounts of Debt

Debt - Carrying Amounts of Debt (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Long-term Debt	$ 561
Unamortized discount and issuance costs	(2.8)	$ (2.9)
Total debt	558.2	354
Less: Current maturities	(29)	(16.3)
Total long-term debt	529.2	337.7
Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Long-term Debt	70	40
Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Long-term Debt	$ 491	$ 316.9

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($)	Jun. 26, 2019	Sep. 30, 2020	Mar. 20, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Long-term debt		$ 561,000,000
Line of Credit
Debt Instrument [Line Items]
Interest rate		2.40%
Line of Credit | Minimum
Debt Instrument [Line Items]
Commitment fee	0.30%
Line of Credit | Maximum
Debt Instrument [Line Items]
Commitment fee	0.50%
Line of Credit | Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate basis	0.50%
Line of Credit | Eurodollar Rate
Debt Instrument [Line Items]
Variable rate basis, minimum	0.00%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One
Debt Instrument [Line Items]
Basis spread on variable rate basis	1.00%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate basis	0.75%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate basis	1.75%
Line of Credit | Eurodollar Rate | Interest Rate Option Two
Debt Instrument [Line Items]
Variable rate basis, minimum	0.00%
Line of Credit | Eurodollar Rate | Interest Rate Option Two | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate basis	1.75%
Line of Credit | Eurodollar Rate | Interest Rate Option Two | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate basis	2.75%
Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Credit agreement, maximum borrowing capacity	$ 325,000,000
Credit agreement, issuance percentage of par	99.66%
Long-term debt		$ 491,000,000		$ 316,900,000
Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Principle of debt issued	$ 100,000,000
Long-term debt		70,000,000		$ 40,000,000
Line of Credit | Line of Credit
Debt Instrument [Line Items]
Long-term debt		70,000,000
Borrowing availability		30,000,000
Line of Credit | Letter of Credit
Debt Instrument [Line Items]
Long-term debt		$ 0
Line of Credit | Incremental Term Loan
Debt Instrument [Line Items]
Additional borrowing capacity			$ 191,100,000

Debt - Scheduled Maturities of

Debt - Scheduled Maturities of Long-Term Debt (Details) $ in Millions	Sep. 30, 2020USD ($)
Debt Disclosure [Abstract]
2020	$ 6.4
2021	32.3
2022	38.7
2023	45.2
2024	438.4
Total	$ 561

Share-Based Compensation - Narr

Share-Based Compensation - Narrative (Details) - USD ($) $ in Millions	3 Months Ended			9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Mar. 31, 2019	Sep. 30, 2020	Dec. 31, 2019	Sep. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 6.8	$ 3.8		$ 15.9		$ 12.8
Related tax benefits	1.2	0.9		2.6		2.3
Income tax benefit	$ 1.2	$ 0.7		$ 2.9		$ 4.1
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum exercisable (in shares)				11,788,879
Minimum | PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage			0.00%		0.00%
Maximum | PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage			350.00%		200.00%

Share-Based Compensation - Comp

Share-Based Compensation - Compensation Expense Allocation (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 6.8	$ 3.8	$ 15.9	$ 12.8
Cost of services
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	2.7	1.5	6.1	4.3
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	4.1	2.3	9.8	8.4
Other
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 0	$ 0	$ 0	$ 0.1

Share-Based Compensation - Assu

Share-Based Compensation - Assumptions (Details)	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected dividend yield	0.00%	0.00%
Risk-free interest rate, minimum	0.40%	1.80%
Risk-free interest rate, maximum	1.70%	2.50%
Expected volatility	43.00%
Expected volatility, minimum		40.00%
Expected volatility, maximum		45.00%
Expected term (in years)	5 years 6 months
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)		2 years
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)		5 years 6 months

Share-Based Compensation - Stoc

Share-Based Compensation - Stock Option Activity (Details)	9 Months Ended
	Sep. 30, 2020$ / sharesshares	Dec. 31, 2019$ / sharesshares
Options
Outstanding at beginning of period (in shares) | shares	10,680,340
Granted (in shares) | shares	74,596
Exercised (in shares) | shares	(2,126,647)
Canceled/forfeited (in shares) | shares	(103,349)
Expired (in shares) | shares	(1,214,220)
Outstanding at end of period (in shares) | shares	7,310,720
Outstanding, vested and exercisable at end of period (in shares) | shares	6,218,553	7,868,280
Weighted- Average Exercise Price
Outstanding at beginning of period (in dollars per share) | $ / shares	$ 5.59
Granted (in dollars per share) | $ / shares	10.69
Exercised (in dollars per share) | $ / shares	5.64
Canceled/forfeited (in dollars per share) | $ / shares	2.67
Expired (in dollars per share) | $ / shares	14.62
Outstanding at end of period (in dollars per share) | $ / shares	4.16
Outstanding, vested and exercisable at end of period (in dollars per share) | $ / shares	$ 4.29	$ 6.57

Share-Based Compensation - Othe

Share-Based Compensation - Other Than Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Millions	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
RSAs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	0
Granted (in shares)	0
Vested (in shares)	0
Forfeited (in shares)	0
Outstanding and unvested at end of period (in shares)	0
Weighted- Average Grant Date Fair Value
Shares surrendered for taxes (in shares)	0	380,564
Cost of shares surrendered for taxes	$ 0	$ 3.7
RSUs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	1,373,356
Granted (in shares)	1,519,970
Vested (in shares)	(478,773)
Forfeited (in shares)	(163,397)
Outstanding and unvested at end of period (in shares)	2,251,156
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 8.03
Granted (in dollars per share)	9.96
Vested (in dollars per share)	6.63
Forfeited (in dollars per share)	8.25
Outstanding and unvested at end of period (in dollars per share)	$ 9.62
Shares surrendered for taxes (in shares)	133,673	108,224
Cost of shares surrendered for taxes	$ 1.2	$ 1
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	4,119,436
Granted (in shares)	1,616,081
Vested (in shares)	0
Forfeited (in shares)	(304,896)
Outstanding and unvested at end of period (in shares)	5,430,621
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 6.37
Granted (in dollars per share)	13.18
Vested (in dollars per share)	0
Forfeited (in dollars per share)	6.06
Outstanding and unvested at end of period (in dollars per share)	$ 8.41
Shares surrendered for taxes (in shares)	0	0
Cost of shares surrendered for taxes	$ 0	$ 0

Other Expenses - Schedule of Ot

Other Expenses - Schedule of Other Costs (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Other Income and Expenses [Abstract]
Severance and related employee benefits	$ 2.5	$ 1.3	$ 5.5	$ 1.7
Strategic initiatives	6.5	3.9	18.2	15
Transitioned employees restructuring expense	0	0.9	(0.2)	3.8
Digital Transformation Office	0	1.3	0	5.7
Facility-exit charges	2.5	(0.1)	7.4	(0.2)
Other	4.2	0.1	11.5	0.9
Total other expenses	15.7	$ 7.4	42.4	$ 26.9
COVID-19 related costs, included in Other	$ 2.6		$ 7.9

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Apr. 01, 2020	Dec. 31, 2019
Income Tax Contingency [Line Items]
Federal statutory tax rate	21.00%	21.00%
Statute of limitations minimum	3 years
Statute of limitations maximum	6 years
Gross deferred tax assets				$ 135
Deferred tax assets related to operating loss carryforwards				$ 64.1
SCI Acquisition
Income Tax Contingency [Line Items]
Deferred tax assets related to operating loss carryforwards	$ 10.4
Deferred income tax liabilities, net	11.4		$ 11.4
Deferred tax assets related to research and experimentation credits	$ 4.1

8.00% Series A Convertible Pr_3

8.00% Series A Convertible Preferred Stock - Schedule of Preferred Stock Activity (Details) - Redeemable Convertible Preferred Stock $ in Millions	9 Months Ended
	Sep. 30, 2020USD ($)shares
Shares Issued and Outstanding
Beginning Balance (in shares) | shares	266,529
Dividends paid/accrued dividends (in shares) | shares	16,312
Ending Balance (in shares) | shares	282,841
Carrying Value
Beginning Balance | $	$ 229.1
Dividends paid/accrued dividends | $	16.6
Ending Balance | $	$ 245.7

Earnings (Loss) Per Share - Com

Earnings (Loss) Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended						9 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2020	Sep. 30, 2019
Basic EPS:
Net income	$ 5.2	$ 15.1	$ 18.2	$ 9.2	$ (5.2)	$ 0.2	$ 38.5	$ 4.2
Less dividends on preferred shares	(5.6)			(5.3)			(16.6)	(15.4)
Less income allocated to preferred shareholders	0			(1.9)			(10.9)	0
Net income (loss) available/allocated to common shareholders - basic	(0.4)			2			11	(11.2)
Diluted EPS:
Less income allocated to preferred shareholders	0			(1.5)			(8.7)	0
Net income (loss) available/(allocated) to common shareholders - diluted	$ (0.4)			$ 2.4			$ 13.2	$ (11.2)
Basic weighted-average common shares (in shares)	115,976,377			112,230,439			115,164,631	111,005,255
Add: Effect of dilutive equity awards (in shares)	0			10,465,800			12,293,285	0
Add: Effect of dilutive warrants (in shares)	0			42,926,168			43,720,170	0
Diluted weighted average common shares (in shares)	115,976,377			165,622,407			171,178,086	111,005,255
Net income (loss) per common share (basic) (in dollars per share)	$ 0			$ 0.02			$ 0.10	$ (0.10)
Net income (loss) per common share (diluted) (in dollars per share)	$ 0			$ 0.01			$ 0.08	$ (0.10)

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	21,350,755	1,480,903	95,210	22,795,316
Warrant | Investor's
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	60,000,000
Dilutive shares (in shares)	46,500,241
Warrant | Intermountain
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)				1,500,000
Dilutive shares (in shares)				41,099,845

Related Party Transactions - Ne

Related Party Transactions - Net Services Revenue (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Related Party Transactions [Abstract]
Ascension	$ 193.4	$ 204.5	$ 608.2	$ 583.7

Related Party Transactions - Su

Related Party Transactions - Summary Amounts Included in Balance Sheet (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Related Party Transaction [Line Items]
Accounts receivable, net of $0.1 million and $0.0 million allowance - related party	$ 35.5	$ 30.8
Accounts receivable, allowance - related party	3.6	2.8
Ascension
Related Party Transaction [Line Items]
Accounts receivable, net of $0.1 million and $0.0 million allowance - related party	35.5	30.8
Accounts receivable, allowance - related party	0.1	0
Current portion of customer liabilities	22.6	34.1
Non-current portion of customer liabilities	17.2	18.6
Total customer liabilities	$ 39.8	$ 52.7

Deferred Contract Costs - Summa

Deferred Contract Costs - Summary of Deferred Contract Costs (Details) - USD ($) $ in Millions	Sep. 30, 2020	Dec. 31, 2019
Capitalized Contract Cost [Line Items]
Total deferred contract costs	$ 25.1	$ 24.8
Prepaid expenses and other current assets
Capitalized Contract Cost [Line Items]
Total deferred contract costs	4.5	4
Other assets
Capitalized Contract Cost [Line Items]
Total deferred contract costs	$ 20.6	$ 20.8

Deferred Contract Costs - Narra

Deferred Contract Costs - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenue from Contract with Customer [Abstract]
Capitalized contract cost, amortization	$ 1,300,000	$ 900,000	$ 3,600,000	$ 2,400,000
Impairment losses	$ 0	$ 0	$ 0	$ 0

Segments and Customer Concent_2

Segments and Customer Concentrations - Narrative (Details) - segment	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Segment Reporting Information [Line Items]
Number of operating segments			1
Number of reportable segments			1
Customer Concentration Risk | Revenue | Ascension
Segment Reporting Information [Line Items]
Concentration percentage	63.00%	68.00%	65.00%	67.00%
Customer Concentration Risk | Revenue | Intermountain Healthcare
Segment Reporting Information [Line Items]
Concentration percentage	12.00%	15.00%	14.00%	15.00%
Customer Concentration Risk | Accounts Receivable | Ascension
Segment Reporting Information [Line Items]
Concentration percentage			32.00%		37.00%

Derivative Financial Instrume_2

Derivative Financial Instruments - Narrative (Details) - Designated as Hedging Instrument - Cash Flow Hedging - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Foreign Currency Hedges
Derivative [Line Items]
Gains (losses) reported in accumulated other comprehensive income			$ 0
Derivatives, net gain (loss) reclassified into cost of services	$ (100,000)	$ 400,000	(800,000)	$ 900,000
Notional amount	13,800,000		13,800,000		$ 52,600,000
Interest Rate Swap
Derivative [Line Items]
Gains (losses) reported in accumulated other comprehensive income			(2,900,000)
Gains (losses) to be reclassified within next 12 months			(1,700,000)
Derivatives, net gain (loss) reclassified into cost of services	(500,000)	$ 0	(800,000)	$ 0
Notional amount	$ 200,000,000		$ 200,000,000		$ 100,000,000