R1 RCM 10-Q 9 May 22 2022 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2022	May 05, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2022
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	434 W. Ascension Way
Entity Address, Address Line Two	6th Floor
Entity Address, City or Town	Murray
Entity Address, State or Province	UT
Entity Address, Postal Zip Code	84123
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)		279,704,879
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Entity Central Index Key	0001472595
Current Fiscal Year End Date	--12-31

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 123.9	$ 130.1
Accounts receivable, net of $2.3 million and $2.4 million allowance	115.3	131.3
Accounts receivable, net of $0.1 million and $0.1 million allowance - related party	20	26.1
Prepaid expenses and other current assets	81.2	77.2
Total current assets	340.4	364.7
Property, equipment and software, net	95	94.7
Operating lease right-of-use assets	49.8	48.9
Non-current portion of deferred contract costs	24.5	23.4
Intangible assets, net	258.3	265.4
Goodwill	554.7	554.7
Non-current deferred tax assets	44.2	51.8
Other assets	69.4	45.7
Total assets	1,436.3	1,449.3
Current liabilities:
Accounts payable	21	17.7
Current portion of customer liabilities	32.7	41.5
Current portion of customer liabilities - related party	6.9	7.9
Accrued compensation and benefits	66.7	97
Current portion of operating lease liabilities	13.4	13.5
Current portion of long-term debt	17.5	17.5
Other accrued expenses	63.3	59.1
Total current liabilities	221.5	254.2
Non-current portion of customer liabilities	3.5	3.3
Non-current portion of customer liabilities - related party	15.3	15.4
Non-current portion of operating lease liabilities	57.4	53.4
Long-term debt	750.7	754.9
Other non-current liabilities	21.4	21.4
Total liabilities	1,069.8	1,102.6
Stockholders’ equity:
Common stock, $0.01 par value, 500,000,000 shares authorized, 300,156,321 shares issued and 279,325,867 shares outstanding at March 31, 2022; 298,320,928 shares issued and 278,226,242 shares outstanding at December 31, 2021	3	3
Additional paid-in capital	639.1	628.5
Accumulated deficit	(34.9)	(64.3)
Accumulated other comprehensive loss	(6.6)	(5.3)
Treasury stock, at cost, 20,830,454 shares as of March 31, 2022; 20,094,686 shares as of December 31, 2021	(234.1)	(215.2)
Total stockholders’ equity	366.5	346.7
Total liabilities and stockholders’ equity	$ 1,436.3	$ 1,449.3

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Accounts receivable, allowance	$ 2.3	$ 2.4
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)	300,156,321	298,320,928
Common stock, shares outstanding (in shares)	279,325,867	278,226,242
Treasury stock, shares (in shares)	20,830,454	20,094,686
Related Party
Accounts receivable, allowance	$ 0.1	$ 0.1

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income (Unaudited) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
Net services revenue ($216.7 million and $215.5 million for the three months ended March 31, 2022 and 2021, from related party, respectively)	$ 385.7	$ 342.6
Operating expenses:
Cost of services	296.5	267.2
Selling, general and administrative	28.9	25.6
Other expenses	17.1	13
Total operating expenses	342.5	305.8
Income from operations	43.2	36.8
Net interest expense	4.7	3.9
Income before income tax provision	38.5	32.9
Income tax provision	9.1	7.1
Net income	$ 29.4	$ 25.8
Net income (loss) per common share:
Basic (in dollars per share)	$ 0.11	$ (2.37)
Diluted (in dollars per share)	$ 0.09	$ (2.37)
Weighted average shares used in calculating net income (loss) per common share:
Basic (in shares)	278,747,261	239,290,145
Diluted (in shares)	321,043,371	239,290,145
Consolidated statements of comprehensive income
Net income	$ 29.4	$ 25.8
Other comprehensive income (loss):
Net change on derivatives designated as cash flow hedges, net of tax	0.1	0.5
Foreign currency translation adjustments	(1.4)	(0.4)
Total other comprehensive income (loss), net of tax	(1.3)	0.1
Comprehensive income	28.1	25.9
Basic:
Net income	29.4	25.8
Less dividends on preferred shares	0	(592.3)
Net income (loss) available/allocated to common shareholders - basic	29.4	(566.5)
Diluted:
Net income	29.4	25.8
Less dividends on preferred shares	0	(592.3)
Net income (loss) available/allocated to common shareholders - diluted	$ 29.4	$ (566.5)

Consolidated Statements of Op_2

Consolidated Statements of Operations and Comprehensive Income (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
Revenue from related parties	$ 216.7	$ 215.5

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Millions	Total	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
Beginning Balance (in shares) at Dec. 31, 2020		137,812,559	16,668,521
Beginning Balance at Dec. 31, 2020	$ 87.9	$ 1.4	$ (139.2)	$ 393.7	$ (161.5)	$ (6.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	12.8			12.8
Issuance of common stock related to share-based compensation plans (in shares)		6,497
Issuance of common stock (in shares)		324,212
Issuance of common stock	7			7
Exercise of vested stock options (in shares)		539,795
Exercise of vested stock options	3.5			3.5
Acquisition of treasury stock related to share-based compensation plans (in shares)			(2,201)
Net change on derivatives designated as cash flow hedges, net of tax	0.5					0.5
Foreign currency translation adjustments	(0.4)					(0.4)
Conversion of preferred shares (in shares)		117,706,400
Conversion of preferred shares	251.5	$ 1.2		250.3
Inducement dividend	(592.3)			(592.3)
Issuance of common stock related to inducement (in shares)		21,582,800
Issuance of common stock related to inducement	487.3	$ 0.2		487.1
Net income	25.8				25.8
Ending Balance (in shares) at Mar. 31, 2021		277,972,263	16,670,722
Ending Balance at Mar. 31, 2021	283.6	$ 2.8	$ (139.2)	562.1	(135.7)	(6.4)
Beginning Balance (in shares) at Dec. 31, 2021		298,320,928	20,094,686
Beginning Balance at Dec. 31, 2021	346.7	$ 3	$ (215.2)	628.5	(64.3)	(5.3)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	$ 10.2			10.2
Issuance of common stock related to share-based compensation plans (in shares)		1,757,955
Exercise of vested stock options (in shares)	77,438	77,438
Exercise of vested stock options	$ 0.4			0.4
Acquisition of treasury stock related to share-based compensation plans (in shares)			(727,768)
Acquisition of treasury stock related to share-based compensation plans	(18.7)
Repurchases of common stock (in shares)			(8,000)
Repurchases of common stock	(0.2)		$ (0.2)
Net change on derivatives designated as cash flow hedges, net of tax	0.1					0.1
Foreign currency translation adjustments	(1.4)					(1.4)
Net income	29.4				29.4
Ending Balance (in shares) at Mar. 31, 2022		300,156,321	20,830,454
Ending Balance at Mar. 31, 2022	$ 366.5	$ 3	$ (234.1)	$ 639.1	$ (34.9)	$ (6.6)

Consolidated Statements of St_2

Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Accumulated Other Comprehensive Loss
Net change on derivatives designated as cash flow hedges, tax	$ 0	$ 0.2

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Operating activities
Net income	$ 29.4	$ 25.8
Adjustments to reconcile net income to net cash provided by operations:
Depreciation and amortization	18.9	17.9
Amortization of debt issuance costs	0.3	0.3
Share-based compensation	10.1	12.7
Loss on disposal and right-of-use asset write-downs	2	0.6
Provision for credit losses	0	0.1
Deferred income taxes	7.3	4.9
Non-cash lease expense	3.2	2.9
Other	1.5	0.5
Changes in operating assets and liabilities:
Accounts receivable and related party accounts receivable	22.1	(7.3)
Prepaid expenses and other assets	(20.5)	(19.4)
Accounts payable	3.2	5.2
Accrued compensation and benefits	(27.5)	9.4
Lease liabilities	(2.1)	(4.1)
Other liabilities	1.7	(4.2)
Customer liabilities and customer liabilities - related party	(18.7)	0.7
Net cash provided by operating activities	30.9	46
Investing activities
Purchases of property, equipment, and software	(10)	(9.6)
Net cash used in investing activities	(10)	(9.6)
Financing activities
Inducement of preferred stock conversion	0	(105)
Exercise of vested stock options	0.4	4.4
Purchase of treasury stock	(0.6)	0
Shares withheld for taxes	(21.5)	0
Other	(0.1)	0
Net cash used in financing activities	(26.2)	(107.1)
Effect of exchange rate changes in cash, cash equivalents and restricted cash	(0.9)	(0.1)
Net decrease in cash, cash equivalents and restricted cash	(6.2)	(70.8)
Cash, cash equivalents and restricted cash, at beginning of period	130.1	174.8
Cash, cash equivalents and restricted cash, at end of period	123.9	104
Supplemental disclosures of cash flow information
Property, equipment and software purchases not paid	23.3	10.3
Senior Term Loan
Financing activities
Repayment of senior secured debt and Repayments on revolver	$ (4.4)	$ (6.5)

Business Description and Basis

Business Description and Basis of Presentation	3 Months Ended
	Mar. 31, 2022
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-driven solutions that transform the patient experience and financial performance of healthcare providers. 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. Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of March 31, 2022, the results of operations of the Company for the three months ended March 31, 2022 and 2021, and the cash flows of the Company for the three months ended March 31, 2022 and 2021. 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 months ended March 31, 2022 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2022. When preparing financial statements in conformity with GAAP, the Company makes a number of significant estimates, assumptions, and judgments in the preparation of the financial statements. Actual results could differ from those estimates. For a more complete discussion of the Company’s significant accounting policies and other information, the unaudited consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements included in the Company’s 2021 Form 10-K. Recently Issued Accounting Standards and Disclosures No new accounting pronouncements issued or effective during the fiscal year had, or are expected to have, a material impact on the Company’s consolidated financial statements.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2022
Business Combination and Asset Acquisition [Abstract]
Acquisitions	Acquisitions Assets acquired and liabilities assumed in a business combination are recorded at their estimated fair value on the date of the acquisition. The difference between the purchase price amount and the net fair value of assets acquired and liabilities assumed is recognized as goodwill on the balance sheet if the purchase price exceeds the estimated net fair value or as a bargain purchase gain on the income statement if the purchase price is less than the estimated net fair value. The allocation of the purchase price may be modified up to one year after the acquisition date as more information is obtained about the fair value of assets acquired and liabilities assumed. During 2021, the Company acquired the following business: Company Name Description of the Business Description of the Acquisition iVinci Partners, LLC d/b/a VisitPay (“VisitPay”) Provider of digital payment solutions Purchased all outstanding equity interests During the three months ended March 31, 2022, there were no significant purchase accounting adjustments to the fair value of assets acquired or the liabilities assumed in connection with the VisitPay acquisition as disclosed in Note 3 of the Company’s 2021 Form 10-K. In 2020, the Company purchased certain assets relating to the RevWorks services business from Cerner Corporation. In accordance with the purchase agreement, the Company paid the first deferred payment of $12.5 million in the third quarter of 2021. There is one remaining deferred payment of $12.5 million which is payable on the second anniversary of the closing date (August 2022), and is included in other accrued expenses on the Consolidated Balance Sheets as of March 31, 2022. The two deferred payments related to the RevWorks acquisition are contractual obligations of the Company; however, they are potentially effectively refundable to the Company if certain RevWorks customer revenue targets defined in the purchase agreement for the first two years following the acquisition are not achieved. At the time of the acquisition, the Company recorded an asset for the fair value of the contingently returnable consideration of $22.3 million. During 2021, the Company updated the contingently returnable consideration to $25.0 million, with the change being recorded as a component of other expenses and interest expense. The full amount is included in prepaid expenses and other current assets on the Consolidated Balance Sheets as of March 31, 2022. Pro Forma Results The following table summarizes, on a pro forma basis, the combined results of the Company as though the VisitPay acquisition had occurred as of January 1, 2020. These pro forma results are not necessarily indicative of the actual consolidated results had the VisitPay acquisition occurred as of January 1, 2020 or of the future consolidated operating results for any period. Pro forma results are: Three Months Ended March 31, 2021 Net services revenue $ 346.0 Net income $ 23.4 Adjustments were made to earnings to adjust depreciation and amortization to reflect the fair value of identified assets acquired, to record the effects of extinguishing the debt of VisitPay and replacing it with the debt of the Company, to adjust timing of acquisition related costs incurred by the Company, and to record the income tax effect of these adjustments.

Revenue Recognition

Revenue Recognition	3 Months Ended
	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition Revenue is measured based on consideration specified in a contract with a customer, and presented net of 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 of revenue: Three Months Ended March 31, 2022 2021 Net operating fees $ 322.8 $ 286.1 Incentive fees 30.2 29.0 Other (1) 32.7 27.5 Net services revenue $ 385.7 $ 342.6 (1) Other revenue primarily consists of physician advisory services (“PAS”), practice management services, subscription revenue, and revenue related to Entri and VisitPay modular services. Contract Balances The following table provides information about contract assets and contract liabilities from contracts with customers: March 31, 2022 December 31, 2021 Contract assets $ 1.9 $ — Contract liabilities 26.9 29.0 Contract assets and contract liabilities are included in other current assets and customer liabilities, respectively. The contract liabilities balance contains related party amounts, including $2.4 million and $2.5 million of current customer liabilities and $15.3 million and $15.4 million of non-current customer liabilities as of March 31, 2022 and December 31, 2021, 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 $89.0 million and $93.7 million during the three months ended March 31, 2022 and 2021, which amounts were included in contract liabilities on January 1 of the respective periods. These revenue amounts include $85.8 million and $88.1 million for the three months ended March 31, 2022 and 2021, 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. The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Remainder of 2022 $ 86.6 $ 39.5 2023 88.7 — 2024 79.5 — 2025 31.4 — 2026 30.9 — 2027 29.5 — Thereafter 114.1 — Total $ 460.7 $ 39.5 The amounts presented in the table above include variable fee estimates for the non-cancellable term of the Company's physician groups revenue cycle management (“RCM”) services contracts, fixed fees, and forecasted incentive fees. Fixed fees are typically recognized ratably as the performance obligation is satisfied and forecasted incentive fees are measured cumulatively over the contractually defined performance period. Estimates of revenue expected to be recognized in future periods exclude unexercised customer options to purchase services within the Company's PAS contracts that do not represent material rights to the customer. The Company does not disclose information about remaining performance obligations with an original expected duration of one year or less and has elected an exemption to the disclosure requirements related to estimate variable consideration.

Debt

Debt	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Debt	Debt The carrying amounts of debt consist of the following: March 31, 2022 December 31, 2021 Senior Revolver (1) $ 80.0 $ 80.0 Senior Term Loan 691.3 695.6 Unamortized discount and issuance costs (3.1) (3.2) Total debt 768.2 772.4 Less: Current maturities (17.5) (17.5) Total long-term debt $ 750.7 $ 754.9 (1) As of March 31, 2022, the Company had $80.0 million in borrowings, $0.5 million letters of credit outstanding, and $369.5 million of availability under the Senior Revolver. Amended and Restated Senior Secured Credit Facilities On July 1, 2021, the Company and certain of its subsidiaries entered into an amended and restated senior credit agreement (the “A&R Credit Agreement”) with Bank of America, N.A., as administrative agent, and the lenders named therein, governing the Company’s amended and restated senior secured credit facilities (the “Senior Secured Credit Facilities”), consisting of a $700.0 million senior secured term loan facility (the “Senior Term Loan”) and a $450.0 million senior secured revolving credit facility (the “Senior Revolver”). The interest rate as of March 31, 2022 was 2.21%. The A&R Credit Agreement contains a number of financial and non-financial covenants. The Company was in compliance with all of the covenants in the A&R Credit Agreement as of March 31, 2022. The obligations under the A&R Credit Agreement are secured by a pledge of 100% of the capital stock of certain domestic subsidiaries owned by the Company and a security interest in substantially all of the Company’s tangible and intangible assets and the tangible and intangible assets of certain domestic subsidiaries.

Derivative Financial Instrument

Derivative Financial Instruments	3 Months Ended
	Mar. 31, 2022
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments	Derivative Financial Instruments The Company utilizes cash flow hedges to manage its currency risk arising from its global delivery resources. As of March 31, 2022, the Company has recorded $1.2 million of unrealized gains in accumulated other comprehensive income related to foreign currency hedges. The Company estimates that $1.2 million of gains reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next 12 months. Amounts reclassified into cost of services were a net gain of $0.2 million and $0.4 million during the three months ended March 31, 2022 and 2021, respectively. As of March 31, 2022, the Company’s currency forward contracts have maturities extending no later than March 31, 2023, and had total notional amounts of $80.4 million. The Company also utilizes cash flow hedges to reduce variability in interest cash flows from its outstanding debt. As of March 31, 2022, the Company has recorded $0.2 million of unrealized losses in accumulated other comprehensive income related to interest rate swaps. The Company estimates that $0.2 million of losses reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next 5 months. Amounts reclassified into interest expense were a net loss of $0.3 million and $0.5 million during the three months ended March 31, 2022 and 2021, respectively. As of March 31, 2022, the Company’s interest rate swaps extend no later than August 31, 2022, and had total notional amounts of $100.0 million. The Company classifies cash flows from its derivative programs as cash flows from operating activities in the consolidated statements of cash flows. Fair values for derivative financial instruments are based on prices computed using third-party valuation models and are classified as Level 2 in accordance with the three-level hierarchy of fair value measurements.

Share-Based Compensation

Share-Based Compensation	3 Months Ended
	Mar. 31, 2022
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 units (“RSUs”), and performance-based restricted stock units (“PBRSUs”) for the three months ended March 31, 2022 and 2021 was $10.1 million and $12.7 million, respectively, with related tax benefits of approximately $1.8 million and $2.2 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 $2.5 million and $2.3 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the three months ended March 31, 2022 and 2021, respectively. Total share-based compensation costs that have been included in the Company’s consolidated statements of operations were as follows: Three Months Ended March 31, 2022 2021 Share-Based Compensation Expense Allocation Details: Cost of services $ 4.3 $ 7.3 Selling, general and administrative 5.8 5.4 Total share-based compensation expense $ 10.1 $ 12.7 The Company uses the Black-Scholes option pricing model to estimate the fair value of its service-based options as of their grant dates. The Company assesses current performance on performance-based PBRSUs by reviewing historical performance to date, along with any adjustments which have been approved to the reported performance, and changes to the projections to determine the probable outcome of the awards. The current estimates are then compared to the scoring metrics and any necessary adjustments are reflected in the current period to update share-based compensation expense to the current performance expectations. The following table sets forth the significant assumptions used in the Black-Scholes option pricing model and the calculation of share-based compensation expense for the three months ended March 31, 2022 and 2021: Three Months Ended March 31, 2022 2021 Expected dividend yield —% —% Risk-free interest rate 1.4% 0.4% Expected volatility 43% 43% Expected term (in years) 5.5 5.5 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 three months ended March 31, 2022 is shown below: Options Weighted- Outstanding at December 31, 2021 4,386,205 $ 3.37 Granted 1,424 25.70 Exercised (77,438) 5.39 Canceled/forfeited (3,750) 6.31 Expired — — Outstanding at March 31, 2022 4,306,441 $ 3.34 Outstanding, vested and exercisable at March 31, 2022 4,293,696 $ 3.30 Outstanding, vested and exercisable at December 31, 2021 4,365,759 $ 3.33 Restricted stock units and performance-based restricted stock units A summary of the RSU and PBRSU activity during the three months ended March 31, 2022 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2021 2,218,651 3,203,013 $ 16.28 $ 16.45 Granted 38,151 — 25.50 — Performance factor adjustment — 876,109 — 10.46 Vested (5,737) (1,752,218) 14.28 10.46 Forfeited (39,862) (2,832) 16.25 27.28 Outstanding and unvested at March 31, 2022 2,211,203 2,324,072 $ 16.44 $ 18.70 Shares surrendered for taxes for the three months ended March 31, 2022 2,198 725,570 Cost of shares surrendered for taxes for the three months ended March 31, 2022 (in millions) $ — $ 18.7 Shares surrendered for taxes for the three months ended March 31, 2021 2,201 — Cost of shares surrendered for taxes for the three months ended March 31, 2021 (in millions) $ — $ — The Company's RSU and PBRSU agreements allow employees to surrender to the Company shares of common stock upon vesting of their RSUs and PBRSUs in lieu of their payment of the required personal employment-related taxes. Shares surrendered for payment of personal employment-related taxes are held in treasury. Outstanding PBRSUs vest 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 4,512,992.

Other Expenses

Other Expenses	3 Months Ended
	Mar. 31, 2022
Other Income and Expenses [Abstract]
Other Expenses	Other Expenses Other expenses are incurred in connection with acquisition and integration costs, various exit activities, transformation initiatives, and organizational changes to improve our business alignment and cost structure. The following table summarizes the other expenses (income) recognized for the three months ended March 31, 2022 and 2021. Three Months Ended March 31, 2022 2021 Severance and related employee benefits (1) $ — $ 1.5 Strategic initiatives (2) 10.1 6.5 Customer employee transition and restructuring expenses (3) (0.4) — Facility-exit charges (4) 4.8 1.5 Other (5) 2.6 3.5 Total other expenses $ 17.1 $ 13.0 (1) Severance expense related to restructuring and business reorganization events. (2) Costs related to evaluating, pursuing, and integrating acquisitions, performing portfolio and capital structure analyses and transactions, 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. For the three months ended March 31, 2022, the balance also includes $3.1 million of costs related to establishing a global business services center in the Philippines. (3) As part of the transition of customer personnel to the Company under certain operating partner model contracts, the Company has agreed to reimburse the customer, or directly pay affected employees, for 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. (4) As part of evaluating its footprint, the Company has exited certain leased facilities. Costs include asset impairment charges, early termination fees, and other costs related to exited leased facilities.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2022
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 global intangible low-taxed income (“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 Company recognized income tax expense for the three months ended March 31, 2022 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 state taxes, GILTI, non-deductible compensation, and discrete items. The Company recognized income tax expense for the three months ended March 31, 2021 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 state taxes, GILTI, non-deductible compensation, and 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 2018 are currently open for examination. State jurisdictions vary for open tax years. The statute of limitations for most states ranges from three

Earnings (Loss) Per Share

Earnings (Loss) Per Share	3 Months Ended
	Mar. 31, 2022
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. Diluted net income per share is calculated 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 and shares issuable upon vesting of RSUs and PBRSUs. Basic and diluted net income (loss) per common share are calculated as follows: Three Months Ended March 31, 2022 2021 Basic EPS: Net income $ 29.4 $ 25.8 Less dividends on preferred shares (1) — (592.3) Net income (loss) available/(allocated) to common shareholders - basic $ 29.4 $ (566.5) Diluted EPS: Net income $ 29.4 $ 25.8 Less dividends on preferred shares (1) — (592.3) Net income (loss) available/(allocated) to common shareholders - diluted $ 29.4 $ (566.5) Basic weighted-average common shares 278,747,261 239,290,145 Add: Effect of dilutive equity awards 6,472,685 — Add: Effect of dilutive warrants 35,823,425 — Diluted weighted average common shares 321,043,371 239,290,145 Net income (loss) per common share (basic) $ 0.11 $ (2.37) Net income (loss) per common share (diluted) $ 0.09 $ (2.37) (1) The 2021 dividend on preferred shares includes amounts related to the conversion of the preferred shares. See Note 16 of the Company’s 2021 Form 10-K for more information. Because of their anti-dilutive effect, 43,206 common share equivalents comprised of stock options, PBRSUs, and RSUs have been excluded from the diluted earnings per share calculation for the three months ended March 31, 2022. For the three months ended March 31, 2021, 13,688,519 common share equivalents have been excluded from the diluted earnings per share calculation because of their anti-dilutive effect. Additionally, for the three months ended March 31, 2021, TCP-ASC ACHI Series LLLP’s (“TCP-ASC” or the “Investor”) and IHC Health Services, Inc.’s (“Intermountain”) exercisable warrants to acquire up to 60.0 million and 1.5 million shares, respectively, of the Company's common stock have been excluded from the diluted earnings per share calculation because they were anti-dilutive.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2022
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. On April 13, 2021 and April 19, 2021, respectively, certain purported stockholders of the Company filed two complaints in the Delaware Court of Chancery regarding the Company’s January 15, 2021 recapitalization transaction with TCP-ASC. Both complaints allege that TCP-ASC, Ascension Health (“Ascension”), and TowerBrook Capital Partners (“TowerBrook”) controlled the Company and breached their fiduciary duties by using that alleged control to force the Company to overpay in redeeming TCP-ASC’s preferred stock as part of the recapitalization transaction. The plaintiffs seek an unspecified amount of damages against TCP-ASC, Ascension, and TowerBrook. The plaintiffs also allege that the Company and TCP-ASC entered into amendments to the Investor Rights Agreement that the plaintiffs contend contains provisions that are void under the Company’s charter, bylaws, and the Delaware General Corporation Law. The cases have since been consolidated into a single action. All defendants have answered the complaint and discovery has commenced. On February 18, 2022, plaintiffs filed a supplement to their complaint, naming certain additional defendants and asserting additional claims related to the Company’s agreement to acquire Cloudmed, which was announced on January 10, 2022. The additional claims assert that: (i) TCP-ASC, Ascension, and TowerBrook, along with the Company’s directors (“Individual Defendants”), breached their fiduciary duties by causing the Company to enter into and approving the Cloudmed acquisition, respectively, which plaintiffs claim will perpetuate TCP-ASC’s, Ascension’s, and TowerBrook’s control over the Company and entrench the Individual Defendants by virtue of certain agreements entered into as part of the transaction, including a Second Amended Investor Rights Agreement with TCP-ASC (the “Seconded Amended Investor Rights Agreement”) and an Investor Rights Agreement with Cloudmed (the “Cloudmed Investor Rights Agreement”); and (ii) Cloudmed’s stockholders aided and abetted such breaches. Plaintiffs also allege that certain provisions in the Cloudmed Investor Rights Agreement and the Second Amended Investor Rights Agreement are void under the Company’s charter, bylaws, and the Delaware General Corporation law. The plaintiffs seek a declaratory judgment and an unspecified amount of damages, as well as attorneys’ fees and costs. The Company believes it has meritorious defenses to all claims against it and intends to vigorously defend against these claims. 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 and 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. Both the Company’s and plaintiff’s motions for summary judgment were denied in December 2020, and the parties have completed damage and expert discovery. Additional dispositive motions are expected to extend through 2022, with trial, if necessary, in June 2023.

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2022
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions This note encompasses transactions between Ascension and its affiliates, including AMITA Health, and the Company pursuant to the Master Professional Services Agreement, 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 19 of the Company's 2021 Form 10-K. Net services revenue from services provided to Ascension, as well as corresponding accounts receivable and customer liabilities are presented in the Consolidated Statements of Operations and Comprehensive Income and the Consolidated Balance Sheets. 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.

Segments and Customer Concentra

Segments and Customer Concentrations	3 Months Ended
	Mar. 31, 2022
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 the way that management operates and views the business. 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 operating and reportable segment. Customers comprising greater than 10% of net services revenue are as follows: Three Months Ended March 31, Customer Name 2022 2021 Ascension and its affiliates 56 % 63 % Intermountain Healthcare 14 % 14 % The loss of customers within the Ascension health system or Intermountain network could have a material adverse impact on the Company’s operations. As of March 31, 2022 and December 31, 2021, the Company had a concentration of credit risk with Ascension accounting for 15% and 17% of accounts receivable, respectively.

Supplemental Financial Informat

Supplemental Financial Information	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Supplemental Financial Information	Supplemental Financial Information The following table summarizes the allocation of depreciation and amortization expense related to property, equipment and software and intangible assets between cost of services and selling, general and administrative expenses: Three Months Ended March 31, 2022 2021 Cost of services $ 18.6 $ 17.1 Selling, general and administrative 0.3 0.8 Total depreciation and amortization $ 18.9 $ 17.9 Supplemental cash flow information related to leases are as follows: Three Months Ended March 31, 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 3.4 $ 9.4 Right-of-use assets obtained in exchange for operating lease obligations: 6.0 5.6

Business Description and Basi_2

Business Description and Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of March 31, 2022, the results of operations of the Company for the three months ended March 31, 2022 and 2021, and the cash flows of the Company for the three months ended March 31, 2022 and 2021. 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 months ended March 31, 2022 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2022.
Recently Issued Accounting Standards and Disclosures	Recently Issued Accounting Standards and Disclosures No new accounting pronouncements issued or effective during the fiscal year had, or are expected to have, a material impact on the Company’s consolidated financial statements.
Revenue Recognition	Revenue RecognitionRevenue is measured based on consideration specified in a contract with a customer, and presented net of 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)	3 Months Ended
	Mar. 31, 2022
Business Combination and Asset Acquisition [Abstract]
Schedule of Acquisitions During 2021	During 2021, the Company acquired the following business: Company Name Description of the Business Description of the Acquisition iVinci Partners, LLC d/b/a VisitPay (“VisitPay”) Provider of digital payment solutions Purchased all outstanding equity interests
Schedule of Pro Forma Results	The following table summarizes, on a pro forma basis, the combined results of the Company as though the VisitPay acquisition had occurred as of January 1, 2020. These pro forma results are not necessarily indicative of the actual consolidated results had the VisitPay acquisition occurred as of January 1, 2020 or of the future consolidated operating results for any period. Pro forma results are: Three Months Ended March 31, 2021 Net services revenue $ 346.0 Net income $ 23.4

Revenue Recognition (Tables)

Revenue Recognition (Tables)	3 Months Ended
	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregated Revenue By Source	In the following table, revenue is disaggregated by source of revenue: Three Months Ended March 31, 2022 2021 Net operating fees $ 322.8 $ 286.1 Incentive fees 30.2 29.0 Other (1) 32.7 27.5 Net services revenue $ 385.7 $ 342.6
Schedule of Assets and Liabilities	The following table provides information about contract assets and contract liabilities from contracts with customers: March 31, 2022 December 31, 2021 Contract assets $ 1.9 $ — Contract liabilities 26.9 29.0
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. The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Remainder of 2022 $ 86.6 $ 39.5 2023 88.7 — 2024 79.5 — 2025 31.4 — 2026 30.9 — 2027 29.5 — Thereafter 114.1 — Total $ 460.7 $ 39.5

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Schedule of Carrying Values Long-Term Debt	The carrying amounts of debt consist of the following: March 31, 2022 December 31, 2021 Senior Revolver (1) $ 80.0 $ 80.0 Senior Term Loan 691.3 695.6 Unamortized discount and issuance costs (3.1) (3.2) Total debt 768.2 772.4 Less: Current maturities (17.5) (17.5) Total long-term debt $ 750.7 $ 754.9 (1) As of March 31, 2022, the Company had $80.0 million in borrowings, $0.5 million letters of credit outstanding, and $369.5 million of availability under the Senior Revolver.

Share-Based Compensation (Table

Share-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2022
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: Three Months Ended March 31, 2022 2021 Share-Based Compensation Expense Allocation Details: Cost of services $ 4.3 $ 7.3 Selling, general and administrative 5.8 5.4 Total share-based compensation expense $ 10.1 $ 12.7
Summary of Valuation Assumptions	The following table sets forth the significant assumptions used in the Black-Scholes option pricing model and the calculation of share-based compensation expense for the three months ended March 31, 2022 and 2021: Three Months Ended March 31, 2022 2021 Expected dividend yield —% —% Risk-free interest rate 1.4% 0.4% Expected volatility 43% 43% Expected term (in years) 5.5 5.5
Schedule of Stock Options Activity	A summary of the options activity during the three months ended March 31, 2022 is shown below: Options Weighted- Outstanding at December 31, 2021 4,386,205 $ 3.37 Granted 1,424 25.70 Exercised (77,438) 5.39 Canceled/forfeited (3,750) 6.31 Expired — — Outstanding at March 31, 2022 4,306,441 $ 3.34 Outstanding, vested and exercisable at March 31, 2022 4,293,696 $ 3.30 Outstanding, vested and exercisable at December 31, 2021 4,365,759 $ 3.33
Schedule of Non-Options Awards Activity	A summary of the RSU and PBRSU activity during the three months ended March 31, 2022 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2021 2,218,651 3,203,013 $ 16.28 $ 16.45 Granted 38,151 — 25.50 — Performance factor adjustment — 876,109 — 10.46 Vested (5,737) (1,752,218) 14.28 10.46 Forfeited (39,862) (2,832) 16.25 27.28 Outstanding and unvested at March 31, 2022 2,211,203 2,324,072 $ 16.44 $ 18.70 Shares surrendered for taxes for the three months ended March 31, 2022 2,198 725,570 Cost of shares surrendered for taxes for the three months ended March 31, 2022 (in millions) $ — $ 18.7 Shares surrendered for taxes for the three months ended March 31, 2021 2,201 — Cost of shares surrendered for taxes for the three months ended March 31, 2021 (in millions) $ — $ —

Other Expenses (Tables)

Other Expenses (Tables)	3 Months Ended
	Mar. 31, 2022
Other Income and Expenses [Abstract]
Schedule of Other Expenses	The following table summarizes the other expenses (income) recognized for the three months ended March 31, 2022 and 2021. Three Months Ended March 31, 2022 2021 Severance and related employee benefits (1) $ — $ 1.5 Strategic initiatives (2) 10.1 6.5 Customer employee transition and restructuring expenses (3) (0.4) — Facility-exit charges (4) 4.8 1.5 Other (5) 2.6 3.5 Total other expenses $ 17.1 $ 13.0 (1) Severance expense related to restructuring and business reorganization events. (2) Costs related to evaluating, pursuing, and integrating acquisitions, performing portfolio and capital structure analyses and transactions, 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. For the three months ended March 31, 2022, the balance also includes $3.1 million of costs related to establishing a global business services center in the Philippines. (3) As part of the transition of customer personnel to the Company under certain operating partner model contracts, the Company has agreed to reimburse the customer, or directly pay affected employees, for 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. (4) As part of evaluating its footprint, the Company has exited certain leased facilities. Costs include asset impairment charges, early termination fees, and other costs related to exited leased facilities.

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	3 Months Ended
	Mar. 31, 2022
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: Three Months Ended March 31, 2022 2021 Basic EPS: Net income $ 29.4 $ 25.8 Less dividends on preferred shares (1) — (592.3) Net income (loss) available/(allocated) to common shareholders - basic $ 29.4 $ (566.5) Diluted EPS: Net income $ 29.4 $ 25.8 Less dividends on preferred shares (1) — (592.3) Net income (loss) available/(allocated) to common shareholders - diluted $ 29.4 $ (566.5) Basic weighted-average common shares 278,747,261 239,290,145 Add: Effect of dilutive equity awards 6,472,685 — Add: Effect of dilutive warrants 35,823,425 — Diluted weighted average common shares 321,043,371 239,290,145 Net income (loss) per common share (basic) $ 0.11 $ (2.37) Net income (loss) per common share (diluted) $ 0.09 $ (2.37) (1) The 2021 dividend on preferred shares includes amounts related to the conversion of the preferred shares. See Note 16 of the Company’s 2021 Form 10-K for more information.

Segments and Customer Concent_2

Segments and Customer Concentrations (Tables)	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Schedule of Customer Concentration, Net Services Revenue	Customers comprising greater than 10% of net services revenue are as follows: Three Months Ended March 31, Customer Name 2022 2021 Ascension and its affiliates 56 % 63 % Intermountain Healthcare 14 % 14 %

Supplemental Financial Inform_2

Supplemental Financial Information (Tables)	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Summary Depreciation and Amortization Expense	The following table summarizes the allocation of depreciation and amortization expense related to property, equipment and software and intangible assets between cost of services and selling, general and administrative expenses: Three Months Ended March 31, 2022 2021 Cost of services $ 18.6 $ 17.1 Selling, general and administrative 0.3 0.8 Total depreciation and amortization $ 18.9 $ 17.9
Schedule of Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases are as follows: Three Months Ended March 31, 2022 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 3.4 $ 9.4 Right-of-use assets obtained in exchange for operating lease obligations: 6.0 5.6

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) - RevWorks $ in Millions	Sep. 03, 2022USD ($)	Sep. 30, 2021USD ($)	Dec. 31, 2020USD ($)payment	Mar. 31, 2022payment	Dec. 31, 2021USD ($)
Business Acquisition [Line Items]
Payments to acquire business		$ 12.5
Number of deferred payments | payment			2	1
Payments to acquire business, number of payments, refund period, if circumstances met			2 years
Asset, contingently returnable consideration			$ 22.3		$ 25
Forecast
Business Acquisition [Line Items]
Payments to acquire business	$ 12.5

Acquisitions - Pro Forma Result

Acquisitions - Pro Forma Results (Details) - VisitPay $ in Millions	3 Months Ended
	Mar. 31, 2021USD ($)
Business Acquisition [Line Items]
Net services revenue	$ 346
Net income	$ 23.4

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregated Revenue by Source (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Disaggregation of Revenue [Line Items]
Net services revenue	$ 385.7	$ 342.6
Net operating fees
Disaggregation of Revenue [Line Items]
Net services revenue	322.8	286.1
Incentive fees
Disaggregation of Revenue [Line Items]
Net services revenue	30.2	29
Other
Disaggregation of Revenue [Line Items]
Net services revenue	$ 32.7	$ 27.5

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Contract Balances (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Contract assets	$ 1.9	$ 0
Contract With Customer Liability
Disaggregation of Revenue [Line Items]
Contract liabilities	$ 26.9	$ 29

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Non-current customer liabilities, related party	$ 15.3		$ 15.4
Revenue recognized	89	$ 93.7
Accounts Receivable
Disaggregation of Revenue [Line Items]
Revenue recognized, advanced billings	85.8	$ 88.1
Investor
Disaggregation of Revenue [Line Items]
Current customer liabilities, related party	$ 2.4		$ 2.5

Revenue Recognition - Transacti

Revenue Recognition - Transaction Price Allocated to the Remaining Performance Obligation (Details) $ in Millions	Mar. 31, 2022USD ($)
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	$ 460.7
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	$ 39.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-04-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	9 months
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-04-01 | 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	$ 86.6
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-04-01 | 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	$ 39.5
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	$ 88.7
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]: 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	$ 79.5
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]: 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	$ 31.4
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]: 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	1 year
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	$ 30.9
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]: 2027-01-01
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]: 2027-01-01 | 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	$ 29.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | 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]: 2028-01-01
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]: 2028-01-01 | 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	$ 114.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01 | 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

Debt - Carrying Amounts of Debt

Debt - Carrying Amounts of Debt (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Unamortized discount and issuance costs	$ (3.1)	$ (3.2)
Total debt	768.2	772.4
Less: Current maturities	(17.5)	(17.5)
Total long-term debt	750.7	754.9
Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Long-term debt	80	80
Borrowing availability	369.5
Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Long-term debt	691.3	$ 695.6
Line of Credit | Letter of Credit
Debt Instrument [Line Items]
Long-term debt	$ 0.5

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($)	Mar. 31, 2022	Jul. 01, 2021
A&R Credit Agreement
Debt Instrument [Line Items]
Debt covenant, secured obligation pledged, capital stock of certain domestic subsidiaries, percent		100.00%
Line of Credit
Debt Instrument [Line Items]
Interest rate	2.21%
Line of Credit | Senior Term Loan | A&R Credit Agreement
Debt Instrument [Line Items]
Principal of debt issued		$ 700,000,000
Line of Credit | Senior Revolver | A&R Credit Agreement
Debt Instrument [Line Items]
Principal of debt issued		$ 450,000,000

Derivative Financial Instrume_2

Derivative Financial Instruments - Narrative (Details) - Designated as Hedging Instrument - Cash Flow Hedging - USD ($)	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Foreign Currency Hedges
Derivative [Line Items]
Unrealized gains (losses) reported in accumulated other comprehensive income	$ 1,200,000
Gains (losses) to be reclassified within next 12 months	1,200,000
Derivatives, net gain (loss) reclassified	200,000	$ 400,000
Notional amount	80,400,000
Interest Rate Swap
Derivative [Line Items]
Unrealized gains (losses) reported in accumulated other comprehensive income	(200,000)
Gains (losses) to be reclassified within next 12 months	(200,000)
Derivatives, net gain (loss) reclassified	(300,000)	$ (500,000)
Notional amount	$ 100,000,000

Share-Based Compensation - Narr

Share-Based Compensation - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 10.1	$ 12.7
Related tax benefits	1.8	2.2
Income tax benefit	$ 2.5	$ 2.3
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum exercisable (in shares)	4,512,992
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%
Maximum | PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage	200.00%

Share-Based Compensation - Comp

Share-Based Compensation - Compensation Expense Allocation (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 10.1	$ 12.7
Cost of services
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	4.3	7.3
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 5.8	$ 5.4

Share-Based Compensation - Assu

Share-Based Compensation - Assumptions (Details)	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Share-based Payment Arrangement [Abstract]
Expected dividend yield	0.00%	0.00%
Risk-free interest rate	1.40%	0.40%
Expected volatility	43.00%	43.00%
Expected term (in years)	5 years 6 months	5 years 6 months

Share-Based Compensation - Stoc

Share-Based Compensation - Stock Options Activity (Details) - $ / shares	3 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Options
Outstanding at beginning of period (in shares)	4,386,205
Granted (in shares)	1,424
Exercised (in shares)	(77,438)
Canceled/forfeited (in shares)	(3,750)
Expired (in shares)	0
Outstanding at end of period (in shares)	4,306,441
Outstanding, vested and exercisable at end of period (in shares)	4,293,696	4,365,759
Weighted- Average Exercise Price
Outstanding at beginning of period (in dollars per share)	$ 3.37
Granted (in dollars per share)	25.70
Exercised (in dollars per share)	5.39
Canceled/forfeited (in dollars per share)	6.31
Expired (in dollars per share)	0
Outstanding at end of period (in dollars per share)	3.34
Outstanding, vested and exercisable at end of period (in dollars per share)	$ 3.30	$ 3.33

Share-Based Compensation - Othe

Share-Based Compensation - Other Than Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
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)	2,218,651
Granted (in shares)	38,151
Performance factor adjustment (in shares)	0
Vested (in shares)	(5,737)
Forfeited (in shares)	(39,862)
Outstanding and unvested at end of period (in shares)	2,211,203
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 16.28
Granted (in dollars per share)	25.50
Performance factor adjustment (in dollars per share)	0
Vested (in dollars per share)	14.28
Forfeited (in dollars per share)	16.25
Outstanding and unvested at end of period (in dollars per share)	$ 16.44
Shares surrendered for taxes (in shares)	2,198	2,201
Cost of shares surrendered for taxes	$ 0	$ 0
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)	3,203,013
Granted (in shares)	0
Performance factor adjustment (in shares)	876,109
Vested (in shares)	(1,752,218)
Forfeited (in shares)	(2,832)
Outstanding and unvested at end of period (in shares)	2,324,072
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 16.45
Granted (in dollars per share)	0
Performance factor adjustment (in dollars per share)	10.46
Vested (in dollars per share)	10.46
Forfeited (in dollars per share)	27.28
Outstanding and unvested at end of period (in dollars per share)	$ 18.70
Shares surrendered for taxes (in shares)	725,570	0
Cost of shares surrendered for taxes	$ 18.7	$ 0

Other Expenses - Schedule of Ot

Other Expenses - Schedule of Other Expenses (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Other Income and Expenses [Abstract]
Severance and related employee benefits	$ 0	$ 1.5
Strategic initiatives	10.1	6.5
Customer employee transition and restructuring expenses	(0.4)	0
Facility-exit charges	4.8	1.5
Other	2.6	3.5
Total other expenses	17.1	13
Costs related to global business services center in Philippines, included in strategic initiatives	3.1
COVID-19 related costs, included in Other	$ 0.5	$ 1.7

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Federal statutory tax rate	21.00%	21.00%
Statute of limitations minimum	3 years
Statute of limitations maximum	6 years
Gross deferred tax assets			$ 123.7
Deferred tax assets related to operating loss carryforwards			$ 54.7

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
	Mar. 31, 2022	Mar. 31, 2021
Basic EPS:
Net income	$ 29.4	$ 25.8
Less dividends on preferred shares	0	(592.3)
Net income (loss) available/allocated to common shareholders - basic	29.4	(566.5)
Diluted EPS:
Net income (loss) available/allocated to common shareholders - diluted	$ 29.4	$ (566.5)
Basic weighted-average common shares (in shares)	278,747,261	239,290,145
Add: Effect of dilutive equity awards (in shares)	6,472,685	0
Add: Effect of dilutive warrants (in shares)	35,823,425	0
Diluted weighted average common shares (in shares)	321,043,371	239,290,145
Net income (loss) per common share (basic) (in dollars per share)	$ 0.11	$ (2.37)
Net income (loss) per common share (diluted) (in dollars per share)	$ 0.09	$ (2.37)

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	43,206	13,688,519
Warrant | Investor
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)		60,000,000
Warrant | Intermountain
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)		1,500,000

Commitments and Contingencies -

Commitments and Contingencies - Narrative (Details)	Apr. 19, 2021claim
TCP-ASC Recapitalization Litigation | Pending Litigation
Loss Contingencies [Line Items]
Number of complaints filed	2

Related Party Transactions - Na

Related Party Transactions - Narrative (Details) - Related Party - TCP-ASC	May 28, 2021$ / sharesshares
Related Party Transaction [Line Items]
Warrant exercise price (in dollars per share)	$ 3.50
Minimum
Related Party Transaction [Line Items]
Warrant market value price (in dollars per share)	24.54
Maximum
Related Party Transaction [Line Items]
Warrant market value price (in dollars per share)	$ 24.64
Common Stock
Related Party Transaction [Line Items]
Exercise of warrants pursuant to cashless provisions (in shares) | shares	16,750,000
Class of warrant or right, number of securities called by warrants or rights (in shares) | shares	19,535,145

Segments and Customer Concent_3

Segments and Customer Concentrations - Narrative (Details) - segment	3 Months Ended	12 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Number of operating segments	1
Number of reporting segments	1
Customer Concentration Risk | Accounts Receivable | Ascension and its affiliates
Segment Reporting Information [Line Items]
Concentration percentage	15.00%	17.00%

Segments and Customer Concent_4

Segments and Customer Concentrations - Concentration Risk by Customer (Details) - Revenue - Customer Concentration Risk	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Ascension and its affiliates
Concentration Risk [Line Items]
Concentration percentage	56.00%	63.00%
Intermountain Healthcare
Concentration Risk [Line Items]
Concentration percentage	14.00%	14.00%

Supplemental Financial Inform_3

Supplemental Financial Information - Schedule of Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 18.9	$ 17.9
Cost of services
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	18.6	17.1
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 0.3	$ 0.8

Supplemental Financial Inform_4

Supplemental Financial Information - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$ 3.4	$ 9.4
Right-of-use assets obtained in exchange for operating lease obligations:	$ 6	$ 5.6