R1 RCM alternatives for mid-size practices and telehealth companies

R1 RCM partners with 95 of the top 100 US health systems and manages more than $77 billion in net patient revenue, according to the company's website. 

That scale makes R1 a strong match for hospital networks that juggle facility billing, inpatient coding, and enterprise EHR rollouts. A 30-provider specialty group or a telehealth company billing across a dozen states faces a different set of problems: a lean billing team, virtual care rules that keep shifting, and patients who message about their bill at 9 p.m. 

If you run one of those organizations, you are probably weighing several kinds of partners, from specialty billing firms to healthcare BPO services that pair claims work with patient support. Below you'll find the criteria that matter at your size, a side-by-side comparison of the main alternatives, and guidance on which model fits which kind of organization. 

What does the telehealth billing landscape look like in 2026? 

Medicare telehealth flexibilities now run through December 31, 2027, after Congress approved the Consolidated Appropriations Act of 2026 on February 3, 2026. The extension ended months of uncertainty. Most of the rules remain temporary, though, so telehealth companies still bill against a policy calendar set by federal funding deadlines. 

The extended flexibilities let Medicare patients receive care at home regardless of where they live, allow audio-only visits, waive in-person requirements for behavioral telehealth, and widen the list of eligible clinicians, Telehealth.org reports. Behavioral telehealth stands on firmer ground: earlier laws made home-based and audio-only behavioral care a permanent Medicare benefit. 

The past year shows why the calendar matters for revenue. The flexibilities lapsed in October 2025 and again on January 31, 2026. During the fall 2025 lapse, CMS told Medicare Administrative Contractors to hold telehealth claims and return the ones that could not be paid, then asked providers to resubmit them once coverage came back, according to Foley & Lardner. A Brown University policy brief cited by Telehealth.org found a 24 percent drop in telehealth use in the first 17 days of the 2025 shutdown. For a small billing team, each lapse means held claims, rechecked rules, and anxious patients. 

Why enterprise RCM models are built around health systems 

Enterprise RCM vendors design their operating models, technology, and client programs around large hospital networks, where facility billing, inpatient coding, and multi-hospital EHR systems drive most of the work. Smaller organizations can still sign with them, but much of what they pay for sits outside their day-to-day needs. 

R1 illustrates the pattern. Its client roster features Ascension, Providence, and Sutter Health, and it markets its Phare platform as a revenue operating system for real-time adjudication. R1's solutions page highlights AI-driven DRG audits, more than 300 Oracle technology installations, and Best in KLAS recognition for extended business office services at hospitals with fewer than 200 beds. 

R1 does serve physician groups, too. The company reports more than 70,000 physicians served and $13 billion in physician net patient revenue under management. For a mid-size practice, the real question is fit: whether an enterprise operating model gives a 20-clinician group or a virtual-first startup the attention, contract flexibility, and patient-facing support it needs. 

What struggles do mid-size practices and telehealth companies face? 

Smaller providers carry the same denial pressure as health systems with far fewer people to absorb it. In Experian Health's 2025 State of Claims survey, 41 percent of providers reported denial rates of 10 percent or higher, and 43 percent said their teams were understaffed. 

Denials start at intake 

Missing or inaccurate claim data drove 50 percent of denials in that survey, authorizations 35 percent, and registration errors 32 percent, Becker's Hospital Review reported. Telehealth companies collect intake data through apps and web forms, often with no staff member checking insurance details before the visit. One wrong member ID can surface as a denial three weeks later. 

Rework still needs people 

Experian found that staff review 90 percent of denied claims at least in part before resubmission, and 68 percent of providers said clean claims had become harder to submit than a year earlier. Automation speeds up the work, yet a five-person billing team still has to clear the queue every week. 

Virtual care adds a billing layer 

Virtual visits bring place-of-service codes, modifiers, and state licensing rules that payers apply in different ways. A company treating patients in many states answers to a different Medicaid program and commercial payer mix in each one. When federal coverage lapses, claims for affected visits can sit on hold until Congress acts. 

Patients expect billing help in the channel they used for care 

A patient who booked a visit on an app wants to sort out a bill over chat or text. Billing questions, refunds, and coverage confusion land on the same support team that handles scheduling and login issues. Many RCM contracts focus on payer-side work and leave that patient-facing layer to you. 

How to evaluate R1 RCM alternatives: six criteria 

Judge alternatives on fit for your size and care model rather than on feature count. Six criteria matter most for mid-size practices and telehealth companies: telehealth billing fluency, front-end coverage, patient support, compliance evidence, contract flexibility, and reporting you can act on. 

• Telehealth billing fluency: Ask how the partner tracks Medicare telehealth deadlines, state Medicaid rules, and payer modifier policies, and what it did with held claims during the 2025 lapse.
  
  

• Front-end coverage: Look for eligibility checks, insurance verification, and prior authorization before the visit, since half of denials trace back to claim data.
  
  

• Patient support: Route billing questions to trained agents over chat, email, and phone, with access to the same records your billing team uses.
  
  

• Compliance evidence: Request HIPAA documentation and a current SOC 2 report, and read both before you sign.
  
  

• Contract flexibility: Choose a partner that offers a pilot or modular scope, so you can start with denials or verification and expand later.
  
  

• Actionable reporting: Expect weekly denial reasons, AR days, and first-pass results broken out by payer and by visit type, virtual and in person.
  
  

Types of R1 RCM alternatives compared 

Mid-size practices and telehealth companies usually choose among four models: an enterprise RCM operating partner, an in-house team with RCM software, a specialty medical billing company, or a healthcare BPO partner that combines revenue cycle work with patient support. Each one trades control, cost, and coverage in a different way. 

Model 

Best fit 

Telehealth fluency 

Patient-facing support 

Main trade-off 

Enterprise RCM partner (e.g., R1) 

Health systems, large groups 

Varies by contract 

Limited; payer-side focus 

Scope built for hospital-scale operations 

In-house team + RCM software 

Groups with a strong billing lead 

Depends on your staff 

Your own team 

Hiring and turnover risk 

Specialty billing company 

Single-specialty practices 

Strong in its niche 

Usually billing only 

Separate vendor needed for support 

Healthcare BPO partner 

Telehealth and multistate groups 

Built into scope 

Included across channels 

Needs clear SLAs across functions 

Enterprise RCM operating partner 

This model makes sense once you bill like a health system, with facility and professional claims on one platform and a CFO who wants a single operating partner. Smaller groups should check minimum scope, implementation timelines, and how much of the service reaches patients directly. 

In-house team with RCM software 

Keeping billing in-house gives you control and close ties between clinicians and coders. The risk sits in staffing: one resignation can stall your denial queue for a month. 

Specialty medical billing company 

Specialty billers know the codes and payer quirks of one field well, such as behavioral health or dermatology. Most handle payer work only, so patient billing calls still need another home. 

Telehealth-focused healthcare BPO partner 

This model bundles revenue cycle tasks, from insurance verification and prior authorization to claims and denial management, with patient support over chat, email, and phone. Telehealth companies benefit because one team sees the intake data, the claim, and the patient's follow-up question. 

Helpware runs this model with a healthcare desk that covers denial management, prior authorization, insurance verification, and telehealth patient support under HIPAA-compliant operations. Its work with Headspace shows how that continuity holds up in virtual care: a former senior manager of partner success at Headspace reported that the team maintained net retention of about 70 percent, 20 percent above the original plan, while reporting progress on a regular cadence. 

Which R1 RCM alternative fits your organization? 

Match the model to how you deliver care and how you bill. A virtual-first company and a merging multispecialty group can both outgrow their current setup, yet they need very different partners. 

• Telehealth company billing in several states: Start with a healthcare BPO partner that runs verification, claims, and patient support in one workflow.
  
  

• Mid-size multispecialty group with an in-house billing team: Keep core billing internal and outsource denial management and prior authorization during volume spikes.
  
  

• Single-specialty practice: Choose a specialty billing company and add a separate patient support service.
  
  

• Practice joining a health system: Consider an enterprise RCM partner once facility and professional billing share one platform.
  
  

Key takeaways 

• Enterprise RCM partners such as R1 serve large health systems well, and their operating model centers on hospital-scale work.
  
  

• Medicare telehealth flexibilities run through December 31, 2027, yet remain temporary, so your billing partner needs a plan for the next deadline.
  
  

• Front-end data errors drive half of denials, so verification and authorization belong in scope.
  
  

• Patient-facing billing support matters as much as payer follow-up for virtual-first organizations.
  
  

• Pilot first, and track denials separately for virtual and in-person visits.
  
  

Frequently asked questions 

What is R1 RCM? 

R1 is a revenue cycle management company that partners with 95 of the top 100 US health systems and also serves physician groups and critical access hospitals. Its Phare platform combines AI agents with human experts across front-end, mid-cycle, and back-end revenue cycle work. 

Is R1 RCM a good fit for small practices? 

Size alone does not rule R1 out, since it serves physician groups. Smaller practices should compare its scope, contract terms, and patient support coverage against partners built for their volume and care model. 

What should a telehealth company outsource first? 

Start where denials begin: eligibility checks, insurance verification, and prior authorization. Add denial management and patient billing support once the front end runs cleanly. 

When do Medicare telehealth flexibilities expire? 

The current extension runs through December 31, 2027. Several behavioral telehealth flexibilities, including home-based and audio-only care, are permanent. 

How do I compare RCM partners fairly? 

Ask each partner for denial rates, AR days, and first-pass results by payer, plus HIPAA and SOC 2 documentation and a pilot option with clear exit terms.