Paying a bill or have a question about your account? Make a paymentConsumer help
Paying a bill or have a question about your account? Make a paymentConsumer help
Revenue cycle"RCM company" covers firms that take over your whole revenue cycle, software you run yourself, and partners that work one part of it. Here's how they differ, the 8 things to compare, and a dated, alphabetical list of firms hospitals often shortlist, TSI included.
The best revenue cycle management company for you depends on how much of the cycle you want to hand over. End-to-end outsourcers take over most of it, software vendors give your team better tools, and partial-scope partners work the parts you choose, such as denials or AR follow-up. Compare them on net collections, denial overturns, cost to collect and how fast they report root causes.
Hospitals and physician groups use the term "RCM company" for 3 different kinds of firm. Picking the kind first saves months, because an end-to-end outsourcer, a software vendor and a back-end partner sell different things on different contracts. What RCM covers, step by step, is on what is revenue cycle management.
| Type | How it works | Contract | Fits when |
|---|---|---|---|
| End-to-end outsourcer | Takes over most of the revenue cycle; your staff often move to the vendor's payroll | Multi-year, often 7 to 10 years, priced as a share of collections | You want one partner accountable for the whole cycle |
| RCM software and clearinghouse | Software your own team runs: eligibility, claims, denials, analytics | Subscription plus per-transaction fees | Your team is strong and needs better tools and payer connections |
| AI and automation vendor | Software that automates coding, prior authorization or claim work | Subscription or a share of revenue recovered | You have a specific high-volume task to automate |
| Partial-scope partner | Works the parts you choose, such as AR follow-up, denials, self-pay or bad debt | Shorter terms, contingency or per-account | You keep the front end and want help where the backlog is |
| Medical billing company | Billing and coding for physician practices | Share of collections | You're a practice, not a hospital |
| Criterion | What to ask | Why it matters |
|---|---|---|
| Scope | Which steps do you own, and which stay with my team? | Gaps between vendor and staff are where claims age out |
| Net collections | What's your net collection rate for clients like me, measured how? | Gross numbers hide what was written off |
| Denials | What share of denials do you appeal, and what share of appeals pay? | A denial nobody appeals is revenue written off |
| Cost to collect | What's the all-in cost per dollar collected, including your fee? | A fee on collections can reward easy money over hard claims |
| Root-cause reporting | How do denial causes get back to my front-end teams, and how often? | Working denials recovers money; preventing them is cheaper |
| Systems | Do you work inside my EHR and billing system, or move data out? | Duplicate systems add errors and security risk |
| Patient experience | Who talks to patients about balances, and how is financial assistance screened first? | Patient balances carry 501(r) duties and reputation risk |
| Exit terms | What happens to staff, data and open accounts if we part ways? | Long contracts are hard to unwind |
The KPIs behind these questions, with formulas, are on days in AR and RCM KPIs.
This list is alphabetical and isn't a ranking. Each description comes from the company's own website as of November 2026. TSI publishes this page and is one of the providers listed, so check every claim, ours included, against your own test.
| Provider | Type | What it offers, per its own site | Ask about |
|---|---|---|---|
| AKASA | AI and automation vendor | Generative AI for pre-bill coding and clinical documentation review, aimed at preventing denials before the claim goes out | How it fits your EHR and coding team |
| Conifer Health Solutions | End-to-end outsourcer | Revenue cycle outsourcing sold end to end or by front-end, mid-cycle or back-end scope, on its ConiferCore platform | Which scopes you can buy on their own |
| Ensemble Health Partners | End-to-end outsourcer | End-to-end revenue cycle partnership covering staff, technology and strategy, with its EIQ intelligence engine | Contract length and staff transition terms |
| R1 RCM | End-to-end outsourcer | Revenue cycle outsourcing and modular services on its Phare OS platform, with AI for intake, coding and claims | Which modules you can buy without a full outsourcing deal |
| Waystar | RCM software and clearinghouse | Cloud revenue cycle software and a clearinghouse network, from financial clearance through claims, denials and analytics | Per-transaction fees at your volume |
| Transworld Systems Inc. (TSI) | Partial-scope partner | Back-end revenue cycle services: eligibility and coverage discovery, extended business office follow-up, denial management, early-out self-pay and bad debt recovery | The section below |
Large health systems also look at revenue cycle services from EHR vendors and from Optum. Medical billing companies for physician practices are a separate market and aren't covered here.
A few. Waystar trades on Nasdaq (WAY) after its June 2024 listing. R1 RCM, once public, was taken private by TowerBrook Capital Partners and Clayton, Dubilier & Rice in November 2024. Conifer is majority-owned by Tenet Healthcare, which is public. Ensemble and AKASA are private. Public companies file quarterly results, which tell you about client counts and revenue trends but little about how a vendor performs on accounts like yours.
Choose a slice with a clear baseline, such as one payer's denials or AR over 90 days.
Agree on net collections, overturn rate, cost to collect and days to resolve before the first claim moves.
Long enough to see appeals pay, short enough to change course.
Ask what the vendor found about why claims were denied, and whether your front end could fix it.
TSI works the back end of the revenue cycle for hospitals, health systems and physician groups: eligibility and coverage discovery, extended business office follow-up, denial management, complex claims, early-out self-pay and bad debt recovery. It works inside your systems, loads your financial assistance policy before the first patient account is touched, and reports the root cause behind each denial it works.
TSI isn't the right fit for everyone. If you want one partner to take over scheduling, registration, coding and billing, an end-to-end outsourcer is the closer match.
Results vary by payer mix and client program.
Hospitals often shortlist end-to-end outsourcers such as Conifer, Ensemble and R1 RCM, software vendors such as Waystar, and partial-scope partners for denials, AR follow-up and self-pay. There's no independent ranking that fits every hospital. Start by deciding how much of the cycle you want to hand over.
It helps a provider get paid for care. Depending on the company, that means running the whole revenue cycle, supplying software for it, or working specific parts such as claims follow-up, denials and patient balances.
End-to-end outsourcers usually charge a share of collections on long contracts. Software vendors charge subscriptions plus per-transaction fees. Partial-scope partners often charge per account or a contingency fee on what they recover. Compare the all-in cost to collect.
Outsource the parts where you lack staff, scale or results, and keep the parts your team does well. Many hospitals keep the front end and outsource AR follow-up, denials or self-pay first.
TSI (Transworld Systems Inc.) publishes it. TSI provides Accounts Receivable Management (ARM), Healthcare Revenue Cycle Management (RCM), CXBPO and Loan Servicing (via UAS). Some options this page describes compete with services TSI sells. Each figure names its publisher and date so you can check it yourself.
General information, current as of Nov 5, 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The Denials Economics Sprint measures one payer and one denial class against your own baseline, so you know what outside help is worth before you sign anything long.
