> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# RCM & billing service directory

> Revenue cycle management vendors by category, typical pricing bands, and the contract terms checklist.

Outsourced revenue cycle management vendors by category. **The category matters more than the individual name** — a national enterprise RCM firm and a five-person specialty billing service are different products solving different problems.

**Checked August 2026.** This market consolidates rapidly. Verify current ownership and capability. Vendor names here are representative of their categories, not endorsements.

## The categories

| Category                            | Serves                               | Typical pricing                        | Fits                       |
| ----------------------------------- | ------------------------------------ | -------------------------------------- | -------------------------- |
| **Enterprise RCM**                  | Health systems, large groups         | Negotiated; often percentage plus fees | 50+ clinicians             |
| **Mid-market RCM**                  | Multi-site groups                    | Percentage of collections              | 10–50 clinicians           |
| **Small-practice billing services** | Solo and small groups                | Percentage of collections              | 1–10 clinicians            |
| **Specialty-specific RCM**          | One vertical, deeply                 | Percentage                             | Any size, in that vertical |
| **Offshore / hybrid**               | Cost-sensitive at volume             | Lower percentage, or FTE-based         | Volume operations          |
| **Technology-enabled RCM**          | Groups wanting software plus service | Percentage, or software plus service   | Growth-stage               |
| **EHR-attached RCM**                | Existing customers of that EHR       | Percentage                             | Already on that EHR        |

## Enterprise

| Vendor                       | Character                           |
| ---------------------------- | ----------------------------------- |
| **R1 RCM**                   | Large-scale, health-system oriented |
| **Optum Revenue Cycle**      | UnitedHealth Group; end-to-end      |
| **Conifer Health**           | Health-system oriented              |
| **Ensemble Health Partners** | Hospital and large group            |
| **Savista**                  | Mid-to-large provider organizations |

Generally beyond what an early MSO-PC group needs, and the contracting is correspondingly heavy.

## Mid-market and technology-enabled

| Vendor                       | Character                                    |
| ---------------------------- | -------------------------------------------- |
| **Waystar**                  | Platform-plus-services; also a clearinghouse |
| **CareCloud**                | Software plus RCM services                   |
| **AdvancedMD RCM**           | Attached to the AdvancedMD platform          |
| **athenahealth RCM**         | Attached to athenahealth; network-model      |
| **Infinx**                   | Technology-enabled RCM, automation-oriented  |
| **AGS Health**               | Technology-enabled with offshore delivery    |
| **Med-Metrix**, **Aspirion** | Specialty and complex-claims focus           |

## Small-practice billing services

A large, fragmented market of regional and specialty billing companies, typically 5–50 people.

**How to find a good one:** ask other practices in your specialty and market. This segment does not advertise well and quality varies enormously between firms that look identical on a website.

**What separates good from adequate:** specialty depth, denial management discipline (do they work denials, or just submit claims?), reporting transparency, and whether they will push fixes upstream into your front-end workflow.

## Specialty-specific

Worth seeking out, because payer quirks are specialty-specific:

| Specialty                        | Note                                                                           |
| -------------------------------- | ------------------------------------------------------------------------------ |
| 🦷 **Dental**                    | 837D, CDT, attachments, and dental payer benefit rules are a distinct skillset |
| 🧠 **Behavioral health**         | Supervision billing and behavioral carve-outs                                  |
| 🦴 **PT/Chiro**                  | Visit authorizations, plan-of-care certification, the 8-minute rule, PI liens  |
| 👁 **Optometry**                 | Dual medical/vision determination                                              |
| 💉 **Aesthetics**                | Largely cash-pay; a different problem entirely                                 |
| Anesthesia, emergency, radiology | Hospital-based billing with its own conventions                                |

## Offshore and hybrid

Common and legitimate at volume. Two things to establish explicitly:

**Ask directly whether PHI is accessed offshore, by whom, under what controls, and in which country.** The vendor is a business associate and remains directly liable under HIPAA regardless of where the work is performed, but you should know, and your BAA should address it.

Also confirm **who bears liability** for errors made offshore, and how escalation works across time zones when a claim needs same-day attention.

## Pricing bands

Directional. Percentage of **net collections** is the dominant model.

| Scope                                 | Typical band                        |
| ------------------------------------- | ----------------------------------- |
| Full-service RCM, small practice      | \~5–9%                              |
| Full-service RCM, larger volume       | \~3–6%                              |
| Back-end only (denials, AR follow-up) | \~3–5%                              |
| Coding only                           | Per-chart or hourly                 |
| Credentialing only                    | Per provider per payer, \~$150–$400 |

Percentage scales your cost with success for a service whose cost to serve does not scale proportionally. **Renegotiate as volume grows** — vendors expect it.

## The contract terms checklist

Non-negotiable items when signing any RCM vendor:

* [ ] **"Collections" defined precisely.** All cash received, or only what the vendor collected? Front-desk copays? Claims submitted before the engagement? **This single definition can swing the effective rate by several points.**
* [ ] **Data rights on termination.** All claim, remittance, AR, and correspondence data, in a usable format, within a stated number of days, at no additional charge.
* [ ] **Performance SLAs with remedies**, days to submission, days to first denial action, clean claim rate, days in AR, AR over 90 days, plus a fee reduction or termination right if missed.
* [ ] **Termination terms**, notice, transition assistance, no penalty for termination on a missed SLA.
* [ ] **BAA**, with offshore access disclosed.
* [ ] **Coding responsibility retained by the PC**, with clinicians able to reject a coding change.
* [ ] **You retain payer relationships** — enrollment, credentialing, and contracting stay yours, or you cannot change vendors.
* [ ] **Reporting** you will actually receive, at a stated cadence, with named metrics.
* [ ] **Audit rights** over the vendor's work on your account.
* [ ] **Escalation path** with named contacts and response times.

**The two clauses that trap groups are the "collections" definition and data rights on termination.** Without the first you cannot compare vendors; without the second you cannot leave.

## Evaluating a candidate

Ask for:

1. **References in your specialty and at your scale**, and call them
2. **Their clean claim rate and days in AR** across comparable clients
3. **Their denial management process**, specifically, do they root-cause and report upstream?
4. **Sample reporting**, actual reports, not a mockup
5. **Who works your account**, a named team, or a pool?
6. **How they handle your multi-entity structure**, separate reporting per PC?
7. **What they need from you**, a vendor that expects nothing from your front end is not managing denials


## Related topics

- [Decide: in-house billing vs outsourced RCM](/guides/billing/in-house-vs-outsourced-billing.md)
- [Hire your first biller](/guides/billing/hire-a-biller.md)
- [Clearinghouse vs RCM vs EHR (vs biller)](/concepts/payments/clearinghouse-vs-rcm-vs-ehr.md)
- [What billers actually do](/concepts/payments/what-billers-do.md)
- [EHR/PM directory by segment](/reference/vendors/ehr-directory.md)
- [The clearinghouses, compared](/reference/vendors/clearinghouse-comparison.md)