CareCloud (CCLD) 10-Q 6 Nov 17 2017 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2017	Nov. 01, 2017
Document And Entity Information
Entity Registrant Name	MEDICAL TRANSCRIPTION BILLING, CORP
Entity Central Index Key	1,582,982
Document Type	10-Q
Document Period End Date	Sep. 30, 2017
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Entity Common Stock, Shares Outstanding		11,530,591
Trading Symbol	MTBC
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2,017

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited Sep 30, 2017) - USD ($)	Sep. 30, 2017	Dec. 31, 2016
CURRENT ASSETS:
Cash	$ 2,789,382	$ 3,476,880
Accounts receivable - net of allowance for doubtful accounts of $268,000 and $156,000 at September 30, 2017 and December 31, 2016, respectively	3,535,673	4,330,901
Current assets - related party	25,203	13,200
Prepaid expenses and other current assets	758,785	618,501
Total current assets	7,109,043	8,439,482
Property and equipment - net	1,424,732	1,588,937
Intangible assets - net	2,997,211	5,833,706
Goodwill	12,263,943	12,178,868
Other assets	152,712	282,713
TOTAL ASSETS	23,947,641	28,323,706
CURRENT LIABILITIES:
Accounts payable	1,017,774	1,905,131
Accrued compensation	848,571	2,009,911
Accrued expenses	758,357	1,236,609
Deferred rent (current portion)	79,150	61,437
Deferred revenue (current portion)	52,145	41,666
Accrued liability to related party	16,614	16,626
Borrowings under line of credit	2,000,000	2,000,000
Current portion of long-term debt		2,666,667
Notes payable - other (current portion)	246,603	5,181,459
Contingent consideration (current portion)	537,736	535,477
Dividend payable	638,905	202,579
Total current liabilities	6,195,855	15,857,562
Long - term debt, net of discount and debt issuance costs		4,033,668
Notes payable - other	137,550	166,184
Deferred rent	371,273	433,186
Deferred revenue	30,001	26,673
Contingent consideration	131,957	394,072
Deferred tax liability	510,530	345,530
Total liabilities	7,377,166	21,256,875
COMMITMENTS AND CONTINGENCIES (Note 8)
SHAREHOLDERS' EQUITY:
Preferred stock, par value $0.001 per share - authorized 2,000,000 shares; issued and outstanding 929,299 and 294,656 shares at September 30, 2017 and December 31, 2016, respectively	929	295
Common stock, $0.001 par value - authorized 19,000,000 shares; issued 12,271,390 and 10,792,352 shares at September 30, 2017 and December 31, 2016, respectively; outstanding, 11,530,591 and 10,051,553 shares at September 30, 2017 and December 31, 2016, respectively	12,272	10,793
Additional paid-in capital	40,985,992	26,038,063
Accumulated deficit	(23,325,897)	(17,944,230)
Accumulated other comprehensive loss	(440,821)	(376,090)
Less: 740,799 common shares held in treasury, at cost at September 30, 2017 and December 31, 2016	(662,000)	(662,000)
Total shareholders' equity	16,570,475	7,066,831
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 23,947,641	$ 28,323,706

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Unaudited Sep 30, 2017) (Parenthetical) - USD ($)	Sep. 30, 2017	Dec. 31, 2016
Statement of Financial Position [Abstract]
Allowance for doubtful accounts receivable	$ 268,000	$ 156,000
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	2,000,000	2,000,000
Preferred stock, shares issued	929,299	294,656
Preferred stock, shares outstanding	929,299	294,656
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	19,000,000	19,000,000
Common stock, shares, issued	12,271,390	10,792,352
Common stock, shares, outstanding	11,530,591	10,051,553
Treasury stock, shares	740,799	740,799

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Income Statement [Abstract]
NET REVENUE	$ 7,513,592	$ 5,341,002	$ 23,518,416	$ 15,663,687
OPERATING EXPENSES:
Direct operating costs	4,171,932	2,670,385	13,592,492	7,292,415
Selling and marketing	228,991	274,796	853,460	838,721
General and administrative	2,474,139	2,569,399	8,232,613	8,173,272
Research and development	249,045	174,876	843,294	575,059
Change in contingent consideration		(196,882)	151,423	(607,978)
Depreciation and amortization	664,441	1,118,282	3,637,131	3,536,940
Restructuring charges			275,628
Total operating expenses	7,788,548	6,610,856	27,586,041	19,808,429
OPERATING LOSS	(274,956)	(1,269,854)	(4,067,625)	(4,144,742)
OTHER:
Interest income	5,446	10,918	13,598	25,310
Interest expense	(678,103)	(176,527)	(1,242,672)	(486,481)
Other income (expense) - net	32,494	(13,933)	107,364	(40,447)
LOSS BEFORE INCOME TAXES	(915,119)	(1,449,396)	(5,189,335)	(4,646,360)
Income tax provision	65,000	45,309	192,332	126,236
NET LOSS	(980,119)	(1,494,705)	(5,381,667)	(4,772,596)
Preferred stock dividend	652,697	231,473	1,283,151	549,945
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (1,632,816)	$ (1,726,178)	$ (6,664,818)	$ (5,322,541)
Loss per common share:
Basic and diluted loss per share	$ (0.14)	$ (0.17)	$ (0.62)	$ (0.53)
Weighted-average basic and diluted shares outstanding	11,485,811	10,006,121	10,835,142	10,031,212

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($)		3 Months Ended		9 Months Ended
		Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Statement of Comprehensive Income [Abstract]
NET LOSS		$ (980,119)	$ (1,494,705)	$ (5,381,667)	$ (4,772,596)
OTHER COMPREHENSIVE (LOSS) INCOME, NET OF TAX
Foreign currency translation adjustment (a)	[1]	(33,880)	1,489	(64,731)	12,305
COMPREHENSIVE LOSS		$ (1,013,999)	$ (1,493,216)	$ (5,446,398)	$ (4,760,291)
[1]	No tax effect has been recorded as the Company recorded a valuation allowance against the tax benefit from its foreign currency translation adjustments.

Condensed Consolidated Stateme6

Condensed Consolidated Statement of Shareholders' Equity (Unaudited) - 9 months ended Sep. 30, 2017 - USD ($)	Preferred Stock [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Deficit [Member]	Accumulated Other Comprehensive Loss [Member]	Treasury (Common) Stock [Member]	Total
Balance at Dec. 31, 2016	$ 295	$ 10,793	$ 26,038,063	$ (17,944,230)	$ (376,090)	$ (662,000)	$ 7,066,831
Balance, shares at Dec. 31, 2016	294,656	10,792,352
Net loss				(5,381,667)			(5,381,667)
Foreign currency translation adjustment					(64,731)		(64,731)
Issuance of stock under the Amended and Restated Equity Incentive Plan	$ 25	$ 267	(267)				25
Issuance of stock under the Amended and Restated Equity Incentive Plan, shares	24,750	266,663
Stock-based compensation, net of cash settlements			907,160				907,160
Issuance of common stock, net of fees and expenses		$ 1,000	1,971,065				1,972,065
Issuance of common stock, net of fees and expenses, shares		1,000,000
Issuance of common stock held as contingent consideration		$ 212	331,464				331,676
Issuance of common stock held as contingent consideration, shares		212,375
Issuance of preferred stock, net of fees and expenses	$ 609		13,021,658				13,022,267
Issuance of preferred stock, net of fees and expenses, shares	609,893
Preferred stock dividends			(1,283,151)				(1,283,151)
Balance at Sep. 30, 2017	$ 929	$ 12,272	$ 40,985,992	$ (23,325,897)	$ (440,821)	$ (662,000)	$ 16,570,475
Balance, shares at Sep. 30, 2017	929,299	12,271,390

Condensed Consolidated Stateme7

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)	9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016
OPERATING ACTIVITIES:
Net loss	$ (5,381,667)	$ (4,772,596)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	3,637,131	3,536,940
Deferred rent	(38,544)	(28,032)
Deferred revenue	13,807	(32,912)
Provision for doubtful accounts	357,671	205,289
Provision for deferred income taxes	165,000	114,893
Foreign exchange (gain) loss	(27,145)	72,360
Interest accretion and write-off of deferred financing costs	672,998	145,038
Non-cash restructuring charges	17,001
Stock-based compensation expense	333,854	765,595
Change in contingent consideration	151,423	(607,978)
Acquisition settlements		(26,296)
Changes in operating assets and liabilities:
Accounts receivable	437,557	(160,523)
Other assets	107,532	211,651
Accounts payable and other liabilities	(1,754,255)	90,843
Net cash used in operating activities	(1,307,637)	(485,728)
INVESTING ACTIVITIES:
Capital expenditures	(499,988)	(319,870)
Cash paid for acquisitions	(205,000)	(1,425,000)
Net cash used in investing activities	(704,988)	(1,744,870)
FINANCING ACTIVITIES:
Contingent consideration payments	(79,603)	(153,799)
Settlement of tax withholding obligations on stock issued to employees	(195,912)	(8,500)
Proceeds from issuance of common stock, net of placement costs	2,000,000
Proceeds from issuance of preferred stock, net of placement costs	13,484,552	1,270,528
Proceeds from long term debt, net of costs		1,908,141
Repayments of debt obligations	(7,626,088)	(554,002)
Repayment of Prudential obligation	(5,000,000)
Proceeds from line of credit	7,000,000	6,000,000
Repayments of line of credit	(7,000,000)	(6,000,000)
Payment of registration statement and bank costs	(335,239)	(119,406)
Preferred stock dividends paid	(846,825)	(506,603)
Purchase of common shares		(546,145)
Net cash provided by financing activities	1,400,885	1,290,214
EFFECT OF EXCHANGE RATE CHANGES ON CASH	(75,758)	11,317
NET DECREASE IN CASH	(687,498)	(929,067)
CASH - Beginning of the period	3,476,880	8,039,562
CASH - End of period	2,789,382	7,110,495
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES:
Vehicle financing obtained	30,746	189,725
Contingent consideration resulting from acquisitions		678,368
Dividends declared, not paid	638,905	202,578
Purchase of prepaid insurance through assumption of note	298,698	313,577
SUPPLEMENTAL INFORMATION - Cash paid during the period for:
Income taxes	9,513	32,816
Interest	$ 599,950	$ 321,530

Organization and Business

Organization and Business	9 Months Ended
	Sep. 30, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Business	1. Organization and Business Medical Transcription Billing, Corp. (and together with its subsidiaries “MTBC” or the “Company”) is a healthcare information technology company that offers an integrated suite of proprietary cloud-based electronic health records and practice management solutions, together with related business services, to healthcare providers. The Company’s integrated services are designed to help customers increase revenues, streamline workflows and make better business and clinical decisions, while reducing administrative burdens and operating costs. The Company’s services include full-scale revenue cycle management, electronic health records, and other technology-driven practice management services for private and hospital-employed healthcare providers. MTBC has its corporate offices in Somerset, New Jersey and maintains account management teams in various US offices and operates facilities in Pakistan and Sri Lanka. MTBC was founded in 1999 and incorporated under the laws of the State of Delaware in 2001. In 2004, MTBC formed MTBC Private Limited (or “MTBC Pvt. Ltd.”) a 99.9% majority-owned subsidiary of MTBC based in Pakistan. The remaining 0.01% of the shares of MTBC Pvt. Ltd. is owned by the founder and Chief Executive Officer of MTBC. MTBC formed MTBC-Europe Sp. z.o.o. (or “MTBC-Europe”), a wholly-owned subsidiary of MTBC based in Poland in 2015. In 2016, MTBC formed MTBC Acquisition Corp. (“MAC”), a Delaware corporation, in connection with its acquisition of substantially all the assets of MediGain, LLC and its subsidiary, Millennium Practice Management Associates, LLC (together “MediGain). MAC has a wholly-owned subsidiary in Sri Lanka, RCM MediGain Colombo, Pvt. Ltd. In conjunction with its continued growth of its offshore operations in Pakistan and Sri Lanka, in April 2017, MTBC began the winding down of its operations in India and Poland. These operations have been terminated and the subsidiaries are being liquidated.

Liquidity

Liquidity	9 Months Ended
	Sep. 30, 2017
Liquidity [Abstract]
Liquidity	2. Liquidity The Company previously adopted FASB Accounting Standard Codification (“ASC”) Topic 205-40, Presentation of Financial Statements – Going Concern, which requires that management evaluate whether there are relevant conditions and events that, in the aggregate, raise substantial doubt about the entity’s ability to continue as a going concern and to meet its obligations as they become due within one year after the date that the financial statements are issued. Based upon the analysis set forth below, management believes there is no longer substantial doubt about the Company’s ability to continue as a going concern and to meet the obligations as they become due within the next twelve months. As part of the evaluation, management considered that on September 30, 2017, the Company had $2.8 million of cash and had positive working capital of $913,000. The loss before income taxes was $915,000 for the three months ended September 30, 2017, of which $664,000 represents non-cash depreciation and amortization and $463,000 of non-cash financing costs, which were written off as a result of the termination of the Opus Bank (“Opus”) credit agreement. During the second and third quarter of 2017, the Company raised a total of $15.0 million in net proceeds from a series of equity financings. In May 2017, the Company completed a registered direct offering of one million shares of its common stock at $2.30 per share, raising net proceeds of approximately $2.0 million. Between June and September 2017, the Company completed five public offerings of approximately 610,000 shares of its 11% Series A Cumulative Redeemable Perpetual Preferred Stock (the “Preferred Stock”) at $25.00 per share, raising net proceeds of approximately $13.0 million. These equity financings improved the financial position of the Company and allowed us to repay the amount owed to Prudential during the third quarter. As a result of the common and preferred stock offerings, the Company’s cash position and the working capital deficit at the end of the second quarter improved to positive net working capital of $913,000 at the end of the third quarter. At September 30, 2017, the total amount outstanding under the Opus credit line was $2 million and the Company has $2.8 million of cash. In October 2017, the Company entered into a new credit facility with Silicon Valley Bank (“SVB”) and repaid and terminated its previous facility with Opus. The SVB credit facility is a $5 million secured revolving line of credit where borrowings are based on a formula of 200% of repeatable revenue adjusted by an annualized attrition rate as defined in the credit facility agreement. Under the SVB credit facility agreement, the facility currently available to the Company is in excess of $4 million. Management continues to focus on the Company’s overall profitability, including growing revenue and managing expenses, and expects that these efforts will continue to enhance our liquidity and financial position. The Company forecasts that cash flow from operations over the next 12 months will be positive and provide sufficient liquidity to the Company. Management has based its expectations on assumptions that may prove to be wrong.

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	3. BASIS OF PRESENTATION The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial reporting and as required by Regulation S-X, Rule 8-03. Accordingly, they do not include all of the information and notes required by GAAP for complete financial statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting of items of a normal and recurring nature) necessary to present fairly the Company’s financial position as of September 30, 2017, the results of operations for the three and nine months ended September 30, 2017 and 2016 and cash flows for the nine months ended September 30, 2017 and 2016. When preparing financial statements in conformity with GAAP, the Company must make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ significantly from those estimates. The condensed consolidated balance sheet as of December 31, 2016 was derived from our audited consolidated financial statements. The accompanying unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2016, which are included in the Company’s Annual Report on Form 10-K, filed with the SEC on March 31, 2017. Recent Accounting Pronouncements In May 2014, the FASB issued Accounting Standards Update (“ASU”) 2014-09, Revenue from Contracts with Customers In February 2016, the FASB issued ASU No. 2016-02, Leases In January 2017, the FASB issued ASU No. 2017-01 Business Combinations Clarifying the Definition of a Business Also in January 2017, the FASB issued ASU No. 2017-04, Intangibles – Goodwill and Other : Simplifying the Accounting for Goodwill Impairment In May 2017, the FASB issued ASU No. 2017-09, Compensation - Stock Compensation: Scope of Modification Accounting

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2017
Business Combinations [Abstract]
Acquisitions	4. ACQUISITIONS 2017 Acquisition Effective July 1, 2017, the Company purchased substantially all of the assets of Washington Medical Billing, LLC (“WMB”), a Washington limited liability company. In accordance with the asset purchase agreement, the Company agreed to a non-refundable initial payment (the “Initial Payment Amount”) of $205,000. In addition to the Initial Payment Amount, the Company agreed to pay the sellers 22%, 23% and 24% of revenue collected from the WMB accounts in the first, second and third year, respectively, subsequent to the acquisition date to the extent such amounts in the aggregate exceed the Initial Payment Amount (the “WMB Installment Payments”). The WMB Installment Payments are to be paid quarterly commencing October, 2017. Based on the Company’s revenue forecast, it does not appear that there will be any WMB Installment Payments and therefore the preliminary aggregate purchase price of WMB was determined to be $205,000. The preliminary purchase price allocation for WMB was performed by the Company and is summarized as follows: Customer relationships $ 120,000 Goodwill 85,000 $ 205,000 The WMB acquisition added additional clients to the Company’s customer base and, similar to previous acquisitions, broadened the Company’s presence in the healthcare technology industry through geographic expansion of its customer base and by increasing available customer relationship resources and specialized trained staff. The weighted-average amortization period of the acquired intangible assets is three years. Revenue earned from the WMB acquisition was approximately $165,000 during the quarter ended September 30, 2017. 2016 Acquisitions On February 15, 2016 (the “GCB Closing Date”), the Company entered into an asset purchase agreement with Gulf Coast Billing, Inc. (“GCB”), pursuant to which the Company purchased substantially all of the assets of GCB. The aggregate final purchase price for GCB was $1,480,000 which consisted of cash of $1,250,000 and contingent consideration of $230,000. During the quarter ended June 30, 2017, an agreement was reached with GCB that no additional contingent consideration will be paid. On May 2, 2016 (the “RMB Closing Date”), the Company entered into an asset purchase agreement with Renaissance Medical Billing, LLC (“RMB”), pursuant to which the Company purchased substantially all of the assets of RMB. In accordance with the RMB asset purchase agreement, the Company paid $175,000 in initial cash consideration (“RMB Initial Payment”), on the RMB Closing Date. In addition, the Company will pay RMB twenty-seven percent (27%) of the revenue earned and received from the acquired RMB accounts for three years, less the RMB Initial Payment which will be deducted in full from the required payments (the “RMB Installment Payments”) before any additional payment is made to the seller. The aggregate purchase price for RMB was $325,000 which consisted of cash of $175,000 and contingent consideration of $150,000. Through September 30, 2017, approximately $24,000 of contingent consideration payments have been made. Effective July 1, 2016 (the “WFS Closing Date”), the Company entered into an asset purchase agreement with WFS Services, Inc. (“WFS”), pursuant to which the Company purchased substantially all of the assets of WFS. In accordance with the WFS asset purchase agreement, the Company did not pay any initial cash consideration on the WFS Closing Date but will make monthly payments of $5,000 for three years beginning July, 2016 subject to proportionate adjustment if annualized revenues decrease below a threshold specified in the APA. In addition, each quarter the Company will pay WFS fifty percent (50%) of Adjusted EBITDA, as defined in the WFS asset purchase agreement, generated from the WFS customer accounts acquired for three years. The aggregate purchase price of WFS was determined to be $298,000, which was recorded as contingent consideration. Through September 30, 2017, $60,000 of contingent consideration payments have been made. On October 3, 2016, MAC acquired substantially all of the assets of MediGain. Since MediGain was in default of its obligations to Prudential prior to the acquisition, MAC purchased 100% of MediGain’s senior secured debt from Prudential. The debt was collateralized by substantially all of MediGain’s assets, so immediately after purchasing the debt, MAC entered into a strict foreclosure agreement with MediGain transferring substantially all the assets (including accounts receivable, fixed assets, client relationships, and MediGain’s wholly-owned subsidiaries in India and Sri Lanka) to MAC in satisfaction of the outstanding obligations under the senior secured notes. The aggregate purchase price was $7 million which consisted of $2 million in cash paid at closing and $5 million, plus interest, which was paid during the third quarter of 2017. MediGain, GCB, RMB and WFS are collectively referred to as the “2016 Acquisitions.” Revenue earned from the 2016 Acquisitions was approximately $4.1 million and $12.8 million during the three and nine months ended September 30, 2017, respectively. Pro forma financial information (Unaudited) The unaudited pro forma information below represents condensed consolidated results of operations as if the 2016 Acquisitions and the WMB Acquisition occurred on January 1, 2016. The pro forma information has been included for comparative purposes and is not indicative of results of operations of the Company would have had if the acquisitions occurred on the above date, nor is it necessarily indicative of future results. Three Months Ended Nine Months Ended September 30, September 30, 2017 2016 2017 2016 ($ in thousands, except per share data) Total revenue $ 7,514 $ 9,984 $ 24,036 $ 32,895 Net loss attributable to common shareholders $ (1,581 ) $ (4,316 ) $ (6,584 ) $ (13,830 ) Net loss per common share $ (0.14 ) $ (0.43 ) $ (0.61 ) $ (1.38 )

Goodwill and Intangible Assets-

Goodwill and Intangible Assets-Net	9 Months Ended
	Sep. 30, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets-Net	5. GOODWILL AND INTANGIBLE ASSETS-NET Goodwill consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. The following is the summary of the changes to the carrying amount of goodwill for the nine months ended September 30, 2017 and the year ended December 31, 2016: September 30, 2017 December 31, 2016 Beginning gross balance $ 12,178,868 $ 8,971,994 Acquisitions 85,075 3,206,874 Ending gross balance $ 12,263,943 $ 12,178,868 Intangible assets include customer contracts and relationships and covenants not-to-compete acquired in connection with acquisitions, as well as software purchase and development costs and trademarks acquired. Intangible assets - net as of September 30, 2017 and December 31, 2016 consist of the following: September 30, 2017 December 31, 2016 Contracts and relationships acquired $ 16,491,300 $ 16,371,375 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,482,864 1,289,339 Total intangible assets 19,210,541 18,897,091 Less: Accumulated amortization (16,213,330 ) (13,063,385 ) Intangible assets - net $ 2,997,211 $ 5,833,706 Amortization expense was approximately $3.2 million for both the nine months ended September 30, 2017 and 2016, and $508,000 and $1.0 million for the three months ended September 30, 2017 and 2016, respectively. The weighted-average amortization period is three years. As of September 30, 2017, future amortization expense scheduled to be expensed is as follows: Years ending December 31 2017 (three months) $ 493,264 2018 1,601,110 2019 827,033 2020 75,804 Total $ 2,997,211

Net Loss Per Common Share

Net Loss Per Common Share	9 Months Ended
	Sep. 30, 2017
Loss per common share:
Net Loss Per Common Share	6. NET LOss per COMMON share The following table presents the weighted-average shares outstanding for basic and diluted net loss per share for the three and nine months ended September 30, 2017 and 2016: Three Months Ended Nine Months Ended September 30, September 30, 2017 2016 2017 2016 Basic and Diluted: Net loss attributable to common shareholders $ (1,632,816 ) $ (1,726,178 ) $ (6,664,818 ) $ (5,322,541 ) Weighted average shares applicable to common shareholders used in computing basic and diluted loss per share 11,485,811 10,006,121 10,835,142 10,031,212 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.14 ) $ (0.17 ) $ (0.62 ) $ (0.53 ) All unvested restricted share units (“RSUs”), the 200,000 warrants granted to Opus in 2015 and 2016 and the two million warrants issued during the second quarter of 2017 as part of the sale of common stock have been excluded from the above calculations as they were anti-dilutive. Vested RSUs and vested restricted shares have been included in the above calculations.

Debt

Debt	9 Months Ended
	Sep. 30, 2017
Debt Disclosure [Abstract]
Debt	7. Debt Opus Interest expense in the consolidated statements of operations for both the three and nine months ended September 30, 2017 includes $463,000 of deferred financing costs which were written off as a result of the termination of the Opus credit agreement. Prudential Deferred Purchase Price Vehicle Financing Notes Insurance Financing

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2017
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	8. Commitments and Contingencies Legal Proceedings Leases Future minimum lease payments under non-cancelable operating leases for office space as of September 30, 2017 are as follows: Years Ending December 31 Total 2017 (three months) $ 68,994 2018 304,357 2019 163,179 Total $ 536,530 Total rental expense, included in direct operating costs and general and administrative expense in the condensed consolidated statements of operations, amounted to approximately $690,000 and $581,000 for the nine months ended September 30, 2017 and 2016, respectively, and approximately $237,000 and $202,000 for the three months ended September 30, 2017 and 2016, respectively. Acquisitions —

Shareholders' Equity Transactio

Shareholders' Equity Transactions	9 Months Ended
	Sep. 30, 2017
Equity [Abstract]
Shareholders' Equity Transactions	9. SHAREHOLDERS’ EQUITY TRANSACTIONS In August 2017, the Company completed two public preferred stock offerings whereby a total of 60,195 shares of its Preferred Stock were sold at $25.00 per share. As a result of this sale, the Company received net proceeds of approximately $1.3 million. In September 2017, the Company completed two public preferred stock offerings whereby a total of 255,000 shares of its Preferred Stock were sold at $25.00 per share. As a result of this sale, the Company received net proceeds of approximately $5.6 million. Dividends on the Preferred Stock of $2.75 annually per share are cumulative from the date of issue and are payable each month when, as and if declared by the Company’s Board of Directors. As of September 30, 2017, the Board of Directors has declared monthly dividends on the Preferred Stock payable through November 2017. Commencing on or after November 4, 2020, the Company may redeem, at its option, the Preferred Stock, in whole or in part, at a cash redemption price of $25.00 per share, plus all accrued and unpaid dividends to, but not including the redemption date. The Preferred Stock has no stated maturity, is not subject to any sinking fund or other mandatory redemption, and is not convertible into or exchangeable for any of the Company’s other securities. Holders of the Preferred Stock have no voting rights except for limited voting rights if dividends payable on the Preferred Stock are in arrears for eighteen or more consecutive or non-consecutive monthly dividend periods. If the Company were to liquidate, dissolve or wind up, the holders of the Preferred Stock will have the right to receive $25.00 per share, plus any accumulated and unpaid dividends to, but not including, the date of payment, before any payment is made to the holders of the common stock. The Preferred Stock is listed on the Nasdaq Capital Market under the trading symbol “MTBCP.”

Related Parties

Related Parties	9 Months Ended
	Sep. 30, 2017
Related Party Transactions [Abstract]
Related Parties	10. Related PARTIES The Company had sales to a related party, a physician who is the wife of the CEO. Revenues from this customer were approximately $12,000 and $13,000 for the nine months ended September 30, 2017 and 2016, respectively, and approximately $4,000 and $5,000 for the three months ended September 30, 2017 and 2016, respectively. As of September 30, 2017 and December 31, 2016, the receivable balance due from this customer was approximately $1,500 and $1,600, respectively. The Company is a party to a nonexclusive aircraft dry lease agreement with Kashmir Air, Inc. (“KAI”), which is owned by the CEO. The Company recorded an expense of approximately $96,000 for both the nine months ended September 30, 2017 and 2016 and approximately $32,000 for both the three months ended September 30, 2017 and 2016. As of September 30, 2017 and December 31, 2016, the Company had a liability outstanding to KAI of approximately $17,000, which is included in accrued liability to related party in the condensed consolidated balance sheets. The Company leases its corporate offices, temporary housing for its foreign visitors and a storage facility in New Jersey and its backup operations center in Bagh, Pakistan, from the CEO. The related party rent expense for the nine months ended September 30, 2017 and 2016 was approximately $141,000 and $131,000, respectively, and $47,000 and $43,000 for the three months ended September 30, 2017 and 2016, respectively, and is included in direct operating costs and general and administrative expense in the condensed consolidated statements of operations. Current assets-related party on the consolidated balance sheets includes security deposits related to the leases of the Company’s corporate offices in the amount of approximately $13,000 as of both September 30, 2017 and December 31, 2016. The September 30, 2017 balance also includes prepaid rent paid to the CEO of approximately $12,000.

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	11. STOCK-BASED COMPENSATION In April 2014, the Company adopted the Medical Transcription Billing, Corp. 2014 Equity Incentive Plan (the “2014 Plan”), reserving a total of 1,351,000 shares of common stock for grants to employees, officers, directors and consultants. During April 2017, the 2014 Plan was amended whereby an additional 1,500,000 shares of common stock and 100,000 shares of Preferred Stock were added to the plan for future issuance. The name of the 2014 Plan was changed to the Amended and Restated Equity Incentive Plan (the “Incentive Plan”). As of September 30, 2017, 1,238,734 shares of common stock and 67,000 shares of Preferred Stock are available for grant. Permissible awards include incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock, restricted stock units (“RSUs”), performance stock and cash-settled awards and other stock-based awards in the discretion of the Compensation Committee of the Board of Directors including unrestricted stock grants. The equity based RSUs contain a provision in which the units shall immediately vest and become converted into common shares at the rate of one common share per RSU, immediately after a change in control, as defined in the award agreement. During the third quarter of 2017, a total of 200,000 RSUs were granted equally to the four outside members of the Board of directors and a total of 300,000 RSUs were granted equally to three executive officers. The RSUs vest over the next two years, at six month intervals. The Company recognizes compensation expense on a straight-line basis over the total requisite service period for the entire award. For stock awards classified as equity, the market price of our common or Preferred Stock on the date of grant is used in recording the fair value of the award. For stock awards classified as a liability, the earned amount is marked to market based on the end of period common stock price. The following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2017 and 2016: Stock-based compensation included in the Condensed Three Months Ended September 30, Nine Months Ended September 30, Consolidated Statement of Operations: 2017 2016 2017 2016 Direct operating costs $ 1,705 $ 3,571 $ 7,162 $ 8,909 General and administrative 124,789 131,077 318,870 731,690 Research and development (675 ) 3,767 7,822 6,910 Selling and marketing - 5,378 - 18,086 Total stock-based compensation expense $ 125,819 $ 143,793 $ 333,854 $ 765,595 The following table summarizes the RSU and restricted stock transactions related to the common stock under the Incentive Plan for the nine months ended September 30, 2017: Outstanding and unvested at January 1, 2017 406,959 Granted 528,000 Vested (327,159 ) Forfeited (29,331 ) Outstanding and unvested at September 30, 2017 578,469 Of the total outstanding and unvested at September 30, 2017, 548,334 RSUs and restricted stock awards are classified as equity and 30,135 RSUs are classified as a liability. The liability for the cash-settled awards was approximately $17,000 and $31,000 at September 30, 2017 and December 31, 2016, respectively, and is included in accrued compensation in the condensed consolidated balance sheets.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2017
Income Tax Disclosure [Abstract]
Income Taxes	12. INCOME TAXES The deferred income tax provision for the nine months ended September 30, 2017 and 2016 primarily relates to the amortization of goodwill. Although the Company is forecasting a return to profitability, it has incurred cumulative losses which make realization of a deferred tax asset difficult to support in accordance with ASC 740. Accordingly, a valuation allowance has been recorded against all Federal and state deferred tax assets as of September 30, 2017 and December 31, 2016. Some of the Federal NOL carry forward is currently subject to certain utilization limitations under Section 382 of the Internal Revenue Code. The Company’s plan to repatriate earnings in its foreign locations to the United States requires that U.S. federal income taxes be provided on the Company’s earnings in those foreign locations. For state tax purposes, the Company’s foreign earnings generally are not taxed due to an exemption available in states where the Company currently transacts business.

Restructuring Charges

Restructuring Charges	9 Months Ended
	Sep. 30, 2017
Restructuring and Related Activities [Abstract]
Restructuring Charges	13. RESTRUCTURING CHARGES During March 2017, the Company decided to close its operations in Poland and India. In connection with the closing of these subsidiaries, in the first quarter of 2017, the Company expensed approximately $276,000 of restructuring charges representing primarily employee severance costs, remaining lease and termination fees, disposal of property and equipment and professional fees. The remaining amounts to be paid of approximately $19,000 are included in accrued expenses in the condensed consolidated balance sheet as of September 30, 2017.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2017
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	14. FAIR VALUE OF FINANCIAL INSTRUMENTS As of September 30, 2017 and December 31, 2016, the carrying amounts of receivables, accounts payable, accrued expenses and the amount due to Prudential (at December 31, 2016 only) approximated their estimated fair values because of the short term nature of these financial instruments. Fair value measurements-Level 2 Our notes payable are carried at cost and approximate fair value since the interest rates being charged approximate market rates. The fair value of our term loans at December 31, 2016 was approximately $7.3 million. The Company’s outstanding borrowings under the line of credit with Opus had a carrying value of $2 million as of both September 30, 2017 and December 31, 2016. The fair value of the outstanding borrowings with Opus under the term loans at December 31, 2016 and the line of credit at December 31, 2016 and September 30, 2017 approximated the carrying value, as these borrowings bore interest based on prevailing variable market rates currently available at those dates. As a result, the Company categorizes these borrowings as Level 2 in the fair value hierarchy. Contingent Consideration The Company’s contingent consideration of approximately $670,000 and $930,000 as of September 30, 2017 and December 31, 2016, respectively, are Level 3 liabilities. The fair value of the contingent consideration at September 30, 2017 and December 31, 2016 was primarily driven by changes in revenue estimates related to the acquisitions during 2015 and 2016, the price of the Company’s common stock on the Nasdaq Capital Market (only for the December 31, 2016 contingent consideration amount), the passage of time and the associated discount rate. Due to the number of factors used to determine contingent consideration, it is not possible to determine a range of outcomes. Subsequent adjustments to the fair value of the contingent consideration liability will continue to be recorded in the Company’s results of operations until all contingencies are settled. The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): Fair Value Measurement at Reporting Date Using Significant Unobservable Inputs, Level 3 Nine Months Ended September 30, 2017 2016 Balance - January 1, $ 929,549 $ 1,172,508 Acquisitions - 678,368 Change in fair value 151,423 (607,978 ) Settlement in the form of shares issued (331,676 ) - Payments (79,603 ) (153,799 ) Balance - September 30, $ 669,693 $ 1,089,099

Subsequent Event

Subsequent Event	9 Months Ended
	Sep. 30, 2017
Subsequent Events [Abstract]
Subsequent Event	15. SUBSEQUENT EVENT During October 2017, the Opus credit facility was replaced with a $5 million revolving line of credit from SVB. Interest on the SVB revolving line of credit is charged at the prime rate plus 1.75%. There is also a fee of one-half of 1% for the unused portion of the credit line. Available borrowings are subject to 200% of repeatable revenue as defined, reduced by an annualized attrition rate. The debt is secured by all of the Company’s domestic assets and 65% of the shares in its offshore facilities. Future acquisitions are subject to approval by SVB. In connection with the SVB debt agreement, the Company paid approximately $90,000 of fees upfront and issued warrants for SVB to purchase 125,000 shares of its common stock, and committed to pay an annual anniversary fee of $50,000 a year. The warrants have a strike price equal to the highest volume weighted average price per share for any five consecutive trading days during the thirty consecutive trading-day period commencing on the fifteenth trading day immediately preceding the date of the loan agreement. They have a five-year exercise window, piggyback registration and net exercise rights, and will be valued once the strike price is determined. The SVB credit agreement contains various covenants and conditions governing the revolving line of credit.

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2017
Business Combinations [Abstract]
Schedule of Business Acquisitions, by Acquisition	The preliminary purchase price allocation for WMB was performed by the Company and is summarized as follows: Customer relationships $ 120,000 Goodwill 85,000 $ 205,000
Business Acquisition, Pro Forma Information	Three Months Ended Nine Months Ended September 30, September 30, 2017 2016 2017 2016 ($ in thousands, except per share data) Total revenue $ 7,514 $ 9,984 $ 24,036 $ 32,895 Net loss attributable to common shareholders $ (1,581 ) $ (4,316 ) $ (6,584 ) $ (13,830 ) Net loss per common share $ (0.14 ) $ (0.43 ) $ (0.61 ) $ (1.38 )

Goodwill and Intangible Asset24

Goodwill and Intangible Assets-Net (Tables)	9 Months Ended
	Sep. 30, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets and Goodwill	Goodwill consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. The following is the summary of the changes to the carrying amount of goodwill for the nine months ended September 30, 2017 and the year ended December 31, 2016: September 30, 2017 December 31, 2016 Beginning gross balance $ 12,178,868 $ 8,971,994 Acquisitions 85,075 3,206,874 Ending gross balance $ 12,263,943 $ 12,178,868
Schedule of Finite-Lived Intangible Assets	Intangible assets include customer contracts and relationships and covenants not-to-compete acquired in connection with acquisitions, as well as software purchase and development costs and trademarks acquired. Intangible assets - net as of September 30, 2017 and December 31, 2016 consist of the following: September 30, 2017 December 31, 2016 Contracts and relationships acquired $ 16,491,300 $ 16,371,375 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,482,864 1,289,339 Total intangible assets 19,210,541 18,897,091 Less: Accumulated amortization (16,213,330 ) (13,063,385 ) Intangible assets - net $ 2,997,211 $ 5,833,706
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	As of September 30, 2017, future amortization expense scheduled to be expensed is as follows: Years ending December 31 2017 (three months) $ 493,264 2018 1,601,110 2019 827,033 2020 75,804 Total $ 2,997,211

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2017
Loss per common share:
Schedule of Losses Per Share, Basic and Diluted	The following table presents the weighted-average shares outstanding for basic and diluted net loss per share for the three and nine months ended September 30, 2017 and 2016: Three Months Ended Nine Months Ended September 30, September 30, 2017 2016 2017 2016 Basic and Diluted: Net loss attributable to common shareholders $ (1,632,816 ) $ (1,726,178 ) $ (6,664,818 ) $ (5,322,541 ) Weighted average shares applicable to common shareholders used in computing basic and diluted loss per share 11,485,811 10,006,121 10,835,142 10,031,212 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.14 ) $ (0.17 ) $ (0.62 ) $ (0.53 )

Commitments and Contingencies (

Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2017
Commitments and Contingencies Disclosure [Abstract]
Schedule of Future Minimum Lease Payments Under Non-cancelable Operating Leases	Future minimum lease payments under non-cancelable operating leases for office space as of September 30, 2017 are as follows: Years Ending December 31 Total 2017 (three months) $ 68,994 2018 304,357 2019 163,179 Total $ 536,530

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs	The following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2017 and 2016: Stock-based compensation included in the Condensed Three Months Ended September 30, Nine Months Ended September 30, Consolidated Statement of Operations: 2017 2016 2017 2016 Direct operating costs $ 1,705 $ 3,571 $ 7,162 $ 8,909 General and administrative 124,789 131,077 318,870 731,690 Research and development (675 ) 3,767 7,822 6,910 Selling and marketing - 5,378 - 18,086 Total stock-based compensation expense $ 125,819 $ 143,793 $ 333,854 $ 765,595
Disclosure of Share-based Compensation Arrangements by Share-based Payment Award	The following table summarizes the RSU and restricted stock transactions related to the common stock under the Incentive Plan for the nine months ended September 30, 2017: Outstanding and unvested at January 1, 2017 406,959 Granted 528,000 Vested (327,159 ) Forfeited (29,331 ) Outstanding and unvested at September 30, 2017 578,469

Fair Value of Financial Instr28

Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2017
Fair Value Disclosures [Abstract]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): Fair Value Measurement at Reporting Date Using Significant Unobservable Inputs, Level 3 Nine Months Ended September 30, 2017 2016 Balance - January 1, $ 929,549 $ 1,172,508 Acquisitions - 678,368 Change in fair value 151,423 (607,978 ) Settlement in the form of shares issued (331,676 ) - Payments (79,603 ) (153,799 ) Balance - September 30, $ 669,693 $ 1,089,099

Organization and Business (Deta

Organization and Business (Details Narrative)	Sep. 30, 2017
Chief Executive Officer [Member]
Equity method investment, ownership percentage in majority-owned subsidiary based in Pakistan	0.01%
MTBC [Member]
Equity method investment, ownership percentage in majority-owned subsidiary based in Pakistan	99.90%

Liquidity (Details Narrative)

Liquidity (Details Narrative) - USD ($)	1 Months Ended	3 Months Ended		9 Months Ended
	May 31, 2017	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016	Dec. 31, 2016	Dec. 31, 2015
Cash		$ 2,789,382	$ 7,110,495	$ 2,789,382	$ 7,110,495	$ 3,476,880	$ 8,039,562
Working capital surplus		913,000		913,000
Net loss before taxes		915,119	1,449,396	5,189,335	4,646,360
Depreciation and amortization expenses		664,441	$ 1,118,282	3,637,131	3,536,940
Non cash financing cost		463,000
Proceeds from a series of equity financings				15,000,000
Net proceeds from issuance of common stock				2,000,000
Opus Credit Facility [Member]
Line of credit		2,000,000		2,000,000
SVB Credit Facility Agreement [Member] | October 2017 [Member]
Line of credit		4,000,000		4,000,000
Line of credit facility Maximum borrowing capacity		$ 5,000,000		$ 5,000,000
Revolving line of credit secured on repeatable revenue percentage		200.00%		200.00%
11% Series A Cumulative Redeemable Preferred Stock [Member]
Number of stock shares issued during the period				610,000
Shares issued price per share		$ 25		$ 25
Net proceeds from issuance of preferred stock				$ 13,000,000
Common Stock [Member]
Number of stock shares issued during the period	1,000,000			1,000,000
Shares issued price per share	$ 2.30
Net proceeds from issuance of common stock	$ 2,000,000

Acquisitions (Details Narrative

Acquisitions (Details Narrative) - USD ($)	Jul. 01, 2017	Oct. 03, 2016	Jul. 01, 2016	May 02, 2016	Sep. 30, 2017	Sep. 30, 2017	Feb. 15, 2016
Payments to acquire business						$ 205,000
Weighted-average amortization period of acquired intangible assets						3 years
Revenue earned from the WMB acquisition						$ 165,000
MediGain [Member]
Purchase of percentage of senior secured debt		100.00%
Purchase price for acquisition		$ 7,000,000
Purchase price paid at closing		$ 2,000,000
Purchase price paid during 2017					$ 5,000,000
Washington Medical Billing, LLC [Member] | First Year [Member] | Revenue Collected from WMB Accounts [Member]
Installment payments percentage	22.00%
Washington Medical Billing, LLC [Member] | Second Year [Member] | Revenue Collected from WMB Accounts [Member]
Installment payments percentage	23.00%
Washington Medical Billing, LLC [Member] | Third Year [Member] | Revenue Collected from WMB Accounts [Member]
Installment payments percentage	24.00%
Gulf Coast Billing Inc [Member]
Business combination, recognized identifiable assets acquired and liabilities assumed, liabilities, total							$ 1,480,000
Business combination, recognized identifiable assets acquired and liabilities assumed, cash and equivalents paid							1,250,000
Business combination, contingent consideration							$ 230,000
2016 Acquisitions [Member]
Revenues					$ 4,100,000	$ 12,800,000
Asset Purchase Agreement [Member] | Washington Medical Billing, LLC [Member]
Non-refundable initial payment amount	$ 205,000
Asset Purchase Agreement [Member] | Renaissance Medical Billing, LLC [Member]
Business combination, recognized identifiable assets acquired and liabilities assumed, liabilities, total				$ 325,000
Business combination, recognized identifiable assets acquired and liabilities assumed, cash and equivalents paid				175,000
Business combination, contingent consideration				150,000
Initial cash consideration				$ 175,000
Future payment as a percentage of revenue				27.00%
Contingent consideration paid since acquisition through September 30, 2017				$ 24,000
Asset Purchase Agreement [Member] | WFS Services, Inc. [Member]
Business combination, recognized identifiable assets acquired and liabilities assumed, liabilities, total			$ 298,000
Business combination, contingent consideration			298,000
Contingent consideration paid since acquisition through September 30, 2017			60,000
Required monthly payments			$ 5,000
Future payment as a percentage of EBITDA			50.00%

Acquisitions - Schedule of Busi

Acquisitions - Schedule of Business Acquisitions, by Acquisition (Details) - USD ($)	Sep. 30, 2017	Dec. 31, 2016
Goodwill	$ 12,263,943	$ 12,178,868
WMB [Member]
Customer relationships	120,000
Goodwill	85,000
Total	$ 205,000

Acquisitions - Business Acquisi

Acquisitions - Business Acquisition, Pro Forma Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Business Combinations [Abstract]
Total revenue	$ 7,514	$ 9,984	$ 24,036	$ 32,895
Net loss attributable to common shareholders	$ (1,581)	$ (4,316)	$ (6,584)	$ (13,830)
Net loss per common share	$ (0.14)	$ (0.43)	$ (0.61)	$ (1.38)

Goodwill and Intangible Asset34

Goodwill and Intangible Assets-Net (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expenses	$ 508,000	$ 1,000,000	$ 3,200,000	$ 3,200,000
Weighted-average amortization period			3 years

Goodwill and Intangible Asset35

Goodwill and Intangible Assets-Net - Schedule of Intangible Assets and Goodwill (Details) - USD ($)	9 Months Ended	12 Months Ended
	Sep. 30, 2017	Dec. 31, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
Beginning gross balance	$ 12,178,868	$ 8,971,994
Acquisitions	85,075	3,206,874
Ending gross balance	$ 12,263,943	$ 12,178,868

Goodwill and Intangible Asset36

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)	Sep. 30, 2017	Dec. 31, 2016
Total intangible assets	$ 19,210,541	$ 18,897,091
Less: Accumulated amortization	(16,213,330)	(13,063,385)
Intangible assets- net	2,997,211	5,833,706
Contracts and Relationships Acquired [Member]
Total intangible assets	16,491,300	16,371,375
Non-Compete Agreements [Member]
Total intangible assets	1,236,377	1,236,377
Other Intangible Assets [Member]
Total intangible assets	$ 1,482,864	$ 1,289,339

Goodwill and Intangible Asset37

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details) - USD ($)	Sep. 30, 2017	Dec. 31, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
2017 (three months)	$ 493,264
2,018	1,601,110
2,019	827,033
2,020	75,804
Total	$ 2,997,211	$ 5,833,706

Net Loss Per Common Share (Deta

Net Loss Per Common Share (Details Narrative) - shares	Jun. 30, 2017	Dec. 31, 2016	Dec. 31, 2015
Number of warrant shares granted	2,000,000
Opus Bank [Member]
Number of warrant shares granted		200,000	200,000

Net Loss Per Common Share - Sch

Net Loss Per Common Share - Schedule of Losses Per Share, Basic and Diluted (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Loss per common share:
Net loss attributable to common shareholders	$ (1,632,816)	$ (1,726,178)	$ (6,664,818)	$ (5,322,541)
Weighted average shares applicable to common shareholders used in computing basic and diluted loss per share	11,485,811	10,006,121	10,835,142	10,031,212
Net loss attributable to common shareholders per share - Basic and Diluted	$ (0.14)	$ (0.17)	$ (0.62)	$ (0.53)

Debt (Details Narrative)

Debt (Details Narrative) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2017	Sep. 30, 2017	Sep. 02, 2015
Deferred financing costs	$ 463,000	$ 463,000
Payments for deferred purchase Price	5,000,000
Accrued interest	$ 270,000	$ 270,000
Insurance financing interest rate	5.25%	5.25%
Opus Bank Loan [Member]
Percentage of shares secured for debt		65.00%
Opus Bank Loan [Member] | Revolving Credit Facility [Member]
Credit facility, maximum borrowing capacity			$ 2,000,000
Opus Bank Loan [Member] | Term Loan [Member]
Credit facility, maximum borrowing capacity			8,000,000
Vehicle Financing Notes [Member]
Debt instrument term description		3 to 6 year terms
Total [Member] | Opus Bank Loan [Member]
Credit facility, maximum borrowing capacity			$ 10,000,000

Commitments and Contingencies41

Commitments and Contingencies (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Operating leases expire year			expiring through 2021.
Operating leases, rent expense	$ 237,000	$ 202,000	$ 690,000	$ 581,000

Commitments and Contingencies -

Commitments and Contingencies - Schedule of Future Minimum Lease Payments Under Non-cancelable Operating Leases (Details)	Sep. 30, 2017USD ($)
Commitments and Contingencies Disclosure [Abstract]
2017 (three months)	$ 68,994
2,018	304,357
2,019	163,179
Total	$ 536,530

Shareholders' Equity Transact43

Shareholders' Equity Transactions (Details Narrative) - Preferred Stock [Member] - USD ($)	1 Months Ended		9 Months Ended
	Sep. 30, 2017	Aug. 31, 2017	Sep. 30, 2017
Number of stock shares issued during the period		60,195
Shares issued price per share	$ 25	$ 25	$ 25
Net proceeds from issuance of preferred stock		$ 1,300,000
Preferred stock redemption price per share	$ 25		$ 25
Two Public Preferred Stock Offerings [Member]
Number of stock shares issued during the period	255,000
Net proceeds from issuance of preferred stock	$ 5,600,000
Cumulative preferred stock dividend per share	$ 2.75

Related Parties (Details Narrat

Related Parties (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016	Dec. 31, 2016
Operating leases, rent expense	$ 237,000	$ 202,000	$ 690,000	$ 581,000
Accrued liability to related party	16,614		16,614		$ 16,626
Kashmir Air, Inc [Member]
Operating leases, rent expense	32,000	32,000	96,000	96,000
Accrued liability to related party	17,000		17,000		17,000
Physician [Member]
Revenues	4,000	5,000	12,000	13,000
Receivable balance due from this customer	1,500		1,500		1,600
Chief Executive Officer [Member]
Operating leases, rent expense	47,000	$ 43,000	141,000	$ 131,000
Security deposit	13,000		13,000		$ 13,000
Prepaid rent	$ 12,000		$ 12,000

Stock-Based Compensation (Detai

Stock-Based Compensation (Details Narrative) - USD ($)	Apr. 30, 2017	Aug. 31, 2017	May 31, 2017	Sep. 30, 2017	Sep. 30, 2017	Dec. 31, 2016	Apr. 30, 2014
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Liability for cash-settled awards				$ 17,000	$ 17,000	$ 31,000
Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Number of shares issued			1,000,000		1,000,000
Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Number of shares issued		60,195
Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Restricted shares granted to outside members of the Board of Directors					528,000
Unvested stock option award, equity				548,334	548,334
Unvested stock option award, liability				30,135	30,135
2014 Equity Incentive Plan [Member] | Employees Officers Directors and Consultants [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized							1,351,000
2014 Equity Incentive Plan [Member] | Board of Directors [Member] | Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Restricted shares granted to outside members of the Board of Directors				200,000
2014 Equity Incentive Plan [Member] | Three Executive Officers [Member] | Restricted Stock Units (RSUs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Restricted shares granted to outside members of the Board of Directors				300,000
Amended and Restated Equity Incentive Plan [Member] | Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Number of shares issued	1,500,000
Share-based compensation arrangement by share-based payment award, number of shares available for grant				1,238,734	1,238,734
Amended and Restated Equity Incentive Plan [Member] | Series A Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Number of shares issued	100,000
Amended and Restated Equity Incentive Plan [Member] | Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares available for grant				67,000	67,000

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 125,819	$ 143,793	$ 333,854	$ 765,595
Direct Operating Costs [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	1,705	3,571	7,162	8,909
General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	124,789	131,077	318,870	731,690
Research and Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	(675)	3,767	7,822	6,910
Selling and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense		$ 5,378		$ 18,086

Stock-Based Compensation - Disc

Stock-Based Compensation - Disclosure of Share-based Compensation Arrangements by Share-based Payment Award (Details) - Restricted Stock Units (RSUs) [Member]	9 Months Ended
	Sep. 30, 2017shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	406,959
Granted	528,000
Vested	(327,159)
Forfeited	(29,331)
Outstanding and unvested at ending	578,469

Restructuring Charges (Details

Restructuring Charges (Details Narrative) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2017	Mar. 31, 2017	Sep. 30, 2016	Sep. 30, 2017	Sep. 30, 2016
Restructuring Charges Details Narrative
Restructuring charges		$ 276,000		$ 275,628
Accrued restructuring charges	$ 19,000			$ 19,000

Fair Value of Financial Instr49

Fair Value of Financial Instruments (Details Narrative) - USD ($)	Sep. 30, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business combination, contingent consideration, liability, current and long term portion	$ 537,736	$ 535,477
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Long-term debt, fair value		7,300,000
Fair Value, Input, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business combination, contingent consideration, liability, current and long term portion	670,000	930,000
Opus Debt [Member] | Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Line of credit	$ 2,000,000	$ 2,000,000

Fair Value of Financial Instr50

Fair Value of Financial Instruments - Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - Fair Value, Input, Level 3 [Member] - USD ($)	9 Months Ended
	Sep. 30, 2017	Sep. 30, 2016
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance, beginning	$ 929,549	$ 1,172,508
Acquisitions		678,368
Change in fair value	151,423	(607,978)
Settlement in the form of shares issued	(331,676)
Payments	(79,603)	(153,799)
Balance, ending	$ 669,693	$ 1,089,099

Subsequent Event (Details Narra

Subsequent Event (Details Narrative) - USD ($)	1 Months Ended
	Oct. 31, 2017	Sep. 30, 2017
Opus Credit Facility [Member]
Revolving line of credit		$ 2,000,000
Subsequent Event [Member] | SVB Debt Agreement [Member]
Payment of fees	$ 90,000
Number of warrants to purchase shares of common stock	125,000
Payments for annual anniversary fee	$ 50,000
Subsequent Event [Member] | Opus Credit Facility [Member]
Revolving line of credit	$ 5,000,000
Unsecured portion of credit line fee, percentage	0.50%
Secured revolving line of credit percentage	200.00%
Percentage of shares in offshore facilities	65.00%
Subsequent Event [Member] | Opus Credit Facility [Member] | Prime Rate [Member]
Revolving line of credit, interest rate - Prime plus	1.75%