CareCloud (CCLD) 10-Q 15 May 18 2018 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2018	May 10, 2018
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	Mar. 31, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Entity Common Stock, Shares Outstanding		11,665,174
Trading Symbol	MTBC
Document Fiscal Period Focus	Q1
Document Fiscal Year Focus	2,018

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($)	Mar. 31, 2018	Dec. 31, 2017
CURRENT ASSETS:
Cash	$ 3,541,070	$ 4,362,232
Accounts receivable - net of allowance for doubtful accounts of $206,000 and $185,000 at March 31, 2018 and December 31, 2017, respectively	3,776,959	3,879,463
Contract asset	1,389,763
Current assets - related party	25,203	25,203
Prepaid expenses and other current assets	721,390	662,822
Total current assets	9,454,385	8,929,720
Property and equipment - net	1,339,675	1,385,743
Intangible assets - net	2,091,878	2,509,544
Goodwill	12,263,943	12,263,943
Other assets	469,916	436,713
TOTAL ASSETS	25,619,797	25,525,663
CURRENT LIABILITIES:
Accounts payable	730,239	991,859
Accrued compensation	960,720	1,137,351
Accrued expenses	828,581	616,778
Deferred rent (current portion)	85,791	81,826
Deferred revenue (current portion)	41,191	62,104
Accrued liability to related party	10,663	10,675
Notes payable - other (current portion)	89,635	168,718
Contingent consideration (current portion)	503,066	505,557
Dividend payable	767,463	747,147
Total current liabilities	4,017,349	4,322,015
Notes payable - other	106,908	120,899
Deferred rent	295,907	333,788
Deferred revenue	27,639	28,615
Contingent consideration	84,983	97,854
Deferred tax liability	410,072	372,072
Total liabilities	4,942,858	5,275,243
COMMITMENTS AND CONTINGENCIES (Note 7)
SHAREHOLDERS' EQUITY:
Preferred stock, par value $0.001 per share - authorized 2,000,000 shares; issued and outstanding 1,116,289 and 1,086,739 shares at March 31, 2018 and December 31, 2017, respectively	1,116	1,087
Common stock, $0.001 par value - authorized 19,000,000 shares; issued 12,405,973 and 12,271,390 shares at March 31, 2018 and December 31, 2017, respectively; outstanding, 11,665,174 and 11,530,591 shares at March 31, 2018 and December 31, 2017, respectively	12,406	12,272
Additional paid-in capital	44,239,862	45,129,517
Accumulated deficit	(21,990,229)	(23,509,386)
Accumulated other comprehensive loss	(924,216)	(721,070)
Less: 740,799 common shares held in treasury, at cost at March 31, 2018 and December 31, 2017	(662,000)	(662,000)
Total shareholders' equity	20,676,939	20,250,420
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 25,619,797	$ 25,525,663

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($)	Mar. 31, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Allowance for doubtful accounts receivable	$ 206,000	$ 185,000
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	2,000,000	2,000,000
Preferred stock, shares issued	1,116,289	1,086,739
Preferred stock, shares outstanding	1,116,289	1,086,739
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	19,000,000	19,000,000
Common stock, shares, issued	12,405,973	12,271,390
Common stock, shares, outstanding	11,665,174	11,530,591
Treasury stock, shares	740,799	740,799

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Income Statement [Abstract]
NET REVENUE	$ 8,307,325	$ 8,220,074
OPERATING EXPENSES:
Direct operating costs	4,484,055	5,222,736
Selling and marketing	305,014	355,511
General and administrative	2,600,734	2,986,663
Research and development	255,880	280,849
Change in contingent consideration	31,749	(11,188)
Depreciation and amortization	590,771	1,519,545
Restructuring charges		275,628
Total operating expenses	8,268,203	10,629,744
OPERATING INCOME (LOSS)	39,122	(2,409,670)
OTHER:
Interest income	5,285	3,421
Interest expense	(74,081)	(279,425)
Other income - net	151,374	38,031
INCOME (LOSS) BEFORE INCOME TAXES	121,700	(2,647,643)
Income tax provision	46,664	60,302
NET INCOME (LOSS)	75,036	(2,707,945)
Preferred stock dividend	775,332	202,579
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (700,296)	$ (2,910,524)
Loss per common share:
Basic and diluted loss per share	$ (0.06)	$ (0.29)
Weighted-average basic and diluted shares outstanding	11,616,938	10,172,108

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($)		3 Months Ended
		Mar. 31, 2018	Mar. 31, 2017
Statement of Comprehensive Income [Abstract]
NET INCOME (LOSS)		$ 75,036	$ (2,707,945)
OTHER COMPREHENSIVE LOSS, NET OF TAX
Foreign currency translation adjustment	[1]	(203,146)	(42,662)
COMPREHENSIVE LOSS		$ (128,110)	$ (2,750,607)
[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) - 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. 28, 2017	$ 1,087	$ 12,272	$ 45,129,517	$ (23,509,386)	$ (721,070)	$ (662,000)	$ 20,250,420
Balance, shares at Dec. 28, 2017	1,086,739	12,271,390
Cumulative effect of adopting ASC 606				1,444,121			1,444,121
Balance at Dec. 31, 2017	$ 1,087	$ 12,272	45,129,517	(22,065,265)	(721,070)	(662,000)	20,250,420
Balance, shares at Dec. 31, 2017	1,086,739	12,271,390
Net Income				75,036			75,036
Foreign currency translation adjustment					(203,146)		(203,146)
Issuance of stock under the Amended and Restated Equity Incentive Plan	$ 29	$ 134	(163)
Issuance of stock under the Amended and Restated Equity Incentive Plan, shares	29,550	134,583
Stock-based compensation, net of cash settlements			112,090				$ 112,090
Tax withholding obligations on stock issued to employees			(226,250)				(226,250)
Preferred stock dividends			(775,332)				(775,332)
Balance at Mar. 31, 2018	$ 1,116	$ 12,406	$ 44,239,862	$ (21,990,229)	$ (924,216)	$ (662,000)	$ 20,676,939
Balance, shares at Mar. 31, 2018	1,116,289	12,405,973

Condensed Consolidated Stateme7

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
OPERATING ACTIVITIES:
Net income (loss)	$ 75,036	$ (2,707,945)
Adjustments to reconcile net income (loss) to net cash provided by (used in) operating activities:
Depreciation and amortization	590,771	1,519,545
Amortization of sales commissions	12,065
Deferred rent	(16,736)	(12,556)
Deferred revenue	(21,889)	(15,105)
Provision for doubtful accounts	78,556	164,745
Provision for deferred income taxes	38,000	54,000
Foreign exchange gain	(146,939)	(30,646)
Interest accretion	48,712	55,819
Non-cash restructuring charges		17,001
Stock-based compensation expense	127,691	129,347
Change in contingent consideration	31,749	(11,188)
Changes in operating assets and liabilities:
Accounts receivable	23,948	248,383
Other assets	44,683	86,883
Accounts payable and other liabilities	(212,266)	(365,732)
Net cash provided by (used in) operating activities	673,381	(867,449)
INVESTING ACTIVITIES:
Capital expenditures	(174,242)	(212,117)
Net cash used in investing activities	(174,242)	(212,117)
FINANCING ACTIVITIES:
Preferred stock dividends paid	(755,016)	(202,579)
Settlement of tax withholding obligations on stock issued to employees	(213,675)
Repayments of debt obligations	(92,561)	(764,791)
Contingent consideration payments	(47,111)	(23,650)
Other financing activities	(5,674)	(126,217)
Net cash used in financing activities	(1,114,037)	(1,117,237)
EFFECT OF EXCHANGE RATE CHANGES ON CASH	(206,264)	(30,227)
NET DECREASE IN CASH	(821,162)	(2,227,030)
CASH - Beginning of the period	4,362,232	3,476,880
CASH - End of period	3,541,070	1,249,850
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES:
Dividends declared, not paid	767,463	202,579
SUPPLEMENTAL INFORMATION - Cash paid during the period for:
Income taxes	20,153	8,017
Interest	$ 9,741	$ 129,549

Organization and Business

Organization and Business	3 Months Ended
	Mar. 31, 2018
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 Executive Chairman of MTBC. 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.

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	2. 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 March 31, 2018, the results of operations for the three months ended March 31, 2018 and 2017 and cash flows for the three months ended March 31, 2018 and 2017. 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, 2017 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, 2017, which are included in the Company’s Annual Report on Form 10-K, filed with the SEC on March 7, 2018. Recent Accounting Pronouncements The Company adopted Accounting Standards Update (“ASU”) 2014-09, Revenue from Contracts with Customers The Company determined that the only significant incremental cost incurred to obtain contracts within the scope of ASC 606, are sales commissions paid to sales people and outside referral sources. Under the new standard, certain costs to obtain a contract, which we previously expensed, are deferred and amortized over the period of contract performance or a longer period, generally the expected client life. The impact to the accumulated deficit as of January 1, 2018 was approximately $101,000. As of March 31, 2018, the capitalized sales commissions were approximately $105,000. Amortization of capitalized sales commissions for the three months ended March 31, 2018 was approximately $12,000. The following table reconciles the balances as presented for the three months ended March 31, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 8,307,325 $ 47,071 $ 8,260,254 OPERATING EXPENSES: Direct operating costs 4,484,055 - 4,484,055 Selling and marketing 305,014 (3,537 ) 308,551 General and administrative 2,600,734 - 2,600,734 Research and development 255,880 - 255,880 Change in contingent consideration 31,749 - 31,749 Depreciation and amortization 590,771 - 590,771 Restructuring charges - - - Total operating expenses 8,268,203 (3,537 ) 8,271,740 OPERATING INCOME (LOSS) 39,122 50,608 (11,486 ) OTHER: Interest income 5,285 - 5,285 Interest expense (74,081 ) - (74,081 ) Other income - net 151,374 - 151,374 INCOME BEFORE INCOME TAXES 121,700 50,608 71,092 Income tax provision 46,664 - 46,664 NET INCOME $ 75,036 $ 50,608 $ 24,428 Preferred stock dividend 775,332 - 775,332 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (700,296 ) $ 50,608 $ (750,904 ) Loss per common share: Basic and diluted loss per share $ (0.06 ) $ 0.00 $ (0.06 ) These condensed consolidated financial statements include enhanced disclosures, particularly around the contract asset and the disaggregation of revenue. See Note 9, “Revenue,” for these enhanced disclosures. In February 2016, the FASB issued ASU No. 2016-02, Leases Also in January 2017, the FASB issued ASU No. 2017-04, Intangibles – Goodwill and Other : Simplifying the Accounting for Goodwill Impairment On February 14, 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income.

Acquisition

Acquisition	3 Months Ended
	Mar. 31, 2018
Business Combinations [Abstract]
Acquisitions	3. ACQUISITION 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 a percentage of revenue collected from the WMB accounts for the three years, subsequent to the acquisition date to the extent such amounts in the aggregate exceed the Initial Payment Amount (the “WMB Installment Payments”). Based on the Company’s revenue forecast, it does not appear that there will be any WMB Installment Payments and therefore the aggregate purchase price of WMB was determined to be $205,000. Revenue earned from the WMB acquisition was approximately $66,000 during the three months ended March 31, 2018. Pro forma financial information (Unaudited) The unaudited pro forma information below represents condensed consolidated results of operations as if the WMB acquisition occurred on January 1, 2017. 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. Pro forma information for the three months ended March 31, 2018 is not presented as there was no acquisition which was not fully reflected in the Company’s condensed consolidated financial statements during those three months. Three Months Ended March 31, 2017 Total revenue $ 8,481,699 Net loss attributable to common shareholders $ (2,895,181 ) Net loss per common share $ (0.28 )

Goodwill and Intangible Assets-

Goodwill and Intangible Assets-Net	3 Months Ended
	Mar. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets-Net	4. 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 three months ended March 31, 2018 and the year ended December 31, 2017: March 31, 2018 December 31, 2017 Beginning gross balance $ 12,263,943 $ 12,178,868 Acquisitions - 85,075 Ending gross balance $ 12,263,943 $ 12,263,943 Intangible assets include customer contracts and relationships and covenants not-to-compete acquired in connection with acquisitions, as well as trademarks acquired and software costs. Intangible assets - net as of March 31, 2018 and December 31, 2017 consist of the following: March 31, 2018 December 31, 2017 Contracts and relationships acquired $ 16,491,300 $ 16,491,300 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,509,896 1,498,417 Total intangible assets 19,237,573 19,226,094 Less: Accumulated amortization (17,145,695 ) (16,716,550 ) Intangible assets - net $ 2,091,878 $ 2,509,544 Amortization expense was approximately $440,000 and $1.4 million for the three months ended March 31, 2018 and 2017, respectively. The weighted-average amortization period is three years. As of March 31, 2018, future amortization scheduled to be expensed is as follows: Years ending December 31 2018 (nine months) $ 1,151,451 2019 842,870 2020 93,942 2021 3,615 Total $ 2,091,878

Net Loss Per Common Share

Net Loss Per Common Share	3 Months Ended
	Mar. 31, 2018
Loss per common share:
Net Loss Per Common Share	5. 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 months ended March 31, 2018 and 2017: Three Months Ended March 31, 2018 2017 Basic and Diluted: Net loss attributable to common shareholders $ (700,296 ) $ (2,910,524 ) Weighted average shares applicable to common shareholders used in computing basic and diluted loss per share 11,616,938 10,172,108 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.06 ) $ (0.29 ) All unvested restricted stock units (“RSUs”), the 200,000 warrants granted to Opus Bank (“Opus”), the 125,000 warrants granted to Silicon Valley Bank (“SVB”) 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	3 Months Ended
	Mar. 31, 2018
Debt Disclosure [Abstract]
Debt	6. Debt SVB In connection with the SVB debt agreement, the Company paid SVB approximately $50,000 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. Based on the terms in the SVB credit agreement, the warrants have a strike price equal to $3.92. They have a five-year exercise window and net exercise rights, and were valued at $3.12 per warrant. The SVB credit agreement contains various covenants and conditions governing the revolving line of credit. These covenants include a minimum level of adjusted EBITDA and a minimum liquidity ratio. At March 31, 2018, the Company was in compliance with all covenants. Opus Vehicle Financing Notes Insurance Financing

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	7. Commitments and Contingencies Legal Proceedings Leases Future minimum lease payments under non-cancelable operating leases for office space as of March 31, 2018 are as follows: Years Ending December 31 Total 2018 (nine months) $ 229,310 2019 179,453 Total $ 408,763 Total rental expense, included in direct operating costs and general and administrative expense in the condensed consolidated statements of operations, amounted to approximately $216,000 and $229,000 for the three months ended March 31, 2018 and 2017, respectively. Acquisitions —

Related Parties

Related Parties	3 Months Ended
	Mar. 31, 2018
Related Party Transactions [Abstract]
Related Parties	8. Related PARTIES The Company had sales to a related party, a physician who is the wife of the Executive Chairman. Revenues from this customer were approximately $4,000 for both the three months ended March 31, 2018 and 2017. As of March 31, 2018 and December 31, 2017, the receivable balance due from this customer was approximately $1,300 and $1,900, respectively. The Company is a party to a nonexclusive aircraft dry lease agreement with Kashmir Air, Inc. (“KAI”), which is owned by the Executive Chairman. The Company recorded an expense of approximately $32,000 for both the three months ended March 31, 2018 and 2017. As of March 31, 2018 and December 31, 2017, the Company had a liability outstanding to KAI of approximately $11,000, which is included in accrued liability to related party in the condensed consolidated balance sheets. The Company leases its corporate offices in New Jersey, its temporary housing for its foreign visitors, a storage facility and its backup operations center in Bagh, Pakistan, from the Executive Chairman. The related party rent expense for the three months ended March 31, 2018 and 2017 was approximately $48,000 and $46,000, respectively, and is included in direct operating costs and general and administrative expense in the condensed consolidated statements of operations. Current assets-related party in the condensed 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 March 31, 2018 and December 31, 2017. The March 31, 2018 balance also includes prepaid rent paid to the Executive Chairman of approximately $12,000.

Revenue

Revenue	3 Months Ended
	Mar. 31, 2018
Revenue from Contract with Customer [Abstract]
Revenue	9. REVENUE The Company accounts for revenue in accordance with ASC 606, Revenue from Contracts with Customers All of our revenue is derived from contracts with customers and is reported as revenue in the condensed consolidated statements of operations. In many cases, our clients may terminate their agreements with 90 days’ notice without cause, thereby limiting the term in which we have enforceable rights and obligations, although this time period can vary between clients. Our payment terms are normally net 30 days. We provide value to our clients over the term of the contract and recognize revenue ratably over the term, which is consistent with the measure of progress. In the event that we are entitled to variable consideration for services provided during a specific time period, fees for these services are allocated to and recognized over the specific time period. Our contracts contain penalty clauses for early termination. Although our contracts have stated terms of one or more years, under ASC 606 our contracts are considered month to month, and accordingly, there is no financing component. Disaggregation of Revenue from Contracts with Customers We derive revenue from six primary sources: medical billing services, ancillary services, printing and mailing, clearinghouse and EDI (electronic data interchange) services, Enrollment Plus TM The following table represents a disaggregation of revenue for the three months ended March 31: 2018 2017 Medical billing revenue $ 7,392,390 $ 7,332,635 Ancillary services 248,637 283,657 Printing and mailing 348,243 346,793 Clearinghouse and EDI services 193,439 186,335 Enrollment Plus 83,657 - Professional services 40,959 70,654 Total $ 8,307,325 $ 8,220,074 We apply the portfolio approach as permitted by ASC 606 as a practical expedient to contracts with similar characteristics and we use estimates and assumptions when accounting for those portfolios. Our contracts generally include standard commercial payment terms. We have no significant obligations for refunds, warranties or similar obligations and our revenue does not include taxes collected from our customers. Medical billing revenue: Medical billing is the recurring process of submitting and following up on claims with health insurance companies in order for the healthcare providers to receive payment for the services they rendered. MTBC invoices customers on a monthly basis based on the actual collections received by its customers and the agreed-upon rate in the sales contract. The series of services under medical billing revenue includes practice management software and related tools, electronic health records, revenue cycle management services and mobile health solutions. We consider the series of services provided under our medical billing contracts to be one performance obligation since the promises are not distinct in the context of the contract. Substantially all of our medical billing contracts contain variable consideration and we estimate the variable consideration which we expect to be entitled to over the contractual period associated with our medical billing contracts, which begins no earlier than go-live and recognize the fees over the term. When a contract includes variable consideration, we evaluate the estimate of the variable consideration to determine whether the estimate needs to be constrained; therefore, we include the variable consideration in the transaction price only to the extent that it is probable that a significant reversal of the amount of cumulative revenue recognized will not occur when the uncertainty associated with the variable consideration is subsequently resolved. For the majority of our medical billing contracts, the total contractual price is variable because our obligation is to process an unknown quantity of transactions, as and when requested by our customers, over the contract period. We allocate the variable price to each claim processed using the time-series concept and recognize revenue based on the most likely amount of consideration to which we will be entitled to, which is generally the amount we have the right to invoice. Estimates to determine the variable consideration such as payment to charge ratios, effective billing rates, and the estimated contractual payment periods are updated at each reporting date. The contract asset in the condensed consolidated balance sheet represents the revenue associated with the amounts our clients will ultimately collect associated with the services they have provided and the relative fee we charge associated with those collections. The performance obligations as of January 1, 2018 were substantially recognized in the quarter ended March 31, 2018. As of March 31, 2018, the estimated revenue expected to be recognized in the future related to the remaining performance obligations was approximately $1.4 million. We expect to recognize substantially all of the revenue for the remaining performance obligations over the next 3 months. Our medical billing performance obligations consist of a series of distinct services that are substantially the same and have the same periodic pattern of transfer to our customers. We consider each periodic rendering of service to be a distinct performance obligation and, accordingly, recognize revenue over time. Other revenue streams: Ancillary services represent services such as coding and transcription that are rendered in connection with the delivery of medical billing and related services. The Company invoices customers monthly, based on the actual amount of services performed at the agreed upon rate in the contract. These services are only offered to medical billing customers. These services do not represent a material right because the services are optional to the customer and customers electing these services are charged the same price for those services as if they were on a standalone basis. Each individual coding or transcription transaction processed represents a performance obligation, which is satisfied once that individual service is completed. The Company provides printing and mailing services for a non-medical billing customer and invoices on a monthly basis based on the number of prints, the agreed-upon rate per print and the postage incurred. The performance obligation is satisfied once the printing and mailing is completed. The medical billing clearinghouse takes claim information from customers, checks the claims for errors and sends this information electronically to insurance companies. MTBC invoices customers on a monthly basis based on the number of claims submitted and the agreed-upon rate in the agreement. This service is provided to non-medical billing customers. The performance obligation is satisfied once the relevant submissions are completed. MTBC also provides implementation and professional services to clearinghouse customers and records revenue monthly on a time and materials basis. This is a separate performance obligation from the clearinghouse and EDI services provided. The performance obligation is satisfied once the implementation or professional services is completed. For the Enrollment Plus Plus For all of the above revenue streams, revenue is recognized over time, when invoiced, which closely matches point in time recognition, as the customer simultaneously receives and consumes the benefits provided by the Company. Each of the services provided above is considered a separate performance obligation and is satisfied over time, which is typically one month or less. Information about contract balances: Accounts receivable are shown separately at their net realizable value in our condensed consolidated balance sheets. Amounts that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end of each month when the services have been provided. The contract asset results from our medical billing services and is due to the timing of revenue recognition, submission of claims from our customers and payments from the insurance providers. The contract asset includes our right to payment for services already transferred to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for medical billing services where we recognize revenue over time but do not have a contractual right to payment until the customer receives payment of their claim from the insurance provider. The contract asset was approximately $1.4 million as of March 31, 2018. Changes in the contract asset are recorded as adjustments to net revenues and primarily result from providing services to customers that result in additional consideration and are offset by our right to payment for services becoming unconditional. Deferred revenue represents sign-up fees received from customers that are amortized over 3 years. The opening and closing balances of the Company’s accounts receivable, contract asset and deferred revenue are as follows: Accounts Receivable, Net Contract Asset Deferred Revenue (current) Deferred Revenue (long term) Beginning balance as of January 1, 2018 $ 3,879,463 $ 1,342,692 $ 62,104 $ 28,615 (Decrease) increase, net (102,504 ) 47,071 (20,913 ) (976 ) Ending balance as of March 31, 2018 $ 3,776,959 $ 1,389,763 $ 41,191 $ 27,639 Deferred commissions: Our sales incentive plans include commissions payable to employees and third parties at the time of initial contract execution that are capitalized as incremental costs to obtain a contract. The capitalized commissions are amortized over the period the related services are transferred. As we do not offer commissions on contract renewals, we have determined the amortization period to be the estimated client life, which is 3 years. Deferred commissions were approximately $105,000 at March 31, 2018 and are included in the Other Assets lines in our condensed consolidated balance sheets.

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	10. STOCK-BASED COMPENSATION In April 2014, the Company adopted its Equity Incentive Plan, reserving 1,351,000 shares of common stock for grants to employees, officers, directors and consultants. During April 2017, this plan was amended and restated whereby an additional 1,500,000 shares of common stock and 100,000 shares of Series A Preferred Stock were added to the plan for future issuance. As of March 31, 2018, 1,212,234 shares of common stock and 27,200 shares of Series A Preferred Stock are available for grant under our equity incentive plan. Permissible awards include incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock, 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. Common stock During the third quarter of 2017, a total of 200,000 RSUs of common stock were granted equally to the four outside members of the Board of Directors and a total of 300,000 RSUs of common stock were granted equally to three executive officers. The RSUs vest over the next two years, at six month intervals. The following table summarizes the RSU transactions related to the common stock under our equity incentive plan for the three months ended March 31, 2018: Outstanding and unvested at January 1, 2018 605,969 Granted - Vested (150,482 ) Forfeited (1,000 ) Outstanding and unvested at March 31, 2018 454,487 Of the total outstanding and unvested at March 31, 2018, 441,251 RSUs are classified as equity and 13,236 RSUs are classified as a liability. The liability for the cash-settled awards was approximately $11,000 and $41,000 at March 31, 2018 and December 31, 2017, respectively, and is included in accrued compensation in the condensed consolidated balance sheets. Stock-based compensation expense 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 stock 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 months ended March 31, 2018 and 2017: Stock-based compensation included in the Condensed Consolidated Statement of Operations: Three Months Ended March 31, 2018 2017 Direct operating costs $ 1,384 $ 2,777 General and administrative 125,926 125,291 Research and development 381 1,279 Total stock-based compensation expense $ 127,691 $ 129,347

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2018
Income Tax Disclosure [Abstract]
Income Taxes	11. INCOME TAXES The deferred income tax provision for the three months ended March 31, 2018 and 2017 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 March 31, 2018 and December 31, 2017. 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. On December 22, 2017, the Tax Cuts and Jobs Act (the “Act”) was enacted. Effective January 1, 2018, among other changes, the Act (a) reduces the U.S. federal corporate tax rate to 21 percent, provides for a deemed repatriation and taxation at reduced rates on historical earnings (a “Transition Tax”) of certain non-US subsidiaries owned by U.S. companies and establishes new mechanisms to tax such earnings going forward. For the Transition Tax, further information is required to finalize the estimated amount of accumulated foreign earnings as well as to validate the amount of earnings represented by the aggregate foreign cash position as defined in the Tax Act. We expect to complete our analysis within the measurement period in accordance with Staff Accounting Bulletin (“SAB”) 118. The Act includes a provision effective January 1, 2018 for a global intangible low-taxed income (“GILTI”) tax, which is a new U.S. income inclusion of certain foreign earnings under the Subpart F tax regulations, but ultimately allowable to be offset by the Company’s available net operating loss carryover. Companies can account for the GILTI inclusion in either the period incurred or establish deferred tax liabilities for the expected future taxes associated with accumulated GILTI. The Company elected to record the GILTI provisions as they are incurred each period. The Company will continue to analyze the effects of the Act on its consolidated financial statements and operations. Our estimates are subject to change as we review the data available and any additional guidance. Any additional impacts from the enactment of the Act will be recorded as they are identified during the measurement period as provided in SAB 118. No provisional amounts were recorded during the quarter ended March 31, 2018.

Restructuring Charges

Restructuring Charges	3 Months Ended
	Mar. 31, 2018
Restructuring and Related Activities [Abstract]
Restructuring Charges	12. 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 Company does not expect to record any additional restructuring charges for these closures.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	3 Months Ended
	Mar. 31, 2018
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	13. FAIR VALUE OF FINANCIAL INSTRUMENTS As of March 31, 2018 and December 31, 2017, the carrying amounts of receivables, accounts payable and accrued expenses 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. Contingent Consideration The Company’s contingent consideration of approximately $588,000 and $603,000 as of March 31, 2018 and December 31, 2017, respectively, are Level 3 liabilities. The fair value of the contingent consideration at March 31, 2018 and December 31, 2017 was primarily driven by changes in revenue estimates related to the acquisitions during 2015 and 2016, 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 Three Months Ended March 31, 2018 2017 Balance - January 1, $ 603,411 $ 929,549 Change in fair value 31,749 (11,188 ) Payments (47,111 ) (23,650 ) Balance - March 31, $ 588,049 $ 894,711

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2018
Subsequent Events [Abstract]
Subsequent Events	15. SUBSEQUENT EVENTS During April 2018, the Company completed a $10.5 million offering of its Preferred Stock and received net proceeds of approximately $9.4 million. On May 3, 2018, the Company executed an asset purchase agreement (“APA”) to acquire substantially all of the revenue cycle, practice management, and group purchasing organization assets of Orion Healthcorp Inc., and 13 of its subsidiaries, (together “Orion”). The purchase price is based on an evaluation of the assets acquired and is currently estimated to be between approximately $10-12 million. The actual purchase price will be determined prior to closing and can exceed $12 million based on the final evaluation. The Company will deposit $1 million into escrow, which will be credited towards the purchase price at closing or returned to the Company if the transaction is terminated for reasons other than a breach by the Company. The $1 million deposit will be funded from the cash on hand. The purchase price will be paid in cash and the assumption of certain specified liabilities. Orion has pending cases under Chapter 11 of the United States Bankruptcy Code in the bankruptcy court. The sale of Orion’s medical billing business assets will be conducted under the auction process of Section 363 of the Bankruptcy Code, and the APA will serve as a stalking horse bid that will be subject to potentially higher and otherwise better bids from other bidders at the proposed auction. Subject to certain conditions, if the APA is terminated, Orion must pay a break-up fee to MTBC equal to $400,000 and reimburse MTBC’s expenses up to $200,000. The APA also remains subject to the satisfaction of certain closing conditions, including bankruptcy court approval and the absence of certain material adverse events. No assurance can be given that the proposed transaction with Orion will be consummated at all or, if consummated, will be consummated on the terms and conditions set forth in the APA.

Basis Of Presentation (Tables)

Basis Of Presentation (Tables)	3 Months Ended
	Mar. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule Prior Adjustments for Implements to New Revenue Recognition	The following table reconciles the balances as presented for the three months ended March 31, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 8,307,325 $ 47,071 $ 8,260,254 OPERATING EXPENSES: Direct operating costs 4,484,055 - 4,484,055 Selling and marketing 305,014 (3,537 ) 308,551 General and administrative 2,600,734 - 2,600,734 Research and development 255,880 - 255,880 Change in contingent consideration 31,749 - 31,749 Depreciation and amortization 590,771 - 590,771 Restructuring charges - - - Total operating expenses 8,268,203 (3,537 ) 8,271,740 OPERATING INCOME (LOSS) 39,122 50,608 (11,486 ) OTHER: Interest income 5,285 - 5,285 Interest expense (74,081 ) - (74,081 ) Other income - net 151,374 - 151,374 INCOME BEFORE INCOME TAXES 121,700 50,608 71,092 Income tax provision 46,664 - 46,664 NET INCOME $ 75,036 $ 50,608 $ 24,428 Preferred stock dividend 775,332 - 775,332 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (700,296 ) $ 50,608 $ (750,904 ) Loss per common share: Basic and diluted loss per share $ (0.06 ) $ 0.00 $ (0.06 )

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2018
Business Combinations [Abstract]
Business Acquisition, Pro Forma Information	Pro forma information for the three months ended March 31, 2018 is not presented as there was no acquisition which was not fully reflected in the Company’s condensed consolidated financial statements during those three months. Three Months Ended March 31, 2017 Total revenue $ 8,481,699 Net loss attributable to common shareholders $ (2,895,181 ) Net loss per common share $ (0.28 )

Goodwill and Intangible Asset24

Goodwill and Intangible Assets-Net (Tables)	3 Months Ended
	Mar. 31, 2018
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 three months ended March 31, 2018 and the year ended December 31, 2017: March 31, 2018 December 31, 2017 Beginning gross balance $ 12,263,943 $ 12,178,868 Acquisitions - 85,075 Ending gross balance $ 12,263,943 $ 12,263,943
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 trademarks acquired and software costs. Intangible assets - net as of March 31, 2018 and December 31, 2017 consist of the following: March 31, 2018 December 31, 2017 Contracts and relationships acquired $ 16,491,300 $ 16,491,300 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,509,896 1,498,417 Total intangible assets 19,237,573 19,226,094 Less: Accumulated amortization (17,145,695 ) (16,716,550 ) Intangible assets - net $ 2,091,878 $ 2,509,544
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	As of March 31, 2018, future amortization scheduled to be expensed is as follows: Years ending December 31 2018 (nine months) $ 1,151,451 2019 842,870 2020 93,942 2021 3,615 Total $ 2,091,878

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2018
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 months ended March 31, 2018 and 2017: Three Months Ended March 31, 2018 2017 Basic and Diluted: Net loss attributable to common shareholders $ (700,296 ) $ (2,910,524 ) Weighted average shares applicable to common shareholders used in computing basic and diluted loss per share 11,616,938 10,172,108 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.06 ) $ (0.29 )

Commitments and Contingencies (

Commitments and Contingencies (Tables)	3 Months Ended
	Mar. 31, 2018
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 March 31, 2018 are as follows: Years Ending December 31 Total 2018 (nine months) $ 229,310 2019 179,453 Total $ 408,763

Revenue (Tables)

Revenue (Tables)	3 Months Ended
	Mar. 31, 2018
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following table represents a disaggregation of revenue for the three months ended March 31: 2018 2017 Medical billing revenue $ 7,392,390 $ 7,332,635 Ancillary services 248,637 283,657 Printing and mailing 348,243 346,793 Clearinghouse and EDI services 193,439 186,335 Enrollment Plus 83,657 - Professional services 40,959 70,654 Total $ 8,307,325 $ 8,220,074
Schedule of Accounts Receivable, Contract Asset and Deferred Revenue	The opening and closing balances of the Company’s accounts receivable, contract asset and deferred revenue are as follows: Accounts Receivable, Net Contract Asset Deferred Revenue (current) Deferred Revenue (long term) Beginning balance as of January 1, 2018 $ 3,879,463 $ 1,342,692 $ 62,104 $ 28,615 (Decrease) increase, net (102,504 ) 47,071 (20,913 ) (976 ) Ending balance as of March 31, 2018 $ 3,776,959 $ 1,389,763 $ 41,191 $ 27,639

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Disclosure of Share-based Compensation Arrangements by Share-based Payment Award	The following table summarizes the RSU transactions related to the common stock under our equity incentive plan for the three months ended March 31, 2018: Outstanding and unvested at January 1, 2018 605,969 Granted - Vested (150,482 ) Forfeited (1,000 ) Outstanding and unvested at March 31, 2018 454,487
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 months ended March 31, 2018 and 2017: Stock-based compensation included in the Condensed Consolidated Statement of Operations: Three Months Ended March 31, 2018 2017 Direct operating costs $ 1,384 $ 2,777 General and administrative 125,926 125,291 Research and development 381 1,279 Total stock-based compensation expense $ 127,691 $ 129,347

Fair Value of Financial Instr29

Fair Value of Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2018
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 Three Months Ended March 31, 2018 2017 Balance - January 1, $ 603,411 $ 929,549 Change in fair value 31,749 (11,188 ) Payments (47,111 ) (23,650 ) Balance - March 31, $ 588,049 $ 894,711

Organization and Business (Deta

Organization and Business (Details Narrative)	Mar. 31, 2018
Founder and Executive Chairman [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%

Basis of Presentation (Details

Basis of Presentation (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017	Dec. 31, 2017
Contract asset	$ 1,389,763
Accumulated deficit	(21,990,229)		$ (23,509,386)
Capitalized sales commissions	105,000
Amortization of sales commissions	12,065
January 1, 2018 [Member]
Accumulated deficit	$ 101,000

Basis of Presentation - Schedul

Basis of Presentation - Schedule Prior Adjustments for Implements to New Revenue Recognition (Details) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
NET REVENUE	$ 8,307,325	$ 8,220,074
OPERATING EXPENSES:
Direct operating costs	4,484,055	5,222,736
Selling and marketing	305,014	355,511
General and administrative	2,600,734	2,986,663
Research and development	255,880	280,849
Change in contingent consideration	31,749	(11,188)
Depreciation and amortization	590,771	1,519,545
Restructuring charges		275,628
Total operating expenses	8,268,203	10,629,744
OPERATING INCOME (LOSS)	39,122	(2,409,670)
OTHER:
Interest income	5,285	3,421
Interest expense	(74,081)	(279,425)
Other income - net	151,374	38,031
INCOME BEFORE INCOME TAXES	121,700	(2,647,643)
Income tax provision	46,664	60,302
Net Income	75,036	(2,707,945)
Preferred stock dividend	775,332	202,579
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (700,296)	$ (2,910,524)
Loss per common share:
Basic and diluted loss per share	$ (0.06)	$ (0.29)
Impact of New Revenue Standard [Member]
NET REVENUE	$ 47,071
OPERATING EXPENSES:
Direct operating costs
Selling and marketing	(3,537)
General and administrative
Research and development
Change in contingent consideration
Depreciation and amortization
Restructuring charges
Total operating expenses	(3,537)
OPERATING INCOME (LOSS)	50,608
OTHER:
Interest income
Interest expense
Other income - net
INCOME BEFORE INCOME TAXES	50,608
Income tax provision
Net Income	50,608
Preferred stock dividend
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ 50,608
Loss per common share:
Basic and diluted loss per share	$ 0
Previous Revenue Standard [Member]
NET REVENUE	$ 8,260,254
OPERATING EXPENSES:
Direct operating costs	4,484,055
Selling and marketing	308,551
General and administrative	2,600,734
Research and development	255,880
Change in contingent consideration	31,749
Depreciation and amortization	590,771
Restructuring charges
Total operating expenses	8,271,740
OPERATING INCOME (LOSS)	(11,486)
OTHER:
Interest income	5,285
Interest expense	(74,081)
Other income - net	151,374
INCOME BEFORE INCOME TAXES	71,092
Income tax provision	46,664
Net Income	24,428
Preferred stock dividend	775,332
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (750,904)
Loss per common share:
Basic and diluted loss per share	$ (0.06)

Acquisitions (Details Narrative

Acquisitions (Details Narrative) - USD ($)	3 Months Ended	9 Months Ended
	Mar. 31, 2018	Mar. 31, 2018	Jul. 01, 2017
Revenue earned from the WMB acquisition	$ 66,000
Asset Purchase Agreement [Member] | Washington Medical Billing, LLC [Member]
Non-refundable initial payment amount			$ 205,000
Payments to acquire business		$ 205,000

Acquisitions - Business Acquisi

Acquisitions - Business Acquisition, Pro Forma Information (Details)	3 Months Ended
	Mar. 31, 2017USD ($)$ / shares
Business Combinations [Abstract]
Total revenue	$ 8,481,699
Net loss attributable to common shareholders	$ (2,895,181)
Net loss per common share | $ / shares	$ (0.28)

Goodwill and Intangible Asset35

Goodwill and Intangible Assets-Net (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expenses	$ 440,000	$ 1,400,000

Goodwill and Intangible Asset36

Goodwill and Intangible Assets-Net - Schedule of Intangible Assets and Goodwill (Details) - USD ($)	3 Months Ended	12 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Beginning gross balance	$ 12,263,943	$ 12,178,868
Acquisitions		85,075
Ending gross balance	$ 12,263,943	$ 12,263,943

Goodwill and Intangible Asset37

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)	Mar. 31, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	$ 19,237,573	$ 19,226,094
Less: Accumulated amortization	(17,145,695)	(16,716,550)
Intangible assets - net	2,091,878	2,509,544
Customer Relationships Acquired [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	16,491,300	16,491,300
Non-Compete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	1,236,377	1,236,377
Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	$ 1,509,896	$ 1,498,417

Goodwill and Intangible Asset38

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details) - USD ($)	Mar. 31, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Years ending 31 December 2018	$ 1,151,451
2,019	842,870
2,020	93,942
2,021	3,615
Total	$ 2,091,878	$ 2,509,544

Net Loss Per Common Share (Deta

Net Loss Per Common Share (Details Narrative)	Jun. 30, 2017shares
SVB Credit Facility Agreement [Member]
Antidilutive securities excluded from computation of earning per share, amount	125,000
Opus Bank [Member]
Antidilutive securities excluded from computation of earning per share, amount	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
	Mar. 31, 2018	Mar. 31, 2017
Loss per common share:
Net loss attributable to common shareholders	$ (700,296)	$ (2,910,524)
Weighted average shares applicable to common shareholders used in computing basic and diluted loss per share	11,616,938	10,172,108
Net loss attributable to common shareholders per share - Basic and Diluted	$ (0.06)	$ (0.29)

Debt (Details Narrative)

Debt (Details Narrative) - USD ($)	1 Months Ended	3 Months Ended
	Oct. 31, 2017	Mar. 31, 2018	Sep. 02, 2015
Revolving line of credit	$ 5,000,000
Opus Bank Loan [Member]
Percentage of shares secured for debt		65.00%
Opus Bank Loan [Member] | Term Loan [Member]
Credit facility, maximum borrowing capacity			$ 8,000,000
Opus Bank Loan [Member] | Total [Member]
Credit facility, maximum borrowing capacity			10,000,000
Vehicle Financing Notes [Member]
Debt instrument term description		three to six year terms
Insurance Financing [Member]
Debt instrument, interest rate, stated percentage		5.25%
SVB Debt Agreement [Member]
Payment of fees	$ 50,000
Class of warrant or right, number of securities called by warrants or rights	125,000
Payments for annual anniversary fee	$ 50,000
Warrant strike price	$ 3.92
Warrant exercise term	5 years
Warrants price per share	$ 3.12
SVB Credit Facility [Member]
Revolving line of credit	$ 5,000,000
Secured revolving line of credit percentage	200.00%
Revolving line of credit, interest rate - Prime plus	1.75%
Percentage of shares in offshore facilities	65.00%
SVB Credit Facility [Member] | Prime Rate [Member]
Unsecured portion of credit line fee, percentage	1.00%
Revolving Credit Facility [Member] | Opus Bank Loan [Member]
Credit facility, maximum borrowing capacity			$ 2,000,000

Commitments and Contingencies42

Commitments and Contingencies (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Operating leases expire year	expiring through 2021.
Operating leases, rent expense	$ 216,000	$ 229,000
Off Shore Lease [Member]
Lease monthly rental payments	22,000
US Corporate Facility and Other Locations [Member]
Monthly rent expense of month to month leases	$ 12,000

Commitments and Contingencies -

Commitments and Contingencies - Schedule of Future Minimum Lease Payments Under Non-cancelable Operating Leases (Details)	Mar. 31, 2018USD ($)
Commitments and Contingencies Disclosure [Abstract]
Years ending 31,Dec 2018	$ 229,310
2,019	179,453
Total	$ 408,763

Related Parties (Details Narrat

Related Parties (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017	Dec. 31, 2017
Operating leases, rent expense	$ 216,000	$ 229,000
Accrued liability to related party	10,663		$ 10,675
Kashmir Air, Inc [Member]
Operating leases, rent expense	32,000	32,000
Accrued liability to related party	11,000		11,000
Physician [Member]
Revenues	4,000	4,000
Receivable balance due from this customer	1,300		1,900
Founder and Executive Chairman [Member]
Operating leases, rent expense	48,000	$ 46,000
Security deposit	13,000		$ 13,000
Prepaid rent	$ 12,000

Revenue (Details Narrative)

Revenue (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Revenue from Contract with Customer [Abstract]
Remaining performance obligations	$ 1,400,000
Contract asset	$ 1,389,763
Revenue received from customer description	amortized over 3 years
Deferred commissions	$ 105,000

Revenue - Schedule of Disaggreg

Revenue - Schedule of Disaggregation of Revenue (Details) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Net revenue	$ 8,307,325	$ 8,220,074
Medical Billing Revenue [Member]
Net revenue	7,392,390	7,332,635
Ancillary Services [Member]
Net revenue	248,637	283,657
Printing and Mailing [Member]
Net revenue	348,243	346,793
Clearing House and EDI Services [Member]
Net revenue	193,439	186,335
Enrollment Plus [Member]
Net revenue	83,657
Professional Services [Member]
Net revenue	$ 40,959	$ 70,654

Revenue - Schedule of Accounts

Revenue - Schedule of Accounts Receivable, Contract Asset and Deferred Revenue (Details) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Accounts receivable net, beginning balance	$ 3,879,463
Accounts receivable (Decrease) increase, net	(23,948)	$ (248,383)
Accounts receivable net, ending balance	3,776,959
Contract asset, beginning balance
Contract asset, ending balance	1,389,763
Deferred revenue(current), beginning balance	62,104
Deferred revenue(current)(Decrease)/ increase, net	(21,889)	$ (15,105)
Deferred revenue(current), ending balance	41,191
Deferred revenue(long term), beginning balance	28,615
Deferred revenue(long term), ending balance	27,639
Contract Balances [Member]
Accounts receivable net, beginning balance	3,879,463
Accounts receivable (Decrease) increase, net	(102,504)
Accounts receivable net, ending balance	3,776,959
Contract asset, beginning balance	1,342,692
Contract asset (Decrease)/ increase, net	47,071
Contract asset, ending balance	1,389,763
Deferred revenue(current), beginning balance	62,104
Deferred revenue(current)(Decrease)/ increase, net	(20,913)
Deferred revenue(current), ending balance	41,191
Deferred revenue(long term), beginning balance	28,615
Deferred revenue(long term) (Decrease)/ increase, net	(976)
Deferred revenue(long term), ending balance	$ 27,639

Stock-based Compensation (Detai

Stock-based Compensation (Details Narrative) - USD ($)	Apr. 30, 2017	Mar. 31, 2018	Sep. 30, 2017	Dec. 31, 2017	Apr. 30, 2014
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Accrued compensation		$ 960,720		$ 1,137,351
Restricted Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, equity instruments other than options, grants in period
Unvested stock option award, equity		441,251
Restricted stock award classified as liability		13,236
Accrued compensation		$ 11,000		$ 41,000
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 added to amended and restated equity incentive plan	1,500,000
Number of shares available for grant		1,212,234
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 added to amended and restated equity incentive plan	100,000
Number of shares available for grant		27,200
Amended and Restated Equity Incentive Plan [Member] | Restricted Shares [Member] | Four Outsides Members of the Board [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, equity instruments other than options, grants in period			200,000
Amended and Restated 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
Amended and Restated Equity Incentive Plan [Member] | Three Executive Officers [Member] | Restricted Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, equity instruments other than options, grants in period			300,000

Stock-Based Compensation - Disc

Stock-Based Compensation - Disclosure of Share-based Compensation Arrangements by Share-based Payment Award (Details) - Restricted Shares [Member]	3 Months Ended
	Mar. 31, 2018shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	605,969
Granted
Vested	(150,482)
Forfeited	(1,000)
Outstanding and unvested at ending	454,487

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs (Details) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 127,691	$ 129,347
Direct Operating Costs [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	1,384	2,777
General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	125,926	125,291
Research and Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 381	$ 1,279

Income Taxes (Details Narrative

Income Taxes (Details Narrative)	Dec. 22, 2017
Federal-Tax Cuts and Jobs Act [Member]
Federal statutory income tax rate	21.00%

Restructuring Charges (Details

Restructuring Charges (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Restructuring and Related Activities [Abstract]
Restructuring charges		$ 275,628

Fair Value of Financial Instr53

Fair Value of Financial Instruments (Details Narrative) - USD ($)	Mar. 31, 2018	Dec. 31, 2017
Fair Value, Input, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business combination, contingent consideration, liability	$ 588,000	$ 603,000

Fair Value of Financial Instr54

Fair Value of Financial Instruments - Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - Fair Value, Input, Level 3 [Member] - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance, beginning	$ 603,411	$ 929,549
Change in fair value	31,749	(11,188)
Payments	(47,111)	(23,650)
Balance, ending	$ 588,049	$ 894,711

Subsequent Events (Details Narr

Subsequent Events (Details Narrative) - Subsequent Event [Member] - USD ($)	May 03, 2018	Mar. 31, 2018
Agreement break up fee	$ 400,000
Reimbursement revenue	$ 200,000
Asset Purchase Agreement [Member]
Business Acquisition description	The actual purchase price will be determined prior to closing and may be more than $12 million based on the evaluation of the assets acquired.
Asset Purchase Agreement [Member] | Cash on Hand [Member]
Escrow deposit	$ 1,000,000
Cash on hand	1,000,000
Minimum [Member]
Business Acquisition price	10,000,000
Maximum [Member]
Business Acquisition price	$ 12,000,000
April 30 2018 [Member]
Public offering amount		$ 10,500,000
Proceeds from issuance of share		$ 9,400,000