CareCloud (CCLD) 10-Q 7 Nov 18 2018 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2018	Nov. 05, 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	Sep. 30, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Small Business Flag	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Common Stock, Shares Outstanding		11,829,758
Trading Symbol	MTBC
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2,018

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($)	Sep. 30, 2018	Dec. 31, 2017
CURRENT ASSETS:
Cash	$ 1,259,574	$ 4,362,232
Accounts receivable - net of allowance for doubtful accounts of $189,000 and $185,000 at September 30, 2018 and December 31, 2017, respectively	8,443,857	3,879,463
Contract asset	2,480,479
Inventory	456,136
Current assets - related party	25,203	25,203
Prepaid expenses and other current assets	1,112,134	662,822
Total current assets	13,777,383	8,929,720
Property and equipment - net	1,869,513	1,385,743
Intangible assets - net	7,180,153	2,509,544
Goodwill	12,681,055	12,263,943
Other assets	553,338	436,713
TOTAL ASSETS	36,061,442	25,525,663
CURRENT LIABILITIES:
Accounts payable	2,711,580	991,859
Accrued compensation	1,866,482	1,137,351
Accrued expenses	1,389,170	616,778
Deferred rent (current portion)	94,348	81,826
Deferred revenue (current portion)	30,214	62,104
Accrued liability to related party	10,663	10,675
Notes payable - other (current portion)	375,503	168,718
Contingent consideration (current portion)	560,169	505,557
Dividend payable	1,056,218	747,147
Total current liabilities	8,094,347	4,322,015
Notes payable - other	264,854	120,899
Deferred rent	231,036	333,788
Deferred revenue	19,632	28,615
Contingent consideration		97,854
Deferred tax liability	185,000	372,072
Total liabilities	8,794,869	5,275,243
COMMITMENTS AND CONTINGENCIES (Note 7)
SHAREHOLDERS' EQUITY:
Preferred stock, par value $0.001 per share - authorized 4,000,000 shares; issued and outstanding 1,536,289 and 1,086,739 shares at September 30, 2018 and December 31, 2017, respectively	1,536	1,087
Common stock, $0.001 par value - authorized 19,000,000 shares; issued 12,570,557 and 12,271,390 shares at September 30, 2018 and December 31, 2017, respectively; outstanding, 11,829,758 and 11,530,591 shares at September 30, 2018 and December 31, 2017, respectively	12,571	12,272
Additional paid-in capital	52,518,310	45,129,517
Accumulated deficit	(23,627,402)	(23,509,386)
Accumulated other comprehensive loss	(976,442)	(721,070)
Less: 740,799 common shares held in treasury, at cost at September 30, 2018 and December 31, 2017	(662,000)	(662,000)
Total shareholders' equity	27,266,573	20,250,420
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 36,061,442	$ 25,525,663

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($)	Sep. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Allowance for doubtful accounts receivable	$ 189,000	$ 185,000
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	4,000,000	4,000,000
Preferred stock, shares issued	1,536,289	1,086,739
Preferred stock, shares outstanding	1,536,289	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	12,570,557	12,271,390
Common stock, shares, outstanding	11,829,758	11,530,591
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, 2018	Sep. 30, 2017	Mar. 31, 2017	Sep. 30, 2018	Sep. 30, 2018	Sep. 30, 2017
Income Statement [Abstract]
NET REVENUE	$ 17,044,526	$ 7,513,592		$ 34,034,788		$ 23,518,416
OPERATING EXPENSES:
Direct operating costs	12,123,907	4,171,932		20,941,535		13,592,492
Selling and marketing	461,512	228,991		1,169,583		853,460
General and administrative	5,131,295	2,474,139		10,786,234		8,232,613
Research and development	263,717	249,045		768,517		843,294
Change in contingent consideration	25,473			68,253		151,423
Depreciation and amortization	822,098	664,441		1,972,565		3,637,131
Restructuring charges			$ 276,000			275,628
Total operating expenses	18,828,002	7,788,548		35,706,687		27,586,041
OPERATING LOSS	(1,783,476)	(274,956)		(1,671,899)		(4,067,625)
OTHER:
Interest income	24,544	5,446		59,768		13,598
Interest expense	(104,872)	(678,103)		(253,120)		(1,242,672)
Other (expense) income - net	(218,721)	32,494		151,242		107,364
LOSS BEFORE INCOME TAXES	(2,082,525)	(915,119)		(1,714,009)		(5,189,335)
Income tax (benefit) provision	(250,072)	65,000		(151,872)		192,332
NET LOSS	(1,832,453)	(980,119)		(1,562,137)	$ (1,562,137)	(5,381,667)
Preferred stock dividend	1,056,214	652,697		3,080,263		1,283,151
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (2,888,667)	$ (1,632,816)		$ (4,642,400)		$ (6,664,818)
Net loss per common share: basic and diluted	$ (0.25)	$ (0.14)		$ (0.40)		$ (0.62)
Weighted-average common shares used to compute basic and diluted loss per share	11,770,178	11,485,811		11,684,659		10,835,142

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($)		3 Months Ended		9 Months Ended
		Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Statement of Comprehensive Income [Abstract]
NET LOSS		$ (1,832,453)	$ (980,119)	$ (1,562,137)	$ (5,381,667)
OTHER COMPREHENSIVE LOSS, NET OF TAX
Foreign currency translation adjustment	[1]	175,032	(33,880)	(255,372)	(64,731)
COMPREHENSIVE LOSS		$ (1,657,421)	$ (1,013,999)	$ (1,817,509)	$ (5,446,398)
[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 Statem_3

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. 29, 2017	$ 1,087	$ 12,272	$ 45,129,517	$ (23,509,386)	$ (721,070)	$ (662,000)	$ 20,250,420
Balance, shares at Dec. 29, 2017	1,086,739	12,271,390
Cumulative effect of adopting ASC 606				1,444,121			1,444,121
Balance at Jan. 02, 2018	$ 1,087	$ 12,272	45,129,517	(22,065,265)	(721,070)	(662,000)	21,694,541
Balance, shares at Jan. 02, 2018	1,086,739	12,271,390
Balance at Dec. 31, 2017							20,250,420
Net loss							(1,562,137)
Balance at Sep. 30, 2018	$ 1,536	$ 12,571	52,518,310	(23,627,402)	(976,442)	(662,000)	27,266,573
Balance, shares at Sep. 30, 2018	1,536,289	12,570,557
Balance at Jan. 02, 2018	$ 1,087	$ 12,272	45,129,517	(22,065,265)	(721,070)	(662,000)	21,694,541
Balance, shares at Jan. 02, 2018	1,086,739	12,271,390
Net loss				(1,562,137)			(1,562,137)
Foreign currency translation adjustment					(255,372)		(255,372)
Issuance of stock under the Amended and Restated Equity Incentive Plan	$ 29	$ 299	(328)
Issuance of stock under the Amended and Restated Equity Incentive Plan, shares	29,550	299,167
Common stock warrants issued			101,989				101,989
Stock-based compensation, net of cash settlements			1,358,405				1,358,405
Tax withholding obligations on stock issued to employees			(345,500)				(345,500)
Issuance of preferred stock, net of fees and expenses	$ 420		9,354,490				9,354,910
Issuance of preferred stock, net of fees and expenses, shares	420,000
Preferred stock dividends			(3,080,263)				(3,080,263)
Balance at Sep. 30, 2018	$ 1,536	$ 12,571	$ 52,518,310	$ (23,627,402)	$ (976,442)	$ (662,000)	$ 27,266,573
Balance, shares at Sep. 30, 2018	1,536,289	12,570,557

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
OPERATING ACTIVITIES:
Net loss	$ (1,562,137)	$ (5,381,667)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	1,972,565	3,637,131
Amortization of sales commissions	42,943
Deferred rent	(49,608)	(38,544)
Deferred revenue	(40,873)	13,807
Provision for doubtful accounts	261,541	357,671
(Benefit) provision for deferred income taxes	(187,072)	165,000
Foreign exchange gain	(105,418)	(27,145)
Interest accretion	143,030	672,998
Non-cash restructuring charges		17,001
Stock-based compensation expense	1,523,682	333,854
Change in contingent consideration	68,253	151,423
Changes in operating assets and liabilities, net of businesses acquired:
Accounts receivable	901,683	437,557
Contract asset	(464,470)
Inventory	(148,858)
Other assets	(24,869)	107,532
Accounts payable and other liabilities	2,418,110	(1,754,255)
Net cash provided by (used in) operating activities	4,748,502	(1,307,637)
INVESTING ACTIVITIES:
Capital expenditures	(743,115)	(499,988)
Cash paid for acquisition	(12,600,000)	(205,000)
Net cash used in investing activities	(13,343,115)	(704,988)
FINANCING ACTIVITIES:
Proceeds from issuance of common stock, net of placement costs		2,000,000
Proceeds from issuance of preferred stock, net of placement costs	9,354,910	13,484,552
Preferred stock dividends paid	(2,771,192)	(846,825)
Settlement of tax withholding obligations on stock issued to employees	(333,007)	(195,912)
Repayments of notes payable	(329,426)	(7,626,088)
Repayment of Prudential obligation		(5,000,000)
Proceeds from line of credit	6,625,000	7,000,000
Repayments of line of credit	(6,625,000)	(7,000,000)
Contingent consideration payments	(111,495)	(79,603)
Other financing activities	(33,150)	(335,239)
Net cash provided by financing activities	5,776,640	1,400,885
EFFECT OF EXCHANGE RATE CHANGES ON CASH	(284,685)	(75,758)
NET DECREASE IN CASH	(3,102,658)	(687,498)
CASH - Beginning of the period	4,362,232	3,476,880
CASH - End of period	1,259,574	2,789,382
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES:
Vehicle financing obtained	90,284	30,746
Dividends declared, not paid	1,056,218	638,905
Purchase of prepaid insurance through assumption of note	271,248	298,698
Warrants issued	101,989
SUPPLEMENTAL INFORMATION - Cash paid during the period for:
Income taxes	29,673	9,513
Interest	$ 45,083	$ 599,950

Organization and Business

Organization and Business	9 Months Ended
	Sep. 30, 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, maintains client support teams throughout the U.S., 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 of 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 May 2018, MTBC formed MTBC Health, Inc. (“MHI”) and MTBC Practice Management, Corp. (“MPM”), each a Delaware corporation in connection MTBC’s acquisition of substantially all of the revenue cycle management, practice management and group purchasing organization assets of Orion Healthcorp, Inc. and 13 of its affiliates (together, “Orion”). MHI is a direct, wholly owned subsidiary of MTBC, and was formed to own and operate the revenue cycle management and group purchasing organization businesses acquired from Orion. MPM is a wholly owned subsidiary of MHI and was formed to own and operate the practice management business acquired from Orion. In conjunction with its continued growth of its offshore operations in Pakistan and Sri Lanka, in April 2017, MTBC began winding down its operations in India and Poland. These operations have been terminated and the Indian subsidiary is being liquidated. The Poland subsidiary has already been liquidated.

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 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 September 30, 2018, the results of operations for the three and nine months ended September 30, 2018 and 2017 and cash flows for the nine months ended September 30, 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 September 30, 2018, the capitalized sales commissions were approximately $108,000 and are included in other assets in the condensed consolidated balance sheet. Amortization of capitalized sales commissions for the three and nine months ended September 30, 2018 was approximately $16,000 and $43,000, respectively, and is included in selling and marketing expenses in the condensed consolidated statements of operations. The following table reconciles the balances as presented for the three and nine months ended September 30, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: Three Months Ended September 30, 2018 Nine Months Ended September 30, 2018 As Presented Impact of New Revenue Standard Previous Revenue Standard As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 17,044,526 $ (251,120 ) $ 17,295,646 $ 34,034,788 $ 75,511 $ 33,959,277 OPERATING EXPENSES: Direct operating costs 12,123,907 - 12,123,907 20,941,535 - 20,941,535 Selling and marketing 461,512 5,076 456,436 1,169,583 (6,149 ) 1,175,732 General and administrative 5,131,295 - 5,131,295 10,786,234 - 10,786,234 Research and development 263,717 - 263,717 768,517 - 768,517 Change in contingent consideration 25,473 - 25,473 68,253 - 68,253 Depreciation and amortization 822,098 - 822,098 1,972,565 - 1,972,565 Total operating expenses 18,828,002 5,076 18,822,926 35,706,687 (6,149 ) 35,712,836 OPERATING (LOSS) INCOME (1,783,476 ) (256,196 ) (1,527,280 ) (1,671,899 ) 81,660 (1,753,559 ) OTHER: Interest income 24,544 - 24,544 59,768 - 59,768 Interest expense (104,872 ) - (104,872 ) (253,120 ) - (253,120 ) Other (expense) income - net (218,721 ) - (218,721 ) 151,242 - 151,242 (LOSS) INCOME BEFORE INCOME TAXES (2,082,525 ) (256,196 ) (1,826,329 ) (1,714,009 ) 81,660 (1,795,669 ) Income tax benefit (250,072 ) - (250,072 ) (151,872 ) - (151,872 ) NET (LOSS) INCOME $ (1,832,453 ) $ (256,196 ) $ (1,576,257 ) $ (1,562,137 ) $ 81,660 $ (1,643,797 ) Preferred stock dividend 1,056,214 - 1,056,214 3,080,263 - 3,080,263 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (2,888,667 ) $ (256,196 ) $ (2,632,471 ) $ (4,642,400 ) $ 81,660 $ (4,724,060 ) Loss per common share: Basic and diluted (loss) income per share $ (0.25 ) $ (0.03 ) $ (0.22 ) $ (0.40 ) $ 0.01 $ (0.41 ) 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 (Topic 842). Leases (Topic 842) Targeted Improvements 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.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2018
Business Combinations [Abstract]
Acquisitions	3. ACQUISITIONS 2018 Acquisition On May 7, 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. The purchase price was $12.6 million, excluding acquisition-related costs of approximately $245,000, which are included in general and administrative expense in the condensed consolidated statement of operations. Per the APA, the acquisition had an effective date of July 1, 2018. The acquisition has been accounted for as a business combination. The Company is in the process of integrating the acquired businesses and determining how the results of the business will be analyzed and reviewed. When the purchase price allocation is finalized and the integration of the businesses has been completed, the Company will determine whether there are additional operating segments. The Orion acquisition added a significant number of clients to the Company’s customer base and, similar to previous acquisitions, broadened the Company’s presence in the healthcare information technology industry through geographic expansion of its customer base and by increasing available customer relationship resources and specialized trained staff. The acquisition also included Orion’s practice management and group purchasing services. The practice management services provide three pediatric medical practices with the nurses, administrative support, facilities, supplies, equipment, marketing, RCM, accounting and other non-clinical services needed to efficiently operate the practices. The group purchasing services enable medical providers to purchase various vaccines directly from selected pharmaceutical companies at a discounted price. The Company engaged a third party valuation specialist to assist the Company in valuing the assets acquired from Orion. The following table summarizes the preliminary purchase price allocation. The Company expects to finalize the purchase price allocation by year-end and is finalizing the projections and the valuation of the acquired assets and assumed liabilities. Acquired intangibles $ 6,100,000 Accounts receivable 5,727,618 Contract asset 673,317 Inventory 307,278 Property and equipment 319,352 Goodwill 417,112 Accounts payable (499,807 ) Accrued expenses (444,870 ) $ 12,600,000 The acquired accounts receivable are recorded at fair value which represents amounts that have subsequently been paid or are expected to be paid. The inventory acquired represents vaccines held at the managed practices. The fair value of acquired intangibles, which is expected to consist primarily of customer relationships, was based on the estimated discounted cash flows generated by these intangibles. The goodwill from this acquisition is deductible ratably for income tax purposes over fifteen years and represents the Company’s ability to have a local presence in additional markets, operational synergies that we expect to achieve that would not be available to other market participants and the ability to offer group purchasing and practice management services. The amortization period of the acquired intangibles is expected to be between four and twelve years. Revenue earned beginning July 1, 2018 from the clients obtained from the Orion acquisition was approximately $9.4 million during the three and nine months ended September 30, 2018. 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 $36,000 and $149,000 during the three and nine months ended September 30, 2018, respectively. Pro forma financial information (Unaudited) The unaudited pro forma information below represents condensed consolidated results of operations as if the Orion and WMB acquisitions occurred on January 1, 2017. The pro forma information has been included for comparative purposes and is not indicative of results of operations that the Company would have had if the acquisitions occurred on the above date, nor is it necessarily indicative of future results. Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 ($ in thousands, except per share data) Total revenue $ 17,045 $ 18,209 $ 53,114 $ 55,746 Net (loss) income $ (837 ) $ (1,648 ) $ (1,613 ) $ (4,367 ) Net (loss) income attributable to common shareholders $ (1,893 ) $ (2,301 ) $ (4,693 ) $ (5,650 ) Net (loss) income per common share $ (0.16 ) $ (0.20 ) $ (0.40 ) $ (0.52 )

Goodwill and Intangible Assets-

Goodwill and Intangible Assets-Net	9 Months Ended
	Sep. 30, 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 nine months ended September 30, 2018 and the year ended December 31, 2017: September 30, December 31, 2018 2017 Beginning gross balance $ 12,263,943 $ 12,178,868 Acquisitions 417,112 85,075 Ending gross balance $ 12,681,055 $ 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 September 30, 2018 and December 31, 2017 consist of the following: September 30, December 31, 2018 2017 Contracts and relationships acquired $ 22,591,300 $ 16,491,300 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,528,688 1,498,417 Total intangible assets 25,356,365 19,226,094 Less: Accumulated amortization (18,176,212 ) (16,716,550 ) Intangible assets - net $ 7,180,153 $ 2,509,544 Amortization expense was approximately $1.5 million and $3.2 million for the nine months ended September 30, 2018 and 2017, and approximately $633,000 and $508,000 for the three months ended September 30, 2018 and 2017, respectively. The weighted-average amortization period is eight years. As of September 30, 2018, future amortization scheduled to be expensed is as follows: Years ending December 31 2018 (three months) $ 607,297 2019 1,764,306 2020 942,635 2021 850,553 2022 577,860 Thereafter 2,437,502 Total $ 7,180,153

Net Loss Per Common Share

Net Loss Per Common Share	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
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 and nine months ended September 30, 2018 and 2017: Three Months Ended Nine Months Ended September 30, September 30, 2018 2017 2018 2017 Basic and Diluted: Net loss attributable to common shareholders $ (2,888,667 ) $ (1,632,816 ) $ (4,642,400 ) $ (6,664,818 ) Weighted - average common shares used to compute basic and diluted loss per share 11,770,178 11,485,811 11,684,659 10,835,142 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.25 ) $ (0.14 ) $ (0.40 ) $ (0.62 ) All unvested restricted stock units (“RSUs”), the 200,000 warrants granted to Opus Bank (“Opus”), the 153,489 warrants granted to Silicon Valley Bank (“SVB”) and, for 2017, 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, 2018
Debt Disclosure [Abstract]
Debt	6. Debt SVB In connection with the original 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 original SVB credit agreement, these 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. As a result of the revision in the SVB credit line, which increased the credit line from $5 million to $10 million and reduced the interest rate by 25 basis points, the Company paid approximately $50,000 of fees upfront and issued an additional 28,489 warrants, with a strike price equal to $5.26, a five-year exercise window and net exercise rights. The additional warrants were valued at $3.58 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 September 30, 2018, the Company was in compliance with all covenants. Opus Vehicle Financing Notes Insurance Financing

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	7. Commitments and Contingencies Legal Proceedings From time to time, we may become involved in other legal proceedings arising in the ordinary course of our business. Including the proceeding described above, we are not presently a party to any legal proceedings that, in the opinion of our management, would individually or taken together have a material adverse effect on our business, consolidated results of operations, financial position or cash flows of the Company. Leases Future minimum lease payments under non-cancelable operating leases for office space as of September 30, 2018 are as follows: Years Ending December 31 Total 2018 (three months) $ 260,467 2019 1,110,363 2020 777,140 2021 558,733 2022 412,585 Thereafter 91,797 Total $ 3,211,085 Total rental expense, included in direct operating costs and general and administrative expense in the condensed consolidated statements of operations, amounted to approximately $1.0 million and $690,000 for the nine months ended September 30, 2018 and 2017, respectively, and approximately $591,000 and $237,000 for the three months ended September 30, 2018 and 2017, respectively. Acquisitions —

Related Parties

Related Parties	9 Months Ended
	Sep. 30, 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 $15,000 and $12,000 for the nine months ended September 30, 2018 and 2017, respectively, and approximately $6,000 and $4,000 for the three months ended September 30, 2018 and 2017, respectively. As of September 30, 2018 and December 31, 2017, the receivable balance due from this customer was approximately $2,000 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 $96,000 each for the nine months ended September 30, 2018 and 2017 and approximately $32,000 each for the three months ended September 30, 2018 and 2017. As of September 30, 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 both the nine months ended September 30, 2018 and 2017 was approximately $141,000 and for both the three months ended September 30, 2018 and 2017 was approximately $46,000 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 September 30, 2018 and December 31, 2017. The September 30, 2018 and December 31, 2017 balances also include prepaid rent paid to the Executive Chairman of approximately $12,000.

Revenue

Revenue	9 Months Ended
	Sep. 30, 2018
Revenue from Contract with Customer [Abstract]
Revenue	9. REVENUE Introduction The Company accounts for revenue in accordance with ASC 606, Revenue from Contracts with Customers All of our current contracts with customers contain a single performance obligation. For contracts where we provide multiple services, such as where we perform multiple ancillary services, each service represents its own performance obligation. Selling prices are based on the contractual price for the service. 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. Disaggregation of Revenue from Contracts with Customers We derive revenue from seven primary sources: revenue cycle management services, practice management services, professional services, ancillary services, group purchasing services, printing and mailing services, and clearinghouse and EDI (electronic data interchange) services. The following table represents a disaggregation of revenue for the three and nine months ended September 30: Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Revenue cycle management services $ 11,695,675 $ 6,725,939 $ 26,954,715 $ 21,085,696 Practice management services 3,314,422 - 3,314,422 - Professional services 532,763 52,418 717,031 162,682 Ancillary services 530,285 203,573 1,092,376 724,780 Group purchasing services 477,168 - 477,168 - Printing and mailing services 335,999 348,060 985,522 989,480 Clearinghouse and EDI services 158,214 183,602 493,554 555,778 Total $ 17,044,526 $ 7,513,592 $ 34,034,788 $ 23,518,416 Revenue cycle management services: Revenue cycle management services 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 typically 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 revenue cycle management services includes use of practice management software and related tools (on a software-as-a-service (“SaaS” basis)), electronic health records (on a SaaS basis), medical billing services and use of mobile health solutions. We consider the series of services provided under our revenue cycle management contracts to be one performance obligation since the promises are not distinct in the context of the contract. All of our revenue cycle management 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. Most of our revenue cycle management contracts contain variable consideration and we estimate the variable consideration which we expect to be entitled to over the contractual period associated with our revenue cycle management 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 revenue cycle management 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 will 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. Our revenue cycle management 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. Practice management services: The Company also provides practice management services under long-term management service agreements to three medical practices. We provide the medical practices with the nurses, administrative support, facilities, supplies, equipment, marketing, RCM, accounting, and other non-clinical services needed to efficiently operate their practices. Revenue is recognized as the services are provided to the medical practices. Revenue recorded in the condensed consolidated statements of operations represents the reimbursement of costs paid by the Company for the practices and the management fee earned each month for managing the practice. The management fee is based on either a fixed fee or a percentage of the net operating income. The Company assumes all financial risk for the performance of the managed medical practices. Revenue is impacted by amount of the costs incurred by the practices and their operating income. The gross billing of the practices is impacted by billing rates, changes in current procedural terminology code reimbursement and collection trends which in turn impacts the management fee that the Company is entitled to. Billing rates are reviewed at least annually and adjusted based on current insurer reimbursement practices. The performance obligation is satisfied as the management services are provided. Our contracts for practice management services extend approximately an additional 20 years and are only cancellable under very limited circumstances. The Company receives a management fee each month for managing the day-to-day business operations of each medical group as a fixed fee or a percentage payment of the net operating income which is included in revenue in the condensed consolidated statements of operations. Our practice management services obligations consist of a series of distinct services that are substantially the same and have the same periodic pattern of transfer to our customers. A management fee is computed at each month end and accordingly, revenue is recognized at a point in time. Other revenue streams: MTBC also provides implementation and professional services to clearinghouse and other customers and records revenue monthly on a time and materials or a fixed rate basis. This is a separate performance obligation from the clearinghouse and recurring EDI services provided, for which the Company receives and records monthly fees. The performance obligation is satisfied once the implementation or professional services is completed. Ancillary services represent services such as coding and transcription that are rendered in connection with the delivery of revenue cycle management 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 revenue cycle management 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. As a result of the Orion acquisition on July 1, 2018, the Company now provides group purchasing services which enables medical providers to purchase various vaccines directly from selected pharmaceutical companies at a discounted price. Currently, there are approximately 4,000 medical providers who are members of the program. Revenue is recognized as the vaccine shipments are made to the medical providers. Fees from the pharmaceutical companies are paid either quarterly or annually and the Company adjusts its revenue accrual at the time of payment. The Company makes significant judgments regarding the variable consideration which we expect to be entitled to for the group purchasing services which includes the anticipated shipments to the members enrolled in the program, anticipated volumes of purchases made by the members, and the changes in the number of members. The amounts recorded are constrained by estimates of decreases in shipments and loss of members to avoid a significant revenue reversal in the subsequent period. The only performance obligation is to provide the pharmaceutical companies with the medical providers who want to become members in order to purchase vaccines. The performance obligation is satisfied once the medical provider agrees to purchase the vaccines and the medical provider’s information is forwarded to the vaccine suppliers. The Company records a contract asset for revenue earned and not paid as the ultimate payment is conditioned on achieving certain volume thresholds. The Company provides printing and mailing services for both revenue cycle management customers and a non- revenue cycle management 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 service 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 medical practices and providers to medical practices who are not revenue cycle management customers. The performance obligation is satisfied once the relevant submissions are completed. For all of the above revenue streams other than group purchasing services, revenue is recognized over time, which is typically one month or less, which closely matches the point in time that the customer simultaneously receives and consumes the benefits provided by the Company. For the group purchasing services, revenue is recognized at a point in time. Each service is substantially the same and has the same periodic pattern of transfer to the customer. Each of the services provided above is considered a separate performance obligation. Information about contract balances: The contract asset in the condensed consolidated balance sheet represents the revenue associated with the amounts we estimate our revenue cycle management clients will ultimately collect associated with the services they have provided and the relative fee we charge associated with those collections, together with amounts related to the group purchasing services. The performance obligations as of January 1, 2018 were substantially recognized in the quarter ended March 31, 2018. As of September 30, 2018, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management performance obligations outstanding was approximately $1.8 million. We expect to recognize substantially all of the revenue for the remaining performance obligations over the next three months. Approximately $0.7 million of the contract asset represents revenue earned, not paid, from the group purchasing services. 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 revenue cycle management 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 revenue cycle management 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 also includes the revenue accrued, not received, for the group purchasing services. The contract asset was approximately $2.5 million as of September 30, 2018. Changes in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. Deferred revenue represents sign-up fees received from customers that are amortized over three 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 Orion acquisition 5,727,618 673,317 - - (Decrease) increase, net (1,163,224 ) 464,470 (31,890 ) (8,983 ) Ending balance as of September 30, 2018 $ 8,443,857 $ 2,480,479 $ 30,214 $ 19,632 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 three years. Deferred commissions were approximately $108,000 at September 30, 2018 and are included in the Other Assets lines in our condensed consolidated balance sheets.

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 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. During June 2018, the Company’s shareholders approved the addition of 200,000 preferred shares to the Equity Incentive Plan for future grants. As of September 30, 2018, 611,620 shares of common stock and 182,400 shares of Series A Preferred Stock are available for grant under the 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 share per RSU, immediately after a change in control, as defined in the award agreement. Common and preferred stock RSUs During the third quarter of 2018, 68,000 RSUs of common stock were granted equally to the four outside members of the Board of Directors with 25% of the shares vesting every six months. Also during the third quarter of 2018, a total of 308,000 RSUs of common stock were granted to certain Company executive officers and employees which vest over the next three years, at six month intervals. 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. In 2017, the Compensation Committee of the Board of Directors approved executive bonuses to be paid in shares of Series A Preferred Stock, with the number of shares and the value based on specified criteria being achieved during the year. In 2018, the Compensation Committee has again approved executive bonuses to be paid in shares of Series A Preferred Stock, with the number of shares and the amount based on specified criteria being achieved during 2018. The actual amount will be settled in early 2019. Through September 30, 2018, approximately $663,000 was accrued for these bonuses and is included in accrued compensation in the condensed consolidated balance sheet. The following table summarizes the RSU transactions related to the common and preferred stock under the equity incentive plan for the nine months ended September 30, 2018: Common Stock Preferred Stock Outstanding and unvested at January 1, 2018 605,969 37,800 Granted 607,200 44,800 Vested (340,066 ) (37,800 ) Forfeited (7,586 ) - Outstanding and unvested at September 30, 2018 865,517 44,800 Of the total outstanding and unvested common stock RSUs at September 30, 2018, 777,667 RSUs are classified as equity and 87,850 RSUs are classified as a liability. All of the preferred stock RSUs are classified as equity. The liability for the cash-settled awards was approximately $117,000 and $41,000 at September 30, 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 and nine months ended September 30, 2018 and 2017: Stock-based compensation included in the Condensed Consolidated Statements of Operations: Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Direct operating costs $ 39,703 $ 1,705 $ 49,562 $ 7,162 General and administrative 935,159 124,789 1,457,759 318,870 Research and development 8,208 (675 ) 13,152 7,822 Selling and marketing 3,209 - 3,209 - Total stock-based compensation expense $ 986,279 $ 125,819 $ 1,523,682 $ 333,854

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income Taxes	11. INCOME TAXES The current income tax provision for the three and nine months ended September 30, 2018 was approximately $15,000 and $35,000, respectively. The deferred income tax benefit for the three and nine months ended September 30, 2018 was approximately $265,000 and $187,000, respectively. The current income tax provision for the three and nine months ended September 30, 2017 was approximately $10,000 and $27,000 respectively. The deferred income tax provision for the three and nine months ended September 30, 2017 was approximately $55,000 and $165,000, respectively. The current income tax provision for the three and nine months ended September 30, 2018 and 2017 primarily relates to state minimum taxes and foreign income taxes. As a result of the Company forecasting a tax loss for 2018 which has an indefinite life under the recent tax reform legislation, the Federal deferred tax liability resulting from the amortization of goodwill was offset against the 2018 Federal net operating loss, resulting in a net deferred Federal income tax benefit of approximately $265,000 for the three months ended September 30, 2018. 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, 2018 and December 31, 2017. 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 was 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 completed our analysis during the third quarter of 2018. During the nine months ended September 30, 2018, no additional impact from the enactment of the Act was identified during the measurement period as provided in Staff Accounting Bulletin 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.

Restructuring Charges

Restructuring Charges	9 Months Ended
	Sep. 30, 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	9 Months Ended
	Sep. 30, 2018
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	13. FAIR VALUE OF FINANCIAL INSTRUMENTS As of September 30, 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. The fair value of the warrants issued to Opus and SVB was determined as of the issuance date using the Black Scholes Model, for which all significant inputs are observable in the market or can be correlated by observable market data, such as the common stock prices and interest rates. Contingent Consideration The Company’s contingent consideration of approximately $560,000 and $603,000 as of September 30, 2018 and December 31, 2017, respectively, are Level 3 liabilities. The fair value of the contingent consideration at September 30, 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 Nine Months Ended September 30, 2018 2017 Balance - January 1, $ 603,411 $ 929,549 Change in fair value 68,253 151,423 Settlement in the form of shares issued - (331,676 ) Payments (111,495 ) (79,603 ) Balance - September 30, $ 560,169 $ 669,693

Subsequent Event

Subsequent Event	9 Months Ended
	Sep. 30, 2018
Subsequent Events [Abstract]
Subsequent Event	14. SUBSEQUENT EVENT During October 2018, the Company issued 600,000 shares of its Series A Preferred Stock receiving net proceeds of approximately $13.4 million.

Basis of Presentation (Tables)

Basis of Presentation (Tables)	9 Months Ended
	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Prior Adjustments for Implements to New Revenue Recognition	The following table reconciles the balances as presented for the three and nine months ended September 30, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: Three Months Ended September 30, 2018 Nine Months Ended September 30, 2018 As Presented Impact of New Revenue Standard Previous Revenue Standard As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 17,044,526 $ (251,120 ) $ 17,295,646 $ 34,034,788 $ 75,511 $ 33,959,277 OPERATING EXPENSES: Direct operating costs 12,123,907 - 12,123,907 20,941,535 - 20,941,535 Selling and marketing 461,512 5,076 456,436 1,169,583 (6,149 ) 1,175,732 General and administrative 5,131,295 - 5,131,295 10,786,234 - 10,786,234 Research and development 263,717 - 263,717 768,517 - 768,517 Change in contingent consideration 25,473 - 25,473 68,253 - 68,253 Depreciation and amortization 822,098 - 822,098 1,972,565 - 1,972,565 Total operating expenses 18,828,002 5,076 18,822,926 35,706,687 (6,149 ) 35,712,836 OPERATING (LOSS) INCOME (1,783,476 ) (256,196 ) (1,527,280 ) (1,671,899 ) 81,660 (1,753,559 ) OTHER: Interest income 24,544 - 24,544 59,768 - 59,768 Interest expense (104,872 ) - (104,872 ) (253,120 ) - (253,120 ) Other (expense) income - net (218,721 ) - (218,721 ) 151,242 - 151,242 (LOSS) INCOME BEFORE INCOME TAXES (2,082,525 ) (256,196 ) (1,826,329 ) (1,714,009 ) 81,660 (1,795,669 ) Income tax benefit (250,072 ) - (250,072 ) (151,872 ) - (151,872 ) NET (LOSS) INCOME $ (1,832,453 ) $ (256,196 ) $ (1,576,257 ) $ (1,562,137 ) $ 81,660 $ (1,643,797 ) Preferred stock dividend 1,056,214 - 1,056,214 3,080,263 - 3,080,263 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (2,888,667 ) $ (256,196 ) $ (2,632,471 ) $ (4,642,400 ) $ 81,660 $ (4,724,060 ) Loss per common share: Basic and diluted (loss) income per share $ (0.25 ) $ (0.03 ) $ (0.22 ) $ (0.40 ) $ 0.01 $ (0.41 )

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2018
Business Combinations [Abstract]
Schedule of Assets Acquired and Liabilities Assumed	The Company expects to finalize the purchase price allocation by year-end and is finalizing the projections and the valuation of the acquired assets and assumed liabilities. Acquired intangibles $ 6,100,000 Accounts receivable 5,727,618 Contract asset 673,317 Inventory 307,278 Property and equipment 319,352 Goodwill 417,112 Accounts payable (499,807 ) Accrued expenses (444,870 ) $ 12,600,000
Business Acquisition, Pro Forma Information	The pro forma information has been included for comparative purposes and is not indicative of results of operations that the Company would have had if the acquisitions occurred on the above date, nor is it necessarily indicative of future results. Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 ($ in thousands, except per share data) Total revenue $ 17,045 $ 18,209 $ 53,114 $ 55,746 Net (loss) income $ (837 ) $ (1,648 ) $ (1,613 ) $ (4,367 ) Net (loss) income attributable to common shareholders $ (1,893 ) $ (2,301 ) $ (4,693 ) $ (5,650 ) Net (loss) income per common share $ (0.16 ) $ (0.20 ) $ (0.40 ) $ (0.52 )

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets-Net (Tables)	9 Months Ended
	Sep. 30, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets and Goodwill	The following is the summary of the changes to the carrying amount of goodwill for the nine months ended September 30, 2018 and the year ended December 31, 2017: September 30, December 31, 2018 2017 Beginning gross balance $ 12,263,943 $ 12,178,868 Acquisitions 417,112 85,075 Ending gross balance $ 12,681,055 $ 12,263,943
Schedule of Finite-Lived Intangible Assets	Intangible assets - net as of September 30, 2018 and December 31, 2017 consist of the following: September 30, December 31, 2018 2017 Contracts and relationships acquired $ 22,591,300 $ 16,491,300 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,528,688 1,498,417 Total intangible assets 25,356,365 19,226,094 Less: Accumulated amortization (18,176,212 ) (16,716,550 ) Intangible assets - net $ 7,180,153 $ 2,509,544
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	As of September 30, 2018, future amortization scheduled to be expensed is as follows: Years ending December 31 2018 (three months) $ 607,297 2019 1,764,306 2020 942,635 2021 850,553 2022 577,860 Thereafter 2,437,502 Total $ 7,180,153

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2018
Earnings Per Share [Abstract]
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, 2018 and 2017: Three Months Ended Nine Months Ended September 30, September 30, 2018 2017 2018 2017 Basic and Diluted: Net loss attributable to common shareholders $ (2,888,667 ) $ (1,632,816 ) $ (4,642,400 ) $ (6,664,818 ) Weighted - average common shares used to compute basic and diluted loss per share 11,770,178 11,485,811 11,684,659 10,835,142 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.25 ) $ (0.14 ) $ (0.40 ) $ (0.62 )

Commitments and Contingencies (

Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 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 September 30, 2018 are as follows: Years Ending December 31 Total 2018 (three months) $ 260,467 2019 1,110,363 2020 777,140 2021 558,733 2022 412,585 Thereafter 91,797 Total $ 3,211,085

Revenue (Tables)

Revenue (Tables)	9 Months Ended
	Sep. 30, 2018
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following table represents a disaggregation of revenue for the three and nine months ended September 30: Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Revenue cycle management services $ 11,695,675 $ 6,725,939 $ 26,954,715 $ 21,085,696 Practice management services 3,314,422 - 3,314,422 - Professional services 532,763 52,418 717,031 162,682 Ancillary services 530,285 203,573 1,092,376 724,780 Group purchasing services 477,168 - 477,168 - Printing and mailing services 335,999 348,060 985,522 989,480 Clearinghouse and EDI services 158,214 183,602 493,554 555,778 Total $ 17,044,526 $ 7,513,592 $ 34,034,788 $ 23,518,416
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 Orion acquisition 5,727,618 673,317 - - (Decrease) increase, net (1,163,224 ) 464,470 (31,890 ) (8,983 ) Ending balance as of September 30, 2018 $ 8,443,857 $ 2,480,479 $ 30,214 $ 19,632

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 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 and preferred stock under the equity incentive plan for the nine months ended September 30, 2018: Common Stock Preferred Stock Outstanding and unvested at January 1, 2018 605,969 37,800 Granted 607,200 44,800 Vested (340,066 ) (37,800 ) Forfeited (7,586 ) - Outstanding and unvested at September 30, 2018 865,517 44,800
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, 2018 and 2017: Stock-based compensation included in the Condensed Consolidated Statements of Operations: Three Months Ended September 30, Nine Months Ended September 30, 2018 2017 2018 2017 Direct operating costs $ 39,703 $ 1,705 $ 49,562 $ 7,162 General and administrative 935,159 124,789 1,457,759 318,870 Research and development 8,208 (675 ) 13,152 7,822 Selling and marketing 3,209 - 3,209 - Total stock-based compensation expense $ 986,279 $ 125,819 $ 1,523,682 $ 333,854

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 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 Nine Months Ended September 30, 2018 2017 Balance - January 1, $ 603,411 $ 929,549 Change in fair value 68,253 151,423 Settlement in the form of shares issued - (331,676 ) Payments (111,495 ) (79,603 ) Balance - September 30, $ 560,169 $ 669,693

Organization and Business (Deta

Organization and Business (Details Narrative)	Sep. 30, 2018
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	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Contract asset	$ 2,480,479	$ 2,480,479
Sales commissions	(23,627,402)	(23,627,402)		$ (23,509,386)
Capitalized sales commissions		108,000
Amortization of capitalized sales commissions	16,000	42,943
Orion Acquisition [Member]
Contract asset	673,000	673,000
Revenue Cycle Management [Member]
Contract asset	400,000	400,000
Group Purchasing Services [Member]
Contract asset	273,000	273,000
January 1, 2018 [Member]
Contract asset	1,300,000	1,300,000
Sales commissions	$ 101,000	$ 101,000

Basis of Presentation - Schedul

Basis of Presentation - Schedule of Prior Adjustments for Implements to New Revenue Recognition (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2018	Sep. 30, 2017
NET REVENUE	$ 17,044,526	$ 7,513,592	$ 34,034,788		$ 23,518,416
Direct operating costs	12,123,907	4,171,932	20,941,535		13,592,492
Selling and marketing	461,512	228,991	1,169,583		853,460
General and administrative	5,131,295	2,474,139	10,786,234		8,232,613
Research and development	263,717	249,045	768,517		843,294
Change in contingent consideration	25,473		68,253		151,423
Depreciation and amortization	822,098	664,441	1,972,565		3,637,131
Total operating expenses	18,828,002	7,788,548	35,706,687		27,586,041
OPERATING (LOSS) INCOME	(1,783,476)	(274,956)	(1,671,899)		(4,067,625)
Interest income	24,544	5,446	59,768		13,598
Interest expense	(104,872)	(678,103)	(253,120)		(1,242,672)
Other (expense) income - net	(218,721)	32,494	151,242		107,364
(LOSS) INCOME BEFORE INCOME TAXES	(2,082,525)	(915,119)	(1,714,009)		(5,189,335)
Income tax benefit	(250,072)	65,000	(151,872)		192,332
NET (LOSS) INCOME	(1,832,453)	(980,119)	(1,562,137)	$ (1,562,137)	(5,381,667)
Preferred stock dividend	1,056,214	652,697	3,080,263		1,283,151
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (2,888,667)	$ (1,632,816)	$ (4,642,400)		$ (6,664,818)
Loss per common share: Basic and diluted (loss) income per share	$ (0.25)	$ (0.14)	$ (0.40)		$ (0.62)
Impact of New Revenue Standard [Member]
NET REVENUE	$ (251,120)		$ 75,511
Direct operating costs
Selling and marketing	5,076		(6,149)
General and administrative
Research and development
Change in contingent consideration
Depreciation and amortization
Total operating expenses	5,076		(6,149)
OPERATING (LOSS) INCOME	(256,196)		81,660
Interest income
Interest expense
Other (expense) income - net
(LOSS) INCOME BEFORE INCOME TAXES	(256,196)		81,660
Income tax benefit
NET (LOSS) INCOME	(256,196)		81,660
Preferred stock dividend
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (256,196)		$ 81,660
Loss per common share: Basic and diluted (loss) income per share	$ (0.03)		$ 0.01
Previous Revenue Standard [Member]
NET REVENUE	$ 17,295,646		$ 33,959,277
Direct operating costs	12,123,907		20,941,535
Selling and marketing	456,436		1,175,732
General and administrative	5,131,295		10,786,234
Research and development	263,717		768,517
Change in contingent consideration	25,473		68,253
Depreciation and amortization	822,098		1,972,565
Total operating expenses	18,822,926		35,712,836
OPERATING (LOSS) INCOME	(1,527,280)		(1,753,559)
Interest income	24,544		59,768
Interest expense	(104,872)		(253,120)
Other (expense) income - net	(218,721)		151,242
(LOSS) INCOME BEFORE INCOME TAXES	(1,826,329)		(1,795,669)
Income tax benefit	(250,072)		(151,872)
NET (LOSS) INCOME	(1,576,257)		(1,643,797)
Preferred stock dividend	1,056,214		3,080,263
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (2,632,471)		$ (4,724,060)
Loss per common share: Basic and diluted (loss) income per share	$ (0.22)		$ (0.41)

Acquisitions (Details Narrative

Acquisitions (Details Narrative) - USD ($)	May 07, 2018	Sep. 30, 2018	Sep. 30, 2018	Sep. 30, 2017	Jul. 02, 2017
Purchase price amount			$ 743,115	$ 499,988
2018 Acquisition [Member] | Minimum [Member]
Amortization, term		4 years
2018 Acquisition [Member] | Maximum [Member]
Amortization, term		12 years
Orion Acquisition [Member]
Revenue earned from acquisition		$ 9,400,000	9,400,000
2017 Acquisition [Member]
Revenue earned from acquisition		$ 36,000	149,000
Asset Purchase Agreement [Member]
Purchase price amount	$ 12,600,000
Acquisition-related costs	$ 245,000
Asset Purchase Agreement [Member] | Washington Medical Billing, LLC [Member]
Non-refundable initial payment amount					$ 205,000
Aggregate purchase price			$ 205,000

Acquisitions - Schedule of Asse

Acquisitions - Schedule of Assets Acquired and Liabilities Assumed (Details) - USD ($)	Sep. 30, 2018	Dec. 31, 2017
Goodwill	$ 12,681,055	$ 12,263,943
2018 Acquisition [Member]
Acquired intangibles	6,100,000
Accounts receivable	5,727,618
Contract asset	673,317
Inventory	307,278
Property and equipment	319,352
Goodwill	417,112
Accounts payable	(499,807)
Accrued expenses	(444,870)
Business Combination, Net	$ 12,600,000

Acquisitions - Business Acquisi

Acquisitions - Business Acquisition, Pro Forma Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Business Combinations [Abstract]
Total revenue	$ 17,045	$ 18,209	$ 53,114	$ 55,746
Net (loss) income	(837)	(1,648)	(1,613)	(4,367)
Net (loss) income attributable to common shareholders	$ (1,893)	$ (2,301)	$ (4,693)	$ (5,650)
Net (loss) income per common share	$ (0.16)	$ (0.20)	$ (0.40)	$ (0.52)

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets-Net (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expenses	$ 633,000	$ 508,000	$ 1,500,000	$ 3,200,000

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets-Net - Schedule of Intangible Assets and Goodwill (Details) - USD ($)	9 Months Ended	12 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Beginning gross balance	$ 12,263,943	$ 12,178,868
Acquisitions	417,112	85,075
Ending gross balance	$ 12,681,055	$ 12,263,943

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)	Sep. 30, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets [Line Items]
Total intangible assets	$ 25,356,365	$ 19,226,094
Less: Accumulated amortization	(18,176,212)	(16,716,550)
Intangible assets - net	7,180,153	2,509,544
Contracts and Relationships Acquired [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets	22,591,300	16,491,300
Non-Compete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets	1,236,377	1,236,377
Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets	$ 1,528,688	$ 1,498,417

Goodwill and Intangible Asset_6

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details) - USD ($)	Sep. 30, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
2018 (three months)	$ 607,297
2,019	1,764,306
2,020	942,635
2,021	850,553
2,022	577,860
Thereafter	2,437,502
Total	$ 7,180,153	$ 2,509,544

Net Loss Per Common Share (Deta

Net Loss Per Common Share (Details Narrative) - shares	9 Months Ended
	Sep. 30, 2018	Jun. 30, 2017
Opus Bank [Member]
Antidilutive securities excluded from computation of earning per share, warrants	200,000
Number of warrant issued		2,000,000
Silicon Valley Bank [Member]
Antidilutive securities excluded from computation of earning per share, warrants	153,489

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, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Earnings Per Share [Abstract]
Net loss attributable to common shareholders	$ (2,888,667)	$ (1,632,816)	$ (4,642,400)	$ (6,664,818)
Weighted - average common shares used to compute basic and diluted loss per share	11,770,178	11,485,811	11,684,659	10,835,142
Net loss attributable to common shareholders per share - Basic and Diluted	$ (0.25)	$ (0.14)	$ (0.40)	$ (0.62)

Debt (Details Narrative)

Debt (Details Narrative) - USD ($)	Sep. 02, 2015	Oct. 31, 2017	Sep. 30, 2018
Opus Bank Loan [Member] | Term Loan [Member]
Revision of borrowing limit from SVB Bank	$ 8,000,000
Opus Bank Loan [Member] | Total [Member]
Revision of borrowing limit from SVB Bank	$ 10,000,000
Percentage of shares secured for debt	65.00%
Vehicle Financing Notes [Member]
Vehicle financing in United stated and Pakistan			three to six year terms
Insurance Financing [Member]
Insurance purchases, interest rate, stated percentage			5.87%
SVB Debt Agreement [Member]
Payment of upfront 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
Decrease in interest rate due to increase in line of credit			0.25%
Upfront fee paid for increase in SVB credit line limit			$ 50,000
SVB Debt Agreement [Member] | Additional Warrant [Member]
Class of warrant or right, number of securities called by warrants or rights			28,489
Warrant strike price			$ 5.26
Warrant exercise term			5 years
Warrants price per share			$ 3.58
SVB Credit Facility [Member]
Secured revolving line of credit percentage		200.00%
Credit facility, currently available company			$ 10,000,000
Revolving line of credit, interest rate - Prime plus		1.75%	1.50%
Unused portion of credit line fee, percentage		0.50%
Percentage of shares in offshore facilities secured for SVB credit line		65.00%
SVB Credit Facility [Member] | Old [Member]
Revision of borrowing limit from SVB Bank			$ 5,000,000
SVB Credit Facility [Member] | New [Member]
Revision of borrowing limit from SVB Bank			$ 10,000,000
Revolving Credit Facility [Member] | Opus Bank Loan [Member]
Revision of borrowing limit from SVB Bank	$ 2,000,000

Commitments and Contingencies_2

Commitments and Contingencies (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Operating leases expire year			expiring through 2023.
Operating leases, rent expense	$ 591,000	$ 237,000	$ 1,000,000	$ 690,000
US Corporate Facility and Other Locations [Member]
Monthly rent expense of month to month leases			12,000
Orion Acquisition [Member]
Monthly rent expense of month to month leases			31,000
Offshore Lease [Member]
Lease monthly rental payments			$ 20,000
Cancellation period in off shore lease			3 months

Commitments and Contingencies -

Commitments and Contingencies - Schedule of Future Minimum Lease Payments Under Non-cancelable Operating Leases (Details) - Years Ending December 31 [Member]	Sep. 30, 2018USD ($)
2018 (three months)	$ 260,467
2,019	1,110,363
2,020	777,140
2,021	558,733
2,022	412,585
Thereafter	91,797
Total	$ 3,211,085

Related Parties (Details Narrat

Related Parties (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Revenues	$ 17,044,526	$ 7,513,592	$ 34,034,788	$ 23,518,416
Operating leases, rent expense	591,000	237,000	1,000,000	690,000
Accrued liability to related party	10,663		10,663		$ 10,675
Kashmir Air, Inc [Member]
Operating leases, rent expense	32,000	32,000	96,000	96,000
Accrued liability to related party	11,000		11,000		11,000
Physician [Member]
Revenues	6,000	4,000	15,000	12,000
Receivable balance due from this customer	2,000		2,000		1,900
Executive Chairman [Member]
Operating leases, rent expense	46,000	$ 46,000	141,000	$ 141,000
Security deposit	13,000		13,000		13,000
Prepaid rent	$ 12,000		$ 12,000		$ 12,000

Revenue (Details Narrative)

Revenue (Details Narrative) - USD ($)	9 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Revenue from Contract with Customer [Abstract]
Remaining performance obligations	$ 1,800,000
Estimated recognition period for remaining performance obligations	3 months
Contract asset represents revenue	$ 700,000
Contract asset	2,480,479
Deferred commissions	$ 108,000

Revenue - Schedule of Disaggreg

Revenue - Schedule of Disaggregation of Revenue (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Net revenue	$ 17,044,526	$ 7,513,592	$ 34,034,788	$ 23,518,416
Revenue Cycle Management Services [Member]
Net revenue	11,695,675	6,725,939	26,954,715	21,085,696
Practice Management Services [Member]
Net revenue	3,314,422		3,314,422
Professional Services [Member]
Net revenue	532,763	52,418	717,031	162,682
Ancillary Services [Member]
Net revenue	530,285	203,573	1,092,376	724,780
Group Purchasing Services [Member]
Net revenue	477,168		477,168
Printing and Mailing Services [Member]
Net revenue	335,999	348,060	985,522	989,480
Clearinghouse and EDI Services [Member]
Net revenue	$ 158,214	$ 183,602	$ 493,554	$ 555,778

Revenue - Schedule of Accounts

Revenue - Schedule of Accounts Receivable, Contract Asset and Deferred Revenue (Details) - USD ($)	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Accounts Receivable net, beginning balance	$ 3,879,463
Accounts Receivable (Decrease) increase, net	(901,683)	$ (437,557)
Accounts Receivable net, ending balance	8,443,857
Contract Asset, beginning balance
Contract Asset, ending balance	2,480,479
Deferred Revenue(current), beginning balance	62,104
Deferred Revenue(current)(Decrease)/ increase, net	(40,873)	$ 13,807
Deferred Revenue(current), ending balance	30,214
Deferred Revenue(long term), beginning balance	28,615
Deferred Revenue(long term), ending balance	19,632
Contract Balances [Member]
Accounts Receivable net, beginning balance	3,879,463
Accounts Receivable, Net Orion acquisition	5,727,618
Accounts Receivable (Decrease) increase, net	(1,163,224)
Accounts Receivable net, ending balance	8,443,857
Contract Asset, beginning balance	1,342,692
Contract Asset Orion acquisition	673,317
Contract Asset (Decrease)/ increase, net	464,470
Contract Asset, ending balance	2,480,479
Deferred Revenue(current), beginning balance	62,104
Deferred Revenue (current) Orion acquisition
Deferred Revenue(current)(Decrease)/ increase, net	(31,890)
Deferred Revenue(current), ending balance	30,214
Deferred Revenue(long term), beginning balance	28,615
Deferred Revenue(long term), Orion acquisition
Deferred Revenue(long term) (Decrease)/ increase, net	(8,983)
Deferred Revenue(long term), ending balance	$ 19,632

Stock-Based Compensation (Detai

Stock-Based Compensation (Details Narrative) - USD ($)	Apr. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Jun. 30, 2018	Sep. 30, 2018	Dec. 31, 2017	Apr. 30, 2014
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Accrued compensation		$ 1,866,482			$ 1,866,482	$ 1,137,351
Restricted Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Unvested stock option award, equity		777,667			777,667
Restricted stock award classified as liability		87,850			87,850
Accrued compensation		$ 117,000			$ 117,000	$ 41,000
Common Stock [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					607,200
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] | Restricted Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Accrued stock bonus		$ 663,000			$ 663,000
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		68,000	200,000
Share-based compensation arrangement by share-based payment award, award vesting rights, percentage		25.00%
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		182,400			182,400
Number of new shares addition to the plan for future grants				200,000
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		611,620			611,620
Amended and Restated Equity Incentive Plan [Member] | Executive Officers and Employees [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		308,000
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]	9 Months Ended
	Sep. 30, 2018shares
Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	605,969
Granted	607,200
Vested	(340,066)
Forfeited	(7,586)
Outstanding and unvested at ending	865,517
Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	37,800
Granted	44,800
Vested	(37,800)
Forfeited
Outstanding and unvested at ending	44,800

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, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 986,279	$ 125,819	$ 1,523,682	$ 333,854
Direct Operating Costs [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	39,703	1,705	49,562	7,162
General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	935,159	124,789	1,457,759	318,870
Research and Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	8,208	(675)	13,152	7,822
Selling and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 3,209		$ 3,209

Income Taxes (Details Narrative

Income Taxes (Details Narrative) - USD ($)	Dec. 22, 2017	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income tax provision		$ 15,000	$ 10,000	$ 35,000	$ 27,000
Deferred income tax provision/(benefit)		(265,000)	$ 55,000	$ (187,072)	$ 165,000
Deferred federal income tax benefit		$ 265,000
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			9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Mar. 31, 2017	Sep. 30, 2018	Sep. 30, 2017
Restructuring and Related Activities [Abstract]
Restructuring charges			$ 276,000		$ 275,628

Fair Value of Financial Instr_3

Fair Value of Financial Instruments (Details Narrative) - USD ($)	Sep. 30, 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	$ 560,000	$ 603,000

Fair Value of Financial Instr_4

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, 2018	Sep. 30, 2017
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance, beginning	$ 603,411	$ 929,549
Change in fair value	68,253	151,423
Settlement in the form of shares issued		(331,676)
Payments	(111,495)	(79,603)
Balance, ending	$ 560,169	$ 669,693

Subsequent Event (Details Narra

Subsequent Event (Details Narrative) - Series A Preferred Stock [Member] - Subsequent Event [Member]	1 Months Ended
	Oct. 31, 2018USD ($)shares
Preferred stock shares issued | shares	600,000
Preferred stock shares issued, value | $	$ 13,400,000