CareCloud (CCLD) 10-K 20 Mar 19 2018 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2018	Mar. 13, 2019	Jun. 30, 2018
Document And Entity Information
Entity Registrant Name	MTBC, Inc.
Entity Central Index Key	0001582982
Document Type	10-K
Document Period End Date	Dec. 31, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filer	No
Entity Current Reporting Status	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business Flag	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Shell Company	false
Entity Public Float			$ 22,730,000
Entity Common Stock, Shares Outstanding		12,009,742
Trading Symbol	MTBC
Document Fiscal Period Focus	FY
Document Fiscal Year Focus	2018

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2018	Dec. 31, 2017
CURRENT ASSETS:
Cash	$ 14,472,483	$ 4,362,232
Accounts receivable - net of allowance for doubtful accounts of $189,000 and $185,000 at December 31, 2018 and December 31, 2017, respectively	7,331,474	3,879,463
Contract asset	2,608,631
Inventory	444,437
Current assets - related party	25,203	25,203
Prepaid expenses and other current assets	1,191,445	662,822
Total current assets	26,073,673	8,929,720
Property and equipment - net	1,832,187	1,385,743
Intangible assets - net	6,634,003	2,509,544
Goodwill	12,593,795	12,263,943
Other assets	489,703	436,713
TOTAL ASSETS	47,623,361	25,525,663
CURRENT LIABILITIES:
Accounts payable	2,438,267	991,859
Accrued compensation	1,731,063	1,137,351
Accrued expenses	1,589,009	616,778
Deferred rent (current portion)	90,657	81,826
Deferred revenue (current portion)	25,355	62,104
Accrued liability to related party	10,663	10,675
Notes payable - (current portion)	277,776	168,718
Contingent consideration (current portion)	526,432	505,557
Dividend payable	1,468,724	747,147
Total current liabilities	8,157,946	4,322,015
Notes payable	222,400	120,899
Deferred rent	189,366	333,788
Deferred revenue	18,949	28,615
Contingent consideration		97,854
Deferred tax liability	164,346	372,072
Total liabilities	8,753,007	5,275,243
COMMITMENTS AND CONTINGENCIES (Note 11)
SHAREHOLDERS' EQUITY:
Preferred stock, par value $0.001 per share - authorized 4,000,000 shares; issued and outstanding 2,136,289 and 1,086,739 shares at December 31, 2018 and December 31, 2017, respectively	2,136	1,087
Common stock, $0.001 par value - authorized 19,000,000 shares; issued 12,570,557 and 12,271,390 shares at December 31, 2018 and December 31, 2017, respectively; outstanding, 11,829,758 and 11,530,591 shares at December 31, 2018 and December 31, 2017, respectively	12,571	12,272
Additional paid-in capital	65,142,460	45,129,517
Accumulated deficit	(24,203,745)	(23,509,386)
Accumulated other comprehensive loss	(1,421,068)	(721,070)
Less: 740,799 common shares held in treasury, at cost at December 31, 2018 and December 31, 2017	(662,000)	(662,000)
Total shareholders' equity	38,870,354	20,250,420
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 47,623,361	$ 25,525,663

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($)	Dec. 31, 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	2,136,289	1,086,739
Preferred stock, shares outstanding	2,136,289	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

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
NET REVENUE	$ 50,545,781	$ 31,810,635
OPERATING EXPENSES:
Direct operating costs	31,252,535	17,679,070
Selling and marketing	1,611,982	1,106,698
General and administrative	16,264,473	11,738,201
Research and development	1,029,510	1,081,832
Change in contingent consideration	73,271	151,423
Depreciation and amortization	2,853,827	4,299,943
Restructuring charges		275,628
Total operating expenses	53,085,598	36,332,795
OPERATING LOSS	(2,539,817)	(4,522,160)
OTHER:
Interest income	100,788	16,944
Interest expense	(351,168)	(1,324,219)
Other income - net	494,332	332,084
LOSS BEFORE INCOME TAXES	(2,295,865)	(5,497,351)
Income tax (benefit) provision	(157,385)	67,805
NET LOSS	(2,138,480)	(5,565,156)
Preferred stock dividend	4,823,987	2,030,295
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (6,962,467)	$ (7,595,451)
Net loss per common share: basic and diluted	$ (0.59)	$ (0.69)
Weighted-average common shares used to compute basic and diluted loss per share	11,721,232	11,010,432

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($)		12 Months Ended
		Dec. 31, 2018	Dec. 31, 2017
Statement of Comprehensive Income [Abstract]
NET LOSS		$ (2,138,480)	$ (5,565,156)
OTHER COMPREHENSIVE LOSS, NET OF TAX
Foreign currency translation adjustment	[1]	(699,998)	(344,980)
COMPREHENSIVE LOSS		$ (2,838,478)	$ (5,910,136)
[1]	No tax effect has been recorded as the Company recorded a valuation allowance against the tax benefit from its foreign currency translation adjustments.

Consolidated Statements of Shar

Consolidated Statements of Shareholders' Equity - USD ($)	Preferred Stock [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Deficit [Member]	Accumulated Other Comprehensive Loss [Member]	Treasury (Common) Stock [Member]	Total
Balance at Dec. 31, 2016	$ 295	$ 10,793	$ 26,038,063	$ (17,944,230)	$ (376,090)	$ (662,000)	$ 7,066,831
Balance, shares at Dec. 31, 2016	294,656	10,792,352
Net loss				(5,565,156)			(5,565,156)
Foreign currency translation adjustment					(344,980)		(344,980)
Issuance of stock under the Amended and Restated Equity Incentive Plan	$ 27	$ 267	(267)				27
Issuance of stock under the Amended and Restated Equity Incentive Plan, shares	26,750	266,663
Common stock warrants issued			390,479				390,479
Stock-based compensation, net of cash settlements			2,036,741				2,036,741
Issuance of common stock, net of fees and expenses		$ 1,000	1,971,065				1,972,065
Issuance of common stock, net of fees and expenses, shares		1,000,000
Issuance of common stock held as contingent consideration		$ 212	331,464				331,676
Issuance of common stock held as contingent consideration, shares		212,375
Issuance of preferred stock, net of fees and expenses	$ 765		16,392,267				16,393,032
Issuance of preferred stock, net of fees and expenses, shares	765,333
Preferred stock dividends			(2,030,295)				(2,030,295)
Balance at Dec. 31, 2017	$ 1,087	$ 12,272	45,129,517	(23,509,386)	(721,070)	(662,000)	20,250,420
Balance, shares at Dec. 31, 2017	1,086,739	12,271,390
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	$ 1,087	$ 12,272	45,129,517	(23,509,386)	(721,070)	(662,000)	20,250,420
Balance, shares at Dec. 31, 2017	1,086,739	12,271,390
Net loss							(2,138,480)
Balance at Dec. 31, 2018	$ 2,136	$ 12,571	65,142,460	(24,203,745)	(1,421,068)	(662,000)	38,870,354
Balance, shares at Dec. 31, 2018	2,136,289	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				(2,138,480)			(2,138,480)
Foreign currency translation adjustment					(699,998)		(699,998)
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			2,264,223				2,264,223
Issuance of preferred stock, net of fees and expenses	$ 1,020		22,816,546				22,817,566
Issuance of preferred stock, net of fees and expenses, shares	1,020,000
Preferred stock dividends			(4,823,987)				(4,823,987)
Tax withholding obligations on stock issued to employees			(345,500)				(345,500)
Balance at Dec. 31, 2018	$ 2,136	$ 12,571	$ 65,142,460	$ (24,203,745)	$ (1,421,068)	$ (662,000)	$ 38,870,354
Balance, shares at Dec. 31, 2018	2,136,289	12,570,557

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
OPERATING ACTIVITIES:
Net loss	$ (2,138,480)	$ (5,565,156)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	2,913,866	4,299,943
Deferred rent	(61,058)	(53,263)
Deferred revenue	(46,415)	22,380
Provision for doubtful accounts	723,611	409,693
(Benefit) provision for deferred income taxes	(207,726)	26,542
Foreign exchange gain	(434,806)	(248,518)
Interest accretion	191,065	722,070
Non-cash restructuring charges		17,001
Stock-based compensation expense	2,463,599	1,487,295
Change in contingent consideration	73,271	151,423
Changes in operating assets and liabilities, net of businesses acquired:
Accounts receivable	1,479,297	41,745
Contract asset	(404,598)
Inventory	(137,159)
Other assets	248,347	511,917
Accounts payable and other liabilities	2,149,660	(1,541,430)
Net cash provided by operating activities	6,812,474	281,642
INVESTING ACTIVITIES:
Capital expenditures	(1,028,249)	(697,211)
Cash paid for acquisition	(12,600,000)	(205,000)
Net cash used in investing activities	(13,628,249)	(902,211)
FINANCING ACTIVITIES:
Proceeds from issuance of common stock, net of fees and expenses		1,972,065
Proceeds from issuance of preferred stock, net of fees and expenses	22,817,566	16,535,656
Preferred stock dividends paid	(4,102,410)	(1,485,727)
Settlement of tax withholding obligations on stock issued to employees	(333,007)	(195,912)
Repayments of notes payable	(464,167)	(12,719,520)
Proceeds from line of credit	11,276,862	9,197,863
Repayments of line of credit	(11,276,862)	(11,197,863)
Contingent consideration payments	(150,250)	(145,885)
Other financing activities	(111,195)	(116,698)
Net cash provided by financing activities	17,656,537	1,843,979
EFFECT OF EXCHANGE RATE CHANGES ON CASH	(730,511)	(338,058)
NET INCREASE IN CASH	10,110,251	885,352
CASH - beginning of the period	4,362,232	3,476,880
CASH - end of the period	14,472,483	4,362,232
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES:
Vehicle financing obtained	90,284	26,746
Dividends declared, not paid	1,468,724	747,147
Purchase of prepaid insurance through assumption of note	271,248	222,634
Value of warrants issued	101,989	390,479
SUPPLEMENTAL INFORMATION - Cash paid during the period for:
Income taxes	42,057	9,304
Interest	$ 64,669	$ 612,285

Organization and Business

Organization and Business	12 Months Ended
	Dec. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Business	1. Organization and Business MTBC, Inc., formerly known as 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, comprehensive practice management services, 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 client support teams throughout the U.S., in Pakistan and in 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. The operations have been terminated and the Indian subsidiary is being liquidated. The Poland subsidiary was liquidated in 2018.

Significant Accounting Policies

Significant Accounting Policies	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Significant Accounting Policies	2. Significant Accounting Policies Principles of Consolidation Segment Reporting Use of Estimates Revenue Recognition Revenue from Contracts with Customers We derive revenue from seven primary sources: (1) revenue cycle management services, (2) professional services, (3) ancillary services, (4) group purchasing services, (5) printing and mailing services, (6) clearinghouse and EDI (electronic data interchange) services and (7) practice management services. All of our revenue arrangements are based on contracts with customers. Most of our contracts with customers contain single performance obligations, although certain contracts do contain multiple performance obligations where we perform more than one service for the same customer. We account for individual performance obligations separately if they are distinct within the context of the contract. For contracts where we provide multiple services such as where we perform multiple ancillary services, each service represents its own performance obligation. Selling or transaction prices are based on the contractual price for the service. A five-step approach is applied in the recognition of revenue under ASC 606: (1) identify the contract with a customer, (2) identify the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations in the contract, and (5) recognize revenue when we satisfy a performance obligation. Although we believe that our approach to estimates and judgments is reasonable, actual results could differ, and we may be exposed to increases or decreases in revenue that could be material. Our estimates of variable consideration may prove to be inaccurate, in which case we may have understated or overstated the revenue recognized in a reporting period. The amount of variable consideration recognized to date that remains subject to estimation is included within the contract asset within the consolidated balance sheet. Payment of invoices is due as specified in the underlying customer agreement, typically 30 days from the invoice date, which occurs on the date of transfer of control of the services to the customer. Since payment terms are less than a year, we have elected the practical expedient and do not assess whether a customer contract has a significant financing component. The Company’s revenue arrangements generally do not include a general right of refund for services provided (See Note 9, Revenue for additional information.) Direct Operating Costs Selling and Marketing Expenses Research and Development Expenses Internal-Use Software Costs Accounts Receivable The movement in the allowance for doubtful accounts for the years ended December 31, 2018 and 2017 was as follows: December 31, 2018 December 31, 2017 Beginning balance $ 185,000 $ 156,000 Provision 724,000 410,000 Write-offs (720,000 ) (381,000 ) Ending balance $ 189,000 $ 185,000 Inventory Property and Equipment Intangible Assets Evaluation of Long-Lived Assets There was no impairment of internal-use software costs, intangibles or property and equipment during the years ended December 31, 2018 and 2017. Goodwill st Treasury Stock Stock-Based Compensation Business Combinations Business Combinations Acquisition costs are expensed as incurred. During the years ended December 31, 2018 and 2017, the Company incurred approximately $245,000 and $30,000 of professional fees related to the acquisitions discussed in Note 3, which are included in general and administrative expenses in the consolidated statement of operations. Income Taxes The Company records net deferred tax assets to the extent that these assets will more likely than not be realized. All available positive and negative evidence is considered in making such a determination, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies, and results of recent operations. A valuation allowance would be recorded to reduce deferred income tax assets when it is determined that it is more likely than not that the Company would not be able to realize its deferred income tax assets in the future in excess of their net recorded amount. The Company records uncertain tax positions on the basis of a two-step process whereby (1) the Company determines whether it is more likely than not that the tax positions will be sustained based on the technical merits of the position and (2) for those tax positions that meet the more-likely-than-not recognition threshold, the Company recognizes the largest amount of tax benefit that is greater than 50 percent likely to be realized upon ultimate settlement with the related tax authority. At December 31, 2018 and 2017, the Company did not have any uncertain tax positions that required recognition. Interest and penalties related to uncertain tax positions are recognized in income tax expense. For the years ended December 31, 2018 and 2017, the Company did not recognize any penalties or interest related to unrecognized tax benefits in its consolidated financial statements. Dividends Deferred Rent Deferred Revenue Fair Value Measurements Fair Value Measurement Level 1 — Inputs are unadjusted quoted market prices in active markets for identical assets or liabilities that the Company has the ability to access at the measurement date. Level 2 — Inputs are directly or indirectly observable, which include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability and inputs that are derived principally from or corroborated by observable market data by correlation or other means. Level 3 — Inputs are unobservable inputs that are used to measure fair value to the extent observable inputs are not available. The Company’s contingent consideration is a Level 3 liability and is measured at fair value at the end of each reporting period. The Company has certain financial instruments that are not measured at fair value on a recurring basis. These financial instruments are subject to fair value adjustments only in certain circumstances and include cash, accounts receivable, accounts payable and accrued expenses, borrowings under term loans and line of credit, and notes payable. Due to the short term nature of these financial instruments and that the borrowings, with the exception of the payable to the managed practices (see Note 8) bear interest at prevailing market rates, the carrying value approximates the fair value. Foreign Currency Translation Stock Offering Costs — Exit Costs, Including Restructuring Costs — Debt Acquisition Costs — 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 December 31, 2018, the capitalized sales commissions were approximately $93,000 and are included in other assets in the consolidated balance sheet. Amortization of capitalized sales commissions for the year ended December 31, 2018 was approximately $60,000 and is included in selling and marketing expenses in the consolidated statement of operations. The following table reconciles the balances as presented for the year ended December 31, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: Year Ended December 31, 2018 As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 50,545,781 $ 40,934 $ 50,504,847 OPERATING EXPENSES: Direct operating costs 31,252,535 - 31,252,535 Selling and marketing 1,611,982 7,986 1,603,996 General and administrative 16,264,473 - 16,264,473 Research and development 1,029,510 - 1,029,510 Change in contingent consideration 73,271 - 73,271 Depreciation and amortization 2,853,827 - 2,853,827 Total operating expenses 53,085,598 7,986 53,077,612 OPERATING (LOSS) INCOME (2,539,817 ) 32,948 (2,572,765 ) OTHER: Interest income 100,788 - 100,788 Interest expense (351,168 ) - (351,168 ) Other income - net 494,332 - 494,332 (LOSS) INCOME BEFORE INCOME TAXES (2,295,865 ) 32,948 (2,328,813 ) Income tax benefit (157,385 ) - (157,385 ) NET (LOSS) INCOME $ (2,138,480 ) $ 32,948 $ (2,171,428 ) Preferred stock dividend 4,823,987 - 4,823,987 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (6,962,467 ) $ 32,948 $ (6,995,415 ) Loss per common share Basic and diluted loss per share $ (0.59 ) $ 0.00 $ (0.60 ) These 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 We adopted the standard on January 1, 2019 using the optional transition method. The Company has made substantial progress in executing our implementation plan. We have summarized the lease data and have selected specific software to assist us in recording and maintaining an inventory of leases. We have revised our processes and controls to address the lease standard and have substantially completed the implementation and data input for our lease accounting software. The Company determined that the adoption of ASC 842 primarily relates to its real estate leases for office and datacenter facilities. We will adopt the requirements of the new standard via a cumulative effect adjustment without restating the prior periods. For leases in place at the transition date, we will use the package of practical expedients that allows us to not reassess: (1) whether any expired or existing contracts are or contain leases, (2) lease classification for any expired or existing leases and (3) initial direct costs for any expired or existing leases. We additionally expect to use the practical expedients that allows us to treat the lease and non-lease components of our leases as a single component for our facility leases. We elected the short-term lease recognition exemption for all leases that qualify. As such, for those leases that qualify, we will not recognize ROU asset or lease liabilities as part of the transition adjustment in the future. While we are finalizing our assessment of all of the effects of adoption, we currently believe that most significant effects relate to (i) the recognition of new right of use assets and lease liabilities on the consolidated balance sheet relating to facility leases and other operating leases with durations greater than twelve months; and (ii) providing significant new disclosures about our leasing activities. Based on the assessment performed to date, we believe that the impact on our consolidated assets and liabilities will be material as of January 1, 2019. The Company does not expect the adoption of ASC 842 to have a material effect on its results of operations, stockholders’ equity, or statement of cash flows. In March 2016, the FASB issued ASU 2016-09, Compensation—Stock Compensation In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments Also in January 2017, the FASB issued ASU No. 2017-04, Intangibles – Goodwill and Other : Simplifying the Accounting for Goodwill Impairment In May 2017, the FASB issued ASU No. 2017-09, Compensation - Stock Compensation: Scope of Modification Accounting 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. In June 2018, the FASB issued ASU 2018-07, Improvements to Nonemployee Share-Based Payment Accounting

Acquisitions

Acquisitions	12 Months Ended
	Dec. 31, 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 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 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 and assumed liabilities acquired from Orion. The following table summarizes the purchase price allocation. Customer relationships $ 6,250,000 Accounts receivable 5,654,919 Contract asset 861,341 Inventory 307,278 Property and equipment 319,352 Goodwill 329,852 Accounts payable (677,872 ) 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 by clients. The inventory acquired represents vaccines held at the managed practices. The fair value 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 an expanded 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 weighted-average amortization period of the acquired intangibles is eight years. Revenue earned beginning July 1, 2018 from the customers obtained from the Orion acquisition was approximately $17.8 million during the year ended December 31, 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 22%, 23% and 24% of revenue collected from the WMB accounts in the first, second and third year, respectively, subsequent to the acquisition date to the extent such amounts in the aggregate exceed the Initial Payment Amount (the “WMB Installment Payments”). 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. The purchase price allocation for WMB was performed by the Company and is summarized as follows: Customer relationships $ 120,000 Goodwill 85,000 $ 205,000 The goodwill from this acquisition is deductible ratably for income tax purposes over 15 years and represents the Company’s ability to have a local presence in the Washington market and the further ability to expand in that market. The weighted-average amortization period of the acquired intangible assets is three years. Revenue earned from the WMB acquisition was approximately $178,000 during the year ended December 31, 2018. Pro forma financial information (Unaudited) The unaudited pro forma information below represents the consolidated results of operations as if the WMB and Orion acquisitions occurred on January 1, 2017. The pro forma information has been included for comparative purposes and is not indicative of results of operations of the Company would have had if the acquisitions occurred on the above date, nor is it necessarily indicative of future results. The unaudited pro forma information reflects adjustments related to (a) additional amortization of purchased intangible assets, (b) expenses are directly attributable to the acquisitions, (c) reversal of goodwill impairment, (d) adjustments for income taxes and (e) adjustments of intercompany balances. Year Ended December 31, 2018 2017 ($ in thousands, except per share data) Net revenue $ 69,625 $ 74,791 Net loss $ (1,571 ) $ (20,711 ) Net loss attributable to common shareholders $ (6,395 ) $ (22,741 ) Net loss per common share $ (0.55 ) $ (2.07 )

Goodwill and Intangible Assets

Goodwill and Intangible Assets - Net	12 Months Ended
	Dec. 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 years ended December 31, 2018 and 2017: December 31, 2018 December 31, 2017 Beginning gross balance $ 12,263,943 $ 12,178,868 Acquisitions 329,852 85,075 Ending gross balance $ 12,593,795 $ 12,263,943 At December 31, 2018, approximately $90,000 of goodwill was allocated to the Practice Management segment and the balance was allocated to the Healthcare IT segment. There was only one reporting unit at December 31, 2017. Below is a summary of intangible asset activity for the years ended December 31, 2018 and 2017: Customer Non-Compete Other Intangible Relationships Agreements Assets Total COST Balance, January 1, 2018 $ 16,491,300 $ 1,236,377 $ 1,498,417 $ 19,226,094 Purchase of other intangible assets - - 108,552 108,552 Translation loss - - (129,910 ) (129,910 ) Allocation from 2018 acquisition 6,250,000 - - 6,250,000 Balance, December 31, 2018 $ 22,741,300 $ 1,236,377 $ 1,477,059 $ 25,454,736 Useful lives 3-12 Years 3 Years 3 Years ACCUMULATED AMORTIZATION Balance, January 1, 2018 $ 14,685,190 $ 1,227,601 $ 803,759 $ 16,716,550 Amortization expense 1,772,688 7,173 324,322 2,104,183 Balance, December 31, 2018 16,457,878 1,234,774 1,128,081 18,820,733 Net book value $ 6,283,422 $ 1,603 $ 348,978 $ 6,634,003 COST Balance, January 1, 2017 $ 16,371,375 $ 1,236,377 $ 1,289,339 $ 18,897,091 Purchase of other intangible assets - - 489,295 489,295 Translation loss - - (280,217 ) (280,217 ) Allocation from 2017 acquisition 119,925 - - 119,925 Balance, December 31, 2017 $ 16,491,300 $ 1,236,377 $ 1,498,417 $ 19,226,094 Useful lives 3 Years 3 Years 3 Years ACCUMULATED AMORTIZATION Balance, January 1, 2017 $ 11,497,555 $ 1,106,706 $ 459,124 $ 13,063,385 Amortization expense 3,187,635 120,895 344,635 3,653,165 Balance, December 31, 2017 14,685,190 1,227,601 803,759 16,716,550 Net book value $ 1,806,110 $ 8,776 $ 694,658 $ 2,509,544 Other intangible assets primarily represent software costs. Amortization expense was approximately $2.2 million and $3.7 million for the years ended December 31, 2018 and 2017, respectively. The weighted-average amortization period is seven years. As of December 31, 2018, future amortization expense scheduled to be expensed is as follows: Years ending December 31 2019 $ 1,823,140 2020 1,009,527 2021 942,226 2022 609,110 2023 300,000 Thereafter 1,950,000 Total $ 6,634,003

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Property and Equipment	5. Property and Equipment Property and equipment as of December 31, 2018 and 2017 consisted of the following: December 31, 2018 December 31, 2017 Computer equipment $ 2,389,865 $ 1,776,463 Office furniture and equipment 1,089,014 1,078,729 Transportation equipment 828,417 719,947 Leasehold improvements 727,519 880,273 Assets not placed in service 50,362 4,415 Total property and equipment 5,085,177 4,459,827 Less accumulated depreciation (3,252,990 ) (3,074,084 ) Property and equipment – net $ 1,832,187 $ 1,385,743 Depreciation expense was approximately $688,000 and $634,000 for the years ended December 31, 2018 and 2017, respectively.

Concentrations

Concentrations	12 Months Ended
	Dec. 31, 2018
Risks and Uncertainties [Abstract]
Concentrations	6. Concentrations Financial Risks Concentrations of credit risk with respect to trade accounts receivable are managed by periodic credit evaluations of customers. The Company does not require collateral for outstanding trade accounts receivable. As of December 31, 2018, two customers individually accounted for approximately 8% and 7% of accounts receivable, respectively. As of December 31, 2017, two customers individually accounted for approximately 8% and 7% of accounts receivable respectively. During the year ended December 31, 2018, there was one customer with sales of approximately 10% of the total revenue. During the year ended December 31, 2017, there was one customer with sales of approximately 9% of total revenue. Geographical Risks Carrying amounts of net assets located outside the United States were approximately $162,000 and $157,000 as of December 31, 2018 and 2017, respectively. These balances exclude intercompany receivables of approximately $7.6 million and $6.5 million as of December 31, 2018 and 2017, respectively. The following is a summary of the net assets located outside the United States as of December 31, 2018 and 2017: December 31, 2018 2017 Current assets $ 156,265 $ 128,932 Non-current assets 1,259,446 1,281,433 1,415,711 1,410,365 Current liabilities (1,044,539 ) (920,770 ) Non-current liabilities (209,333 ) (333,060 ) Net assets $ 161,839 $ 156,535

Net Loss Per Common Share

Net Loss Per Common Share	12 Months Ended
	Dec. 31, 2018
Earnings Per Share [Abstract]
Net Loss Per Common Share	7. NET LOss per COMMON share The following table reconciles the weighted-average shares outstanding for basic and diluted net loss per common share for the years ended December 31, 2018 and 2017: Year Ended December 31, 2018 2017 Basic and Diluted: Net loss attributable to common shareholders $ (6,962,467 ) $ (7,595,451 ) Weighted-average common shares used to compute basic and diluted loss per share 11,721,232 11,010,432 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.59 ) $ (0.69 ) All unvested restricted stock units (“RSUs”), the 200,000 warrants granted to 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	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Debt	8. 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 December 31, 2018, the Company was in compliance with all covenants. Opus Interest expense in the consolidated statements of operations for the year ended December 31, 2017 includes $463,000 of deferred financing costs which were written off as a result of the termination of the Opus credit agreement. Prudential Deferred Purchase Price Vehicle Financing Notes Insurance Financing Payable to Managed Practices — Maturities of the outstanding notes payable and other obligations as of December 31, 2018 are as follows: Years ending December 31 Vehicle Financing Notes Insurance Financing Payable to Managed Practices Total 2019 $ 71,750 $ 122,026 $ 84,000 $ 277,776 2020 65,475 - 84,000 149,475 2021 29,413 - 26,000 55,413 2022 12,857 - - 12,857 2023 4,655 - - 4,655 Total $ 184,150 $ 122,026 $ 194,000 $ 500,176

Revenue

Revenue	12 Months Ended
	Dec. 31, 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 Most 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 years ended December 31, 2018 and 2017: Year Ended December 31, 2018 2017 Healthcare IT: Revenue cycle management services $ 38,559,180 $ 28,410,557 Professional services 1,244,894 281,572 Ancillary services 1,594,364 1,002,296 Group purchasing services 654,805 - Printing and mailing services 1,344,011 1,372,239 Clearinghouse and EDI services 647,446 743,971 Practice Management: Practice management services 6,501,081 - Total $ 50,545,781 $ 31,810,635 Revenue cycle management services: Revenue cycle management services are 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 services include 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 services to be one performance obligation since the promises are not distinct in the context of the contract. The performance obligation consists of a series of distinct services that are substantially the same and have the same periodic pattern of transfer to our customers. 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. Although our contracts typically 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. For the majority of our revenue cycle management contracts, the total transaction price is variable because our obligation is to process an unknown quantity of claims, as and when requested by our customers over the contract period. 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 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 variable consideration is subsequently resolved. Estimates to determine variable consideration such as payment to charge ratios, effective billing rates, and the estimated contractual payment periods are updated at each reporting date. Revenue is recognized over the performance period using the input method. 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 over time as the implementation or professional services are rendered. Ancillary services represent services such as coding and transcription that are rendered in connection with the delivery of revenue cycle management and related medical 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 over time as that individual service is rendered. As a result of the Orion acquisition on July 1, 2018, the Company now provides group purchasing services which enable 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 a specific quantity of 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. 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 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 have approximately an additional 20 years remaining 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 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. Revenue is recognized over time, however for reporting and convenience purposes management fee is computed at each month end. Information about contract balances: As a result of the Orion acquisition, a contract asset of approximately $861,000 was recorded as part of the purchase price allocation. Of this amount, approximately $400,000 was related to revenue cycle management and $461,000 was related to group purchasing services. The revenue recognition for the group purchasing services was not impacted by the new revenue standard. For group purchasing services, the revenue earned and not paid is recorded as part of the contract asset. The contract asset in the 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 December 31, 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 $0.8 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 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 $2.6 million as of December 31, 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 revenue cycle management 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 5,654,919 861,341 - - (Decrease) increase, net (2,202,908 ) 404,598 (36,749 ) (9,666 ) Ending balance as of December 31, 2018 $ 7,331,474 $ 2,608,631 $ 25,355 $ 18,949 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 $93,000 at December 31, 2018 and is included in the Other Assets lines in the consolidated balance sheet.

Shareholders' Equity

Shareholders' Equity	12 Months Ended
	Dec. 31, 2017
Equity [Abstract]
Shareholders' Equity	10. SHAREHOLDERS’ EQUITY Treasury stock The Board of Directors of the Company previously approved stock repurchase programs. The last program expired January 25, 2017. As a result of these stock repurchases, the Company has 740,799 shares held as treasury stock at an aggregate cost of $662,000. Common stock In May 2017, the Company completed a registered direct offering of one million shares of its common stock at $2.30 per share, raising net proceeds of approximately $2.0 million. There were no common stock offerings during 2018. Holders of our common stock are entitled to one vote for each share held on all matters properly submitted to a vote of shareholders on which holders of common stock are entitled to vote. Holders of common stocks are entitled to receive dividends only at times and amounts as determined by the Board of Directors. The common stock is not entitled to pre-emptive rights, and is not subject to conversion, redemption or sinking fund provisions. Preferred Stock During the year ended December 31, 2018, the Company completed two additional public offerings of approximately one million shares of its Preferred Stock at $25.00 per share, raising net proceeds of approximately $22.8 million after underwriting commissions and other directly attributable expenses. Between June and December 2017, the Company completed six additional public offerings of approximately 765,000 shares of its Preferred Stock at $25.00 per share, raising net proceeds of approximately $16.4 million after underwriting commissions and expenses. Dividends on the Preferred Stock of $2.75 annually per share are cumulative from the date of issue and are payable each month when, as and if declared by the Company’s Board of Directors. As of December 31, 2018, the Board of Directors has declared monthly dividends on the Preferred Stock payable through February 2019. Commencing on or after November 4, 2020, the Company may redeem, at its option, the Preferred Stock, in whole or in part, at a cash redemption price of $25.00 per share, plus all accrued and unpaid dividends to, but not including the redemption date. The Preferred Stock has no stated maturity, is not subject to any sinking fund or other mandatory redemption, and is not convertible into or exchangeable for any of the Company’s other securities. Holders of the Preferred Stock have no voting rights except for limited voting rights if dividends payable on the Preferred Stock are in arrears for eighteen or more consecutive or non-consecutive monthly dividend periods. If the Company were to liquidate, dissolve or wind up, the holders of the Preferred Stock will have the right to receive $25.00 per share, plus any accumulated and unpaid dividends to, but not including, the date of payment, before any payment is made to the holders of the common stock. The Preferred Stock is listed on the Nasdaq Capital Market under the trading symbol “MTBCP.” Warrants The Company has issued 2,353,489 warrants for its common stock, of which 353,489 remain outstanding at December 31, 2018. The 2,000,000 warrants previously issued at a $5 exercise price expired in May 2018. The outstanding warrants consist of 100,000 warrants at a $5 exercise price which will expire in September, 2022, 125,000 warrants at a $3.92 exercise price which will expire in October 2022, 100,000 warrants at a $5 exercise price which will expire in July, 2023 and 28,489 warrants at a $5.26 exercise price which will expire in September, 2023.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	11. 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 Certain other leases are being maintained on a month to month basis. This includes leases for our US corporate facility and other locations with the Executive Chairman (see Note 12). As of December 31, 2018, total lease payments for our month-to-month and cancelable leases are approximately $47,000 per month. The Company also has an offshore lease with monthly rent payments of approximately $19,000 that has a three-month cancellation provision. Month to month leases and cancelable leases were not included in the table below. Future minimum lease payments under non-cancelable operating leases as of December 31, 2018 are as follows: Years Ending December 31 Total 2019 $ 932,068 2020 715,059 2021 510,927 2022 412,585 2023 91,797 Total $ 2,662,436 Total rental expense, included in direct operating costs and general and administrative expense in the consolidated statements of operations, amounted to approximately $1.6 million and $935,000 for the years ended December 31, 2018 and 2017, respectively. Acquisitions —

Related Parties

Related Parties	12 Months Ended
	Dec. 31, 2018
Related Party Transactions [Abstract]
Related Parties	12. 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 $20,000 for the year ended December 31, 2018 and approximately $17,000 for the year ended December 31, 2017. As of December 31, 2018 and 2017, the accounts receivable balance due from this customer was approximately $1,600 and $1,900, respectively and is included in accounts receivable in the consolidated balance sheets. 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 expense of approximately $128,000 for both the years ended December 31, 2018 and 2017. As of both December 31, 2018 and 2017, the Company had liabilities outstanding to KAI of approximately $11,000, which are included in accrued liability to related party in the 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 years ended December 31, 2018 and 2017 were approximately $187,000 and $189,000, respectively, and is included in direct operating costs and general and administrative expense in the consolidated statements of operations. Current assets-related party in the consolidated balance sheets includes security deposits related to the leases of the Company’s corporate offices in the amount of $13,000 as of both December 31, 2018 and 2017. Both the December 31, 2018 and 2017 balances for current assets - in related party include prepaid rent paid to the Executive Chairman of approximately $12,000.

Employee Benefit Plans

Employee Benefit Plans	12 Months Ended
	Dec. 31, 2018
Retirement Benefits [Abstract]
Employee Benefit Plans	13. Employee Benefit PlanS The Company has a qualified 401(k) plan covering all U.S. employees of MTBC, Inc. and MAC who have completed one month of service. The plan provides for matching contributions by the Company equal to 100% of the first 3% of qualified compensation, plus 50% of the next 2%. The Company also maintain a qualified 401(k) plan for MHI and MPM employees who have completed one month of service. There is a discretionary match for MHI employees equal to 50% of the first 3% of qualified compensation. There is no match for MPM employees. Employer contributions to the plans for the years ended December 31, 2018 and 2017 were approximately $161,000 and $137,000, respectively. Additionally, the Company has a defined contribution retirement plan covering all employees located in Pakistan who have completed three months of service. The plan provides for monthly contributions by the Company which are the lower of 10% of qualified employees’ basic monthly compensation or 750 Pakistani rupees. The Company’s contributions for the years ended December 31, 2018 and 2017 were approximately $110,000 and $123,000, respectively. The Company maintains a defined contribution retirement plan covering all employees in Sri Lanka. The employee and employer contribute 8% and 12%, respectively, of the employee’s gross salary. The Company’s contribution for the year ended December 31, 2018 and 2017 were approximately $56,000 and $67,000, respectively. The contributions are required to be deposited with the Employees’ Provident Fund Organization, a government owned entity.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	14. STOCK-BASED COMPENSATION In April 2014, the Company adopted the Medical Transcription Billing, Corp. 2014 Equity Incentive Plan (the “2014 Plan”), reserving a total of 1,351,000 shares of common stock for grants to employees, officers, directors and consultants. During 2017, the 2014 Plan was amended whereby an additional 1,500,000 shares of common stock and 100,000 shares of Preferred Stock were added to the plan for future issuance. During 2018, an additional 200,000 shares of Preferred Stock was added to the plan for future issuance. The name of the 2014 Plan was changed to the Amended and Restated Equity Incentive Plan (the “Incentive Plan”). As of December 31, 2018, 547,790 shares of common stock and 182,400 shares of Preferred Stock are available for grant. 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 2018, 68,000 RSUs of common stock were granted over two years 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. The following table summarizes the RSU and restricted stock transactions related to the common and Preferred Stock under the Incentive Plan for the years ended December 31, 2018 and 2017: Common Stock Preferred Stock Outstanding and unvested shares at January 1, 2017 406,959 33,000 Granted 555,500 39,800 Vested (327,159 ) (33,000 ) Forfeited (29,331 ) - Outstanding and unvested shares at January 1, 2018 605,969 39,800 Granted 707,200 44,800 Vested (340,066 ) (39,800 ) Forfeited (43,756 ) - Outstanding and unvested shares at December 31, 2018 929,347 44,800 As of December 31, 2018 and 2017, there was approximately $2,456,000 and $793,000, respectively of total unrecognized compensation cost related to the common stock RSUs classified as equity that will be expensed through 2021. There was no unrecognized compensation cost related to the Preferred Stock RSUs. Of the total outstanding and unvested common stock RSUs at December 31, 2018, 845,167 RSUs are classified as equity and 84,180 RSUs are classified as a liability. All of the Preferred Stock RSUs are classified as equity. The following table summarizes the share activity during the years ended December 31, 2018 and 2017 and the amount of common and preferred shares available for grant at December 31, 2018: Common Stock Preferred Stock Shares available for grant at January 1, 2017 237,403 67,000 Additional shares available for grant 1,500,000 - RSUs granted (555,500 ) (39,800 ) RSUs forfeited 29,331 - Shares available for grant at December 31, 2017 1,211,234 27,200 Additional shares available for grant - 200,000 RSUs granted (707,200 ) (44,800 ) RSUs forfeited 43,756 - Shares available for grant at December 31, 2018 547,790 182,400 The liability for the cash-settled awards was approximately $118,000 and $41,000 at December 31, 2018 and 2017, respectively, and is included in accrued compensation in the consolidated balance sheets. During the years ended December 31, 2018 and 2017, approximately $39,000 and $54,000, respectively, was paid in connection with the cash-settled awards. Preferred stock In November 2016, the Compensation Committee granted cash bonuses to three executives for the successful MediGain acquisition to be paid upon the closing of additional funding, which did not occur. The expense for this bonus was recorded in 2016. In January 2017, the Board of Directors recommended that these bonuses be paid in shares of Preferred Stock, subject to shareholder approval. In April 2017, shareholder approval was obtained and 33,000 shares of Preferred Stock were issued. In the fourth quarter of 2017, the Compensation Committee of the Board of Directors again approved the issuance of a total of 33,000 restricted shares of Preferred Stock, contingent on meeting 2017 financial objectives, to three executive officers. Subsequent to year-end, the Compensation Committee determined that the financial objectives were attained and all of the shares were issued. Additional Preferred Stock awards of 6,800 shares were also granted to two employees as performance bonuses. Stock-based compensation expense recorded during 2017 for these awards was approximately $1.0 million based on the liquidation value of $25 per share which approximated the fair value on the date of the grant. In 2018, the Compensation Committee has again approved executive bonuses to be paid in 40,000 shares of Preferred Stock, with the final number of shares and the amount based on specified performance criteria being achieved during 2018. An additional Preferred Stock award of 4,800 shares was granted as a performance bonus to one employee. Stock-based compensation expense recorded during 2018 for these awards was approximately $1.2 million based on the liquidation value of $25 per share which approximated the fair value on the date of the grant. During February 2019, the Compensation Committee determined that the financial objectives were attained and all of the shares were issued including the performance bonus shares. 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 weighted average grant date fair value of the common stock price in connection with the RSUs classified as equity was $4.53 and $1.73 for the years ended December 31, 2018 and 2017, respectively. The following table summarizes the components of share-based compensation expense for the years ended December 31, 2018 and 2017: Stock-based compensation included in the Year Ended December 31, Consolidated Statement of Operations: 2018 2017 Direct operating costs $ 88,195 $ 9,849 General and administrative 2,352,850 1,419,068 Research and development 14,506 8,378 Selling and marketing 8,048 50,000 Total stock-based compensation expense $ 2,463,599 $ 1,487,295

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income Taxes	15. INCOME TAXES For the years ended December 31, 2018 and 2017, the Company estimated its income tax provision based upon the annual pre-tax loss. Although the Company is forecasting a return to profitability, it 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 December 31, 2018 and December 31, 2017, with the exception of a net deferred tax liability relating to the amortization of intangibles for tax purposes. As of January 1, 2018, all adjusted foreign income amounts became taxable due to a change in U.S. tax law under the recent tax reform legislation discussed below. For state tax purposes, the Company’s foreign earnings may be taxable depending on each individual state’s legislative stance on the recent tax reform legislation. The activity in the deferred tax valuation allowance was as follows for the years ended December 31, 2018 and 2017: Year ended December 31, 2018 2017 Beginning balance $ 6,620,464 $ 7,221,443 Provision/ (Benefit) 400,158 (648,281 ) Adjustments/true-ups 155,769 47,302 Ending balance $ 7,176,391 $ 6,620,464 The adjustments/true-ups for 2018 primarily represent the adjustment for the additional net operating loss as a result of completing the 2017 federal and state income tax returns. The adjustments/true-ups for 2017 primarily represent the use of federal net operating losses to offset the Transition Tax as defined below. Accordingly, additional valuation allowances needed to be provided. Since a full valuation allowance is recorded on the Company’s deferred tax assets, there was no effect on the Company’s consolidated balance sheets. The (loss) income before tax for financial reporting purposes during the years ended December 31, 2018 and 2017 consisted of the following: Year ended December 31, 2018 2017 United States $ (4,111,539 ) $ (6,949,433 ) Foreign 1,815,674 1,452,082 Total $ (2,295,865 ) $ (5,497,351 ) The (benefit) provision for income taxes for the years ended December 31, 2018 and 2017 consisted of the following: Year ended December 31, 2018 2017 Current: Federal $ - $ - State 49,000 31,028 Foreign 1,341 10,235 50,341 41,263 Deferred: Federal (225,347 ) 7,183 State 17,621 19,359 (207,726 ) 26,542 Total income tax (benefit) provision $ (157,385 ) $ 67,805 The components of the Company’s deferred income taxes as of December 31, 2018 and 2017 are as follows: December 31, 2018 December 31, 2017 Deferred tax assets: Allowance for doubtful accounts $ 46,492 $ 45,944 Deferred revenue 4,664 7,121 Deferred rent 4,275 1,857 Property and intangible assets 2,336,221 2,227,454 State net operating loss (“NOL”) carryforwards 636,578 569,847 Federal net operating loss (“NOL”) carryforwards 3,789,618 3,245,846 Section 163(j) interest limitation 51,319 - Cumulative translation adjustment 349,834 179,510 Stock based compensation 335,785 325,243 Other (24,654 ) 17,642 Valuation allowance (7,176,391 ) (6,620,464 ) Total deferred tax assets 353,741 - Deferred tax liabilities: Goodwill amortization (518,087 ) (372,072 ) Net deferred tax liability $ (164,346 ) $ (372,072 ) Deferred income tax balances reflect the effects of temporary differences between the carrying amounts of assets and liabilities and their tax bases, as well as from net operating loss carryforwards. Deferred income tax assets represent amounts available to reduce income taxes payable on taxable income in future years. The Company has recorded goodwill as a result of its acquisitions. Goodwill is generally not amortized for financial reporting purposes. For tax purposes, goodwill is tax deductible and amortized over 15 years. As such, deferred income tax expense and a deferred tax liability arise as a result of the tax-deductibility of this indefinitely lived asset (also known as a naked credit). The resulting deferred tax liability, which is expected to continue to increase over the amortization period, will have an indefinite life. As a result of the Company incurring 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 operating net loss, to the extent allowable. This resulted in a deferred tax benefit of approximately $208,000. The remaining deferred tax liability could remain on the Company’s consolidated balance sheet indefinitely unless there is an impairment of goodwill (for financial reporting purposes) or a portion of the business is sold. Due to the fact that the aforementioned deferred tax liability could have an indefinite life, it is not netted against the Company’s deferred tax assets when determining the required valuation allowance in accordance with ASC 740 guidelines. Doing so would result in the understatement of the valuation allowance and related deferred income tax expense. A reconciliation of the federal statutory income tax rate (21%) for 2018 and (34%) for 2017 to the Company’s effective income tax rate (determined in dollars) for the years ended December 31, 2018 and 2017 is as follows: Year ended December 31, 2018 2017 Federal benefit at statutory rate $ (482,132 ) $ (1,869,100 ) Increase (decrease) in income taxes resulting from: State tax expense, net of federal benefit 29,646 27,733 Non-deductible items 15,332 18,168 Impact of foreign operations (525,583 ) (733,043 ) Deferred tax impact from rate change - 3,105,106 Subpart F GILTI inclusion 360,742 - Deferred true-up (142,869 ) (42,453 ) Valuation allowance 555,927 (600,978 ) Additional tax goodwill/contingent consideration 31,553 162,372 Total income tax (benefit) provision $ (157,385 ) $ 67,805 At December 31, 2018 and 2017, the Company did not record any uncertain tax positions based on the technical merits. Therefore, a tabular roll forward was excluded and there has been no accrued interest and penalties. The Company is subject to taxation in the United States, various states, Pakistan and Sri Lanka. As of December 31, 2018, tax years 2015 through 2017 remain open to examination in the United States by major taxing jurisdictions in which the Company is subject to tax. The Company’s 2015 federal income tax return was examined during 2017 by the Internal Revenue Service. Upon the conclusion of the audit, there was an immaterial change to the reported amounts which slightly reduced the Company’s NOL carryforward. The Pakistan Federal Board of Revenue issued a tax holiday, which precludes the Pakistan subsidiary from being subject to income taxes through June 2025. It is the Company’s policy that any assessed penalties and interest on uncertain tax positions would be charged to income tax expense. The Pakistan tax holiday does not have a significant impact on the Company’s effective tax rate as all of its earnings in Pakistan have been fully included in the U.S. federal tax rate of 21% for 2018 and 34% for 2017. The Pakistan statutory corporate tax rate is 30% before consideration of the aforementioned tax holiday. The Company has a federal NOL carry forward of approximately $18.0 million of which approximately $15.8 million will expire between 2034 and 2037 and $2.2 million has an indefinite life. The Company has state NOL carry forwards which mainly consists of approximately $34.9 million, of which $17.6 million relates to the State of New Jersey. These NOLs expire between 2034 to 2038. On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act (the “Tax Act”). The Tax Act makes broad and complex changes to the U.S. tax code, including, but not limited to, (1) reducing the U.S. federal corporate tax rate from 35% to 21%; (2) requiring companies to incur a one-time transition tax on certain un-repatriated earnings of foreign subsidiaries; (3) generally eliminating U.S. federal income taxes on future dividends from foreign subsidiaries; (4) requiring a current inclusion in U.S. federal taxable income of certain earnings of controlled foreign corporations commonly referred to as the Global Intangible Low-Taxed Income (“GILTI”); (5) eliminating the corporate alternative minimum tax (“AMT”) and changing how existing AMT credits can be realized; (6) creating a new limitation on deductible interest expense; and (7) changing rules related to uses and limitations of net operating loss carryforwards created in tax years beginning after December 31, 2017. As a result of the Tax Act, and pursuant to ASC 740 guidelines, impacts of legislative changes to deferred taxes are recorded in the period of enactment (fourth quarter of 2017). Consequently, at December 31, 2017, we revalued all our ending deferred tax balances to the new statutory 21% federal U.S. tax rate which was effective January 1, 2018. The impact of the revaluation to our total gross deferred tax asset balance, before valuation allowance, was a reduction of approximately $3.3 million as of December 31, 2017. The Tax Act reduced the corporate tax rate to 21 percent, effective January 1, 2018. For our deferred tax liability related to the amortization of goodwill for tax purposes, we recorded a decrease of $196,000, with a corresponding net adjustment to deferred tax benefit of that amount for the year ended December 31, 2017. The Company has a full valuation allowance on its deferred tax assets in the U.S. which results in there being no U.S. deferred tax assets or liabilities recorded on the consolidated balances sheet.

Other Income - Net

Other Income - Net	12 Months Ended
	Dec. 31, 2018
Other Income and Expenses [Abstract]
Other Income - Net	16. OTHER INCOME – NET Other income - net for the years ended December 31, 2018 and 2017 consisted of the following: Year Ended December 31, 2018 2017 Foreign exchange gains $ 434,806 $ 248,517 Other 59,526 83,567 Other income - net $ 494,332 $ 332,084 Foreign currency transaction gains and losses primarily result from transactions in foreign currencies other than the functional currency. These transaction gains and losses are recorded in the consolidated statements of operations related to the recurring measurement and settlement of such transactions.

Segment Reporting

Segment Reporting	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Segment Reporting	17. segment reporting Both our Chief Executive Officer and Executive Chairman serve as the CODM, organize the Company, manage resource allocations and measure performance among two operating and reportable segments: (i) Healthcare IT and (ii) Practice Management. The Healthcare IT segment includes revenue cycle management and other services. The Practice management segment includes the management of three medical practices. Each segment is considered a reporting unit. The CODM evaluates financial performance of the business units on the basis of revenue and direct operating costs excluding unallocated amounts, which are mainly corporate overhead costs. Our CODM does not evaluate operating segments using asset or liability information. The accounting policies of the segments are the same as those disclosed in the summary of significant accounting policies. There was only one operating segment during the year ended December 31, 2017 as the Practice Management segment was acquired in 2018. The following table presents revenues, operating expenses and operating income by reportable segment: Year Ended December 31, 2018 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 44,044,700 $ 6,501,081 $ - $ 50,545,781 Operating expenses: Direct operating costs 26,289,770 4,962,765 - 31,252,535 Selling and marketing 1,593,052 18,930 - 1,611,982 General and administrative 9,834,749 1,164,505 5,265,219 16,264,473 Research and development 1,029,510 - - 1,029,510 Change in contingent consideration 73,271 - - 73,271 Depreciation and amortization 2,700,577 153,250 - 2,853,827 Total operating expenses 41,520,929 6,299,450 5,265,219 53,085,598 Operating income (loss) $ 2,523,771 $ 201,631 $ (5,265,219 ) $ (2,539,817 )

Fair Value of Financial Instrum

Fair Value of Financial Instruments	12 Months Ended
	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	18. FAIR VALUE OF FINANCIAL INSTRUMENTS As of December 31, 2018 and December 31, 2017, the carrying amounts of accounts receivable, 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. As a result, the Company categorizes these borrowings as Level 2 in the fair value hierarchy. Contingent Consideration The Company’s contingent consideration of approximately $526,000 and $603,000 as of December 31, 2018 and 2017, respectively, are Level 3 liabilities. The fair value of the contingent consideration at December 31, 2018 and 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 Year Ended December 31, 2018 2017 Balance - January 1, $ 603,411 $ 929,549 Change in fair value 73,271 151,423 Settlement in the form of shares issued - (331,676 ) Payments (150,250 ) (145,885 ) Balance - December 31, $ 526,432 $ 603,411

Subsequent Event

Subsequent Event	12 Months Ended
	Dec. 31, 2018
Subsequent Events [Abstract]
Subsequent Event	19. SUBSEQUENT EVENT On February 6, 2019, the Company’s Board of Directors approved an amendment to the Articles of Incorporation to change the Company’s name to MTBC, Inc.

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation
Segment Reporting	Segment Reporting
Use of Estimates	Use of Estimates
Revenue Recognition	Revenue Recognition Revenue from Contracts with Customers We derive revenue from seven primary sources: (1) revenue cycle management services, (2) professional services, (3) ancillary services, (4) group purchasing services, (5) printing and mailing services, (6) clearinghouse and EDI (electronic data interchange) services and (7) practice management services. All of our revenue arrangements are based on contracts with customers. Most of our contracts with customers contain single performance obligations, although certain contracts do contain multiple performance obligations where we perform more than one service for the same customer. We account for individual performance obligations separately if they are distinct within the context of the contract. For contracts where we provide multiple services such as where we perform multiple ancillary services, each service represents its own performance obligation. Selling or transaction prices are based on the contractual price for the service. A five-step approach is applied in the recognition of revenue under ASC 606: (1) identify the contract with a customer, (2) identify the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations in the contract, and (5) recognize revenue when we satisfy a performance obligation. Although we believe that our approach to estimates and judgments is reasonable, actual results could differ, and we may be exposed to increases or decreases in revenue that could be material. Our estimates of variable consideration may prove to be inaccurate, in which case we may have understated or overstated the revenue recognized in a reporting period. The amount of variable consideration recognized to date that remains subject to estimation is included within the contract asset within the consolidated balance sheet. Payment of invoices is due as specified in the underlying customer agreement, typically 30 days from the invoice date, which occurs on the date of transfer of control of the services to the customer. Since payment terms are less than a year, we have elected the practical expedient and do not assess whether a customer contract has a significant financing component. The Company’s revenue arrangements generally do not include a general right of refund for services provided (See Note 9, Revenue for additional information.)
Direct Operating Costs	Direct Operating Costs
Selling and Marketing Expenses	Selling and Marketing Expenses
Research and Development Expenses	Research and Development Expenses
Internal-Use Software Costs	Internal-Use Software Costs
Accounts Receivable	Accounts Receivable The movement in the allowance for doubtful accounts for the years ended December 31, 2018 and 2017 was as follows: December 31, 2018 December 31, 2017 Beginning balance $ 185,000 $ 156,000 Provision 724,000 410,000 Write-offs (720,000 ) (381,000 ) Ending balance $ 189,000 $ 185,000
Inventory	Inventory
Property and Equipment	Property and Equipment
Intangible Assets	Intangible Assets
Evaluation of Long-Lived Assets	Evaluation of Long-Lived Assets There was no impairment of internal-use software costs, intangibles or property and equipment during the years ended December 31, 2018 and 2017.
Goodwill	Goodwill st
Treasury Stock	Treasury Stock
Stock-Based Compensation	Stock-Based Compensation
Business Combinations	Business Combinations Business Combinations Acquisition costs are expensed as incurred. During the years ended December 31, 2018 and 2017, the Company incurred approximately $245,000 and $30,000 of professional fees related to the acquisitions discussed in Note 3, which are included in general and administrative expenses in the consolidated statement of operations.
Income Taxes	Income Taxes The Company records net deferred tax assets to the extent that these assets will more likely than not be realized. All available positive and negative evidence is considered in making such a determination, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies, and results of recent operations. A valuation allowance would be recorded to reduce deferred income tax assets when it is determined that it is more likely than not that the Company would not be able to realize its deferred income tax assets in the future in excess of their net recorded amount. The Company records uncertain tax positions on the basis of a two-step process whereby (1) the Company determines whether it is more likely than not that the tax positions will be sustained based on the technical merits of the position and (2) for those tax positions that meet the more-likely-than-not recognition threshold, the Company recognizes the largest amount of tax benefit that is greater than 50 percent likely to be realized upon ultimate settlement with the related tax authority. At December 31, 2018 and 2017, the Company did not have any uncertain tax positions that required recognition. Interest and penalties related to uncertain tax positions are recognized in income tax expense. For the years ended December 31, 2018 and 2017, the Company did not recognize any penalties or interest related to unrecognized tax benefits in its consolidated financial statements.
Dividends	Dividends
Deferred Rent	Deferred Rent
Deferred Revenue	Deferred Revenue
Fair Value Measurements	Fair Value Measurements Fair Value Measurement Level 1 — Inputs are unadjusted quoted market prices in active markets for identical assets or liabilities that the Company has the ability to access at the measurement date. Level 2 — Inputs are directly or indirectly observable, which include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability and inputs that are derived principally from or corroborated by observable market data by correlation or other means. Level 3 — Inputs are unobservable inputs that are used to measure fair value to the extent observable inputs are not available. The Company’s contingent consideration is a Level 3 liability and is measured at fair value at the end of each reporting period. The Company has certain financial instruments that are not measured at fair value on a recurring basis. These financial instruments are subject to fair value adjustments only in certain circumstances and include cash, accounts receivable, accounts payable and accrued expenses, borrowings under term loans and line of credit, and notes payable. Due to the short term nature of these financial instruments and that the borrowings, with the exception of the payable to the managed practices (see Note 8) bear interest at prevailing market rates, the carrying value approximates the fair value.
Foreign Currency Translation	Foreign Currency Translation
Stock Offering Costs	Stock Offering Costs —
Exit Costs, Including Restructuring Costs	Exit Costs, Including Restructuring Costs —
Debt Acquisition Costs	Debt Acquisition Costs —
Recent Accounting Pronouncements	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 December 31, 2018, the capitalized sales commissions were approximately $93,000 and are included in other assets in the consolidated balance sheet. Amortization of capitalized sales commissions for the year ended December 31, 2018 was approximately $60,000 and is included in selling and marketing expenses in the consolidated statement of operations. The following table reconciles the balances as presented for the year ended December 31, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: Year Ended December 31, 2018 As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 50,545,781 $ 40,934 $ 50,504,847 OPERATING EXPENSES: Direct operating costs 31,252,535 - 31,252,535 Selling and marketing 1,611,982 7,986 1,603,996 General and administrative 16,264,473 - 16,264,473 Research and development 1,029,510 - 1,029,510 Change in contingent consideration 73,271 - 73,271 Depreciation and amortization 2,853,827 - 2,853,827 Total operating expenses 53,085,598 7,986 53,077,612 OPERATING (LOSS) INCOME (2,539,817 ) 32,948 (2,572,765 ) OTHER: Interest income 100,788 - 100,788 Interest expense (351,168 ) - (351,168 ) Other income - net 494,332 - 494,332 (LOSS) INCOME BEFORE INCOME TAXES (2,295,865 ) 32,948 (2,328,813 ) Income tax benefit (157,385 ) - (157,385 ) NET (LOSS) INCOME $ (2,138,480 ) $ 32,948 $ (2,171,428 ) Preferred stock dividend 4,823,987 - 4,823,987 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (6,962,467 ) $ 32,948 $ (6,995,415 ) Loss per common share Basic and diluted loss per share $ (0.59 ) $ 0.00 $ (0.60 ) These 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 We adopted the standard on January 1, 2019 using the optional transition method. The Company has made substantial progress in executing our implementation plan. We have summarized the lease data and have selected specific software to assist us in recording and maintaining an inventory of leases. We have revised our processes and controls to address the lease standard and have substantially completed the implementation and data input for our lease accounting software. The Company determined that the adoption of ASC 842 primarily relates to its real estate leases for office and datacenter facilities. We will adopt the requirements of the new standard via a cumulative effect adjustment without restating the prior periods. For leases in place at the transition date, we will use the package of practical expedients that allows us to not reassess: (1) whether any expired or existing contracts are or contain leases, (2) lease classification for any expired or existing leases and (3) initial direct costs for any expired or existing leases. We additionally expect to use the practical expedients that allows us to treat the lease and non-lease components of our leases as a single component for our facility leases. We elected the short-term lease recognition exemption for all leases that qualify. As such, for those leases that qualify, we will not recognize ROU asset or lease liabilities as part of the transition adjustment in the future. While we are finalizing our assessment of all of the effects of adoption, we currently believe that most significant effects relate to (i) the recognition of new right of use assets and lease liabilities on the consolidated balance sheet relating to facility leases and other operating leases with durations greater than twelve months; and (ii) providing significant new disclosures about our leasing activities. Based on the assessment performed to date, we believe that the impact on our consolidated assets and liabilities will be material as of January 1, 2019. The Company does not expect the adoption of ASC 842 to have a material effect on its results of operations, stockholders’ equity, or statement of cash flows. In March 2016, the FASB issued ASU 2016-09, Compensation—Stock Compensation In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments Also in January 2017, the FASB issued ASU No. 2017-04, Intangibles – Goodwill and Other : Simplifying the Accounting for Goodwill Impairment In May 2017, the FASB issued ASU No. 2017-09, Compensation - Stock Compensation: Scope of Modification Accounting 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. In June 2018, the FASB issued ASU 2018-07, Improvements to Nonemployee Share-Based Payment Accounting

Significant Accounting Polici_3

Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Schedule of Allowance for Doubtful Accounts	The movement in the allowance for doubtful accounts for the years ended December 31, 2018 and 2017 was as follows: December 31, 2018 December 31, 2017 Beginning balance $ 185,000 $ 156,000 Provision 724,000 410,000 Write-offs (720,000 ) (381,000 ) Ending balance $ 189,000 $ 185,000
Schedule of Prior Adjustments for Implements to New Revenue Recognition	The following table reconciles the balances as presented for the year ended December 31, 2018 to the balances prior to the adjustments made to implement the new revenue recognition standard for the same period: Year Ended December 31, 2018 As Presented Impact of New Revenue Standard Previous Revenue Standard NET REVENUE $ 50,545,781 $ 40,934 $ 50,504,847 OPERATING EXPENSES: Direct operating costs 31,252,535 - 31,252,535 Selling and marketing 1,611,982 7,986 1,603,996 General and administrative 16,264,473 - 16,264,473 Research and development 1,029,510 - 1,029,510 Change in contingent consideration 73,271 - 73,271 Depreciation and amortization 2,853,827 - 2,853,827 Total operating expenses 53,085,598 7,986 53,077,612 OPERATING (LOSS) INCOME (2,539,817 ) 32,948 (2,572,765 ) OTHER: Interest income 100,788 - 100,788 Interest expense (351,168 ) - (351,168 ) Other income - net 494,332 - 494,332 (LOSS) INCOME BEFORE INCOME TAXES (2,295,865 ) 32,948 (2,328,813 ) Income tax benefit (157,385 ) - (157,385 ) NET (LOSS) INCOME $ (2,138,480 ) $ 32,948 $ (2,171,428 ) Preferred stock dividend 4,823,987 - 4,823,987 NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS $ (6,962,467 ) $ 32,948 $ (6,995,415 ) Loss per common share Basic and diluted loss per share $ (0.59 ) $ 0.00 $ (0.60 )

Acquisitions (Tables)

Acquisitions (Tables)	12 Months Ended
	Dec. 31, 2018
Business Acquisition, Pro Forma Information	The unaudited pro forma information reflects adjustments related to (a) additional amortization of purchased intangible assets, (b) expenses are directly attributable to the acquisitions, (c) reversal of goodwill impairment, (d) adjustments for income taxes and (e) adjustments of intercompany balances. Year Ended December 31, 2018 2017 ($ in thousands, except per share data) Net revenue $ 69,625 $ 74,791 Net loss $ (1,571 ) $ (20,711 ) Net loss attributable to common shareholders $ (6,395 ) $ (22,741 ) Net loss per common share $ (0.55 ) $ (2.07 )
2018 Acquisition [Member]
Schedule of Assets Acquired and Liabilities Assumed	The Company engaged a third party valuation specialist to assist the Company in valuing the assets and assumed liabilities acquired from Orion. The following table summarizes the purchase price allocation. Customer relationships $ 6,250,000 Accounts receivable 5,654,919 Contract asset 861,341 Inventory 307,278 Property and equipment 319,352 Goodwill 329,852 Accounts payable (677,872 ) Accrued expenses (444,870 ) $ 12,600,000
2017 Acquisition [Member]
Schedule of Assets Acquired and Liabilities Assumed	The purchase price allocation for WMB was performed by the Company and is summarized as follows: Customer relationships $ 120,000 Goodwill 85,000 $ 205,000

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Net (Tables)	12 Months Ended
	Dec. 31, 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 years ended December 31, 2018 and 2017: December 31, 2018 December 31, 2017 Beginning gross balance $ 12,263,943 $ 12,178,868 Acquisitions 329,852 85,075 Ending gross balance $ 12,593,795 $ 12,263,943
Schedule of Finite-Lived Intangible Assets	Below is a summary of intangible asset activity for the years ended December 31, 2018 and 2017: Customer Non-Compete Other Intangible Relationships Agreements Assets Total COST Balance, January 1, 2018 $ 16,491,300 $ 1,236,377 $ 1,498,417 $ 19,226,094 Purchase of other intangible assets - - 108,552 108,552 Translation loss - - (129,910 ) (129,910 ) Allocation from 2018 acquisition 6,250,000 - - 6,250,000 Balance, December 31, 2018 $ 22,741,300 $ 1,236,377 $ 1,477,059 $ 25,454,736 Useful lives 3-12 Years 3 Years 3 Years ACCUMULATED AMORTIZATION Balance, January 1, 2018 $ 14,685,190 $ 1,227,601 $ 803,759 $ 16,716,550 Amortization expense 1,772,688 7,173 324,322 2,104,183 Balance, December 31, 2018 16,457,878 1,234,774 1,128,081 18,820,733 Net book value $ 6,283,422 $ 1,603 $ 348,978 $ 6,634,003 COST Balance, January 1, 2017 $ 16,371,375 $ 1,236,377 $ 1,289,339 $ 18,897,091 Purchase of other intangible assets - - 489,295 489,295 Translation loss - - (280,217 ) (280,217 ) Allocation from 2017 acquisition 119,925 - - 119,925 Balance, December 31, 2017 $ 16,491,300 $ 1,236,377 $ 1,498,417 $ 19,226,094 Useful lives 3 Years 3 Years 3 Years ACCUMULATED AMORTIZATION Balance, January 1, 2017 $ 11,497,555 $ 1,106,706 $ 459,124 $ 13,063,385 Amortization expense 3,187,635 120,895 344,635 3,653,165 Balance, December 31, 2017 14,685,190 1,227,601 803,759 16,716,550 Net book value $ 1,806,110 $ 8,776 $ 694,658 $ 2,509,544
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	As of December 31, 2018, future amortization expense scheduled to be expensed is as follows: Years ending December 31 2019 $ 1,823,140 2020 1,009,527 2021 942,226 2022 609,110 2023 300,000 Thereafter 1,950,000 Total $ 6,634,003

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment as of December 31, 2018 and 2017 consisted of the following: December 31, 2018 December 31, 2017 Computer equipment $ 2,389,865 $ 1,776,463 Office furniture and equipment 1,089,014 1,078,729 Transportation equipment 828,417 719,947 Leasehold improvements 727,519 880,273 Assets not placed in service 50,362 4,415 Total property and equipment 5,085,177 4,459,827 Less accumulated depreciation (3,252,990 ) (3,074,084 ) Property and equipment – net $ 1,832,187 $ 1,385,743

Concentrations (Tables)

Concentrations (Tables)	12 Months Ended
	Dec. 31, 2018
Risks and Uncertainties [Abstract]
Schedule of Concentration of Risk, by Geographical Risks Factor	The following is a summary of the net assets located outside the United States as of December 31, 2018 and 2017: December 31, 2018 2017 Current assets $ 156,265 $ 128,932 Non-current assets 1,259,446 1,281,433 1,415,711 1,410,365 Current liabilities (1,044,539 ) (920,770 ) Non-current liabilities (209,333 ) (333,060 ) Net assets $ 161,839 $ 156,535

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	12 Months Ended
	Dec. 31, 2018
Earnings Per Share [Abstract]
Schedule of Losses Per Share, Basic and Diluted	The following table reconciles the weighted-average shares outstanding for basic and diluted net loss per common share for the years ended December 31, 2018 and 2017: Year Ended December 31, 2018 2017 Basic and Diluted: Net loss attributable to common shareholders $ (6,962,467 ) $ (7,595,451 ) Weighted-average common shares used to compute basic and diluted loss per share 11,721,232 11,010,432 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.59 ) $ (0.69 )

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Schedule of Maturities of Long-term Debt	Maturities of the outstanding notes payable and other obligations as of December 31, 2018 are as follows: Years ending December 31 Vehicle Financing Notes Insurance Financing Payable to Managed Practices Total 2019 $ 71,750 $ 122,026 $ 84,000 $ 277,776 2020 65,475 - 84,000 149,475 2021 29,413 - 26,000 55,413 2022 12,857 - - 12,857 2023 4,655 - - 4,655 Total $ 184,150 $ 122,026 $ 194,000 $ 500,176

Revenue (Tables)

Revenue (Tables)	12 Months Ended
	Dec. 31, 2018
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following table represents a disaggregation of revenue for the years ended December 31, 2018 and 2017: Year Ended December 31, 2018 2017 Healthcare IT: Revenue cycle management services $ 38,559,180 $ 28,410,557 Professional services 1,244,894 281,572 Ancillary services 1,594,364 1,002,296 Group purchasing services 654,805 - Printing and mailing services 1,344,011 1,372,239 Clearinghouse and EDI services 647,446 743,971 Practice Management: Practice management services 6,501,081 - Total $ 50,545,781 $ 31,810,635
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 5,654,919 861,341 - - (Decrease) increase, net (2,202,908 ) 404,598 (36,749 ) (9,666 ) Ending balance as of December 31, 2018 $ 7,331,474 $ 2,608,631 $ 25,355 $ 18,949

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 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 as of December 31, 2018 are as follows: Years Ending December 31 Total 2019 $ 932,068 2020 715,059 2021 510,927 2022 412,585 2023 91,797 Total $ 2,662,436

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 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 and restricted stock transactions related to the common and Preferred Stock under the Incentive Plan for the years ended December 31, 2018 and 2017: Common Stock Preferred Stock Outstanding and unvested shares at January 1, 2017 406,959 33,000 Granted 555,500 39,800 Vested (327,159 ) (33,000 ) Forfeited (29,331 ) - Outstanding and unvested shares at January 1, 2018 605,969 39,800 Granted 707,200 44,800 Vested (340,066 ) (39,800 ) Forfeited (43,756 ) - Outstanding and unvested shares at December 31, 2018 929,347 44,800
Schedule of Share-based Compensation, Restricted Stock Units Award Activity	The following table summarizes the share activity during the years ended December 31, 2018 and 2017 and the amount of common and preferred shares available for grant at December 31, 2018: Common Stock Preferred Stock Shares available for grant at January 1, 2017 237,403 67,000 Additional shares available for grant 1,500,000 - RSUs granted (555,500 ) (39,800 ) RSUs forfeited 29,331 - Shares available for grant at December 31, 2017 1,211,234 27,200 Additional shares available for grant - 200,000 RSUs granted (707,200 ) (44,800 ) RSUs forfeited 43,756 - Shares available for grant at December 31, 2018 547,790 182,400
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 years ended December 31, 2018 and 2017: Stock-based compensation included in the Year Ended December 31, Consolidated Statement of Operations: 2018 2017 Direct operating costs $ 88,195 $ 9,849 General and administrative 2,352,850 1,419,068 Research and development 14,506 8,378 Selling and marketing 8,048 50,000 Total stock-based compensation expense $ 2,463,599 $ 1,487,295

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Schedule of Deferred Tax Valuation Allowance	The activity in the deferred tax valuation allowance was as follows for the years ended December 31, 2018 and 2017: Year ended December 31, 2018 2017 Beginning balance $ 6,620,464 $ 7,221,443 Provision/ (Benefit) 400,158 (648,281 ) Adjustments/true-ups 155,769 47,302 Ending balance $ 7,176,391 $ 6,620,464
Schedule of Income before Income Tax, Domestic and Foreign	The (loss) income before tax for financial reporting purposes during the years ended December 31, 2018 and 2017 consisted of the following: Year ended December 31, 2018 2017 United States $ (4,111,539 ) $ (6,949,433 ) Foreign 1,815,674 1,452,082 Total $ (2,295,865 ) $ (5,497,351 )
Schedule of Components of Income Tax Expense (Benefit)	The (benefit) provision for income taxes for the years ended December 31, 2018 and 2017 consisted of the following: Year ended December 31, 2018 2017 Current: Federal $ - $ - State 49,000 31,028 Foreign 1,341 10,235 50,341 41,263 Deferred: Federal (225,347 ) 7,183 State 17,621 19,359 (207,726 ) 26,542 Total income tax (benefit) provision $ (157,385 ) $ 67,805
Schedule of Deferred Tax Assets and Liabilities	The components of the Company’s deferred income taxes as of December 31, 2018 and 2017 are as follows: December 31, 2018 December 31, 2017 Deferred tax assets: Allowance for doubtful accounts $ 46,492 $ 45,944 Deferred revenue 4,664 7,121 Deferred rent 4,275 1,857 Property and intangible assets 2,336,221 2,227,454 State net operating loss (“NOL”) carryforwards 636,578 569,847 Federal net operating loss (“NOL”) carryforwards 3,789,618 3,245,846 Section 163(j) interest limitation 51,319 - Cumulative translation adjustment 349,834 179,510 Stock based compensation 335,785 325,243 Other (24,654 ) 17,642 Valuation allowance (7,176,391 ) (6,620,464 ) Total deferred tax assets 353,741 - Deferred tax liabilities: Goodwill amortization (518,087 ) (372,072 ) Net deferred tax liability $ (164,346 ) $ (372,072 )
Schedule of Effective Income Tax Rate Reconciliation	A reconciliation of the federal statutory income tax rate (21%) for 2018 and (34%) for 2017 to the Company’s effective income tax rate (determined in dollars) for the years ended December 31, 2018 and 2017 is as follows: Year ended December 31, 2018 2017 Federal benefit at statutory rate $ (482,132 ) $ (1,869,100 ) Increase (decrease) in income taxes resulting from: State tax expense, net of federal benefit 29,646 27,733 Non-deductible items 15,332 18,168 Impact of foreign operations (525,583 ) (733,043 ) Deferred tax impact from rate change - 3,105,106 Subpart F GILTI inclusion 360,742 - Deferred true-up (142,869 ) (42,453 ) Valuation allowance 555,927 (600,978 ) Additional tax goodwill/contingent consideration 31,553 162,372 Total income tax (benefit) provision $ (157,385 ) $ 67,805

Other Income - Net (Tables)

Other Income - Net (Tables)	12 Months Ended
	Dec. 31, 2018
Other Income and Expenses [Abstract]
Schedule of Other Income Net	Other income - net for the years ended December 31, 2018 and 2017 consisted of the following: Year Ended December 31, 2018 2017 Foreign exchange gains $ 434,806 $ 248,517 Other 59,526 83,567 Other income - net $ 494,332 $ 332,084

Segment Reporting (Tables)

Segment Reporting (Tables)	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Schedule of Revenues, Operating Expenses and Operating Income by Reportable Segment	The following table presents revenues, operating expenses and operating income by reportable segment: Year Ended December 31, 2018 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 44,044,700 $ 6,501,081 $ - $ 50,545,781 Operating expenses: Direct operating costs 26,289,770 4,962,765 - 31,252,535 Selling and marketing 1,593,052 18,930 - 1,611,982 General and administrative 9,834,749 1,164,505 5,265,219 16,264,473 Research and development 1,029,510 - - 1,029,510 Change in contingent consideration 73,271 - - 73,271 Depreciation and amortization 2,700,577 153,250 - 2,853,827 Total operating expenses 41,520,929 6,299,450 5,265,219 53,085,598 Operating income (loss) $ 2,523,771 $ 201,631 $ (5,265,219 ) $ (2,539,817 )

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	12 Months Ended
	Dec. 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 Year Ended December 31, 2018 2017 Balance - January 1, $ 603,411 $ 929,549 Change in fair value 73,271 151,423 Settlement in the form of shares issued - (331,676 ) Payments (150,250 ) (145,885 ) Balance - December 31, $ 526,432 $ 603,411

Organization and Business (Deta

Organization and Business (Details Narrative)	Dec. 31, 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%

Significant Accounting Polici_4

Significant Accounting Policies (Details Narrative)	12 Months Ended
	Dec. 31, 2018USD ($)Segmentshares	Dec. 31, 2017USD ($)Segmentshares
Number of operating segments | Segment	2	1
Advertising costs	$ 950,000	$ 395,000
Capitalized software cost	$ 62,000	170,000
Depreciation calculation period	Depreciation for computers is calculated over three years, while remaining assets (except leasehold improvements) are depreciated over five years.
Intangible assets amortized period, description	Straight line basis over four and twelve years
Impairment of internal-use software costs
Impairment of goodwill
Treasury stock, share, repurchased | shares
Professional fees	$ 245,000	$ 30,000
Income tax likely to be realized upon ultimate settlement, description	greater than 50 percent
Uncertain tax positions
Penalties or interest related to unrecognized tax benefits
Foreign currency transaction gain (loss), before tax	434,806	248,517
Deferred financing costs written off		463,000
Contract asset	2,608,631
Capitalized sales commissions	93,000
Amortization of capitalized sales commissions	60,000
January 1, 2018 [Member]
Contract asset	1,300,000
Impact on accumulated deficit by adopting new accounting standard	101,000
Equity Offerings [Member]
Adjustments to additional paid in capital, stock issued, issuance costs	$ 282,000	$ 1,100,000
Minimum [Member]
Estimated lives of the assets	3 years
Intangible assets amortized period	3 years
Maximum [Member]
Estimated lives of the assets	5 years
Intangible assets amortized period	4 years

Significant Accounting Polici_5

Significant Accounting Policies - Schedule of Allowance for Doubtful Accounts (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Accounting Policies [Abstract]
Beginning balance	$ 185,000	$ 156,000
Provision	724,000	410,000
Write-offs	(720,000)	(381,000)
Ending balance	$ 189,000	$ 185,000

Significant Accounting Polici_6

Significant Accounting Policies - Schedule of Prior Adjustments for Implements to New Revenue Recognition (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
NET REVENUE	$ 50,545,781	$ 31,810,635
Direct operating costs	31,252,535	17,679,070
Selling and marketing	1,611,982	1,106,698
General and administrative	16,264,473	11,738,201
Research and development	1,029,510	1,081,832
Change in contingent consideration	73,271	151,423
Depreciation and amortization	2,853,827	4,299,943
Total operating expenses	53,085,598	36,332,795
OPERATING (LOSS) INCOME	(2,539,817)	(4,522,160)
Interest income	100,788	16,944
Interest expense	(351,168)	(1,324,219)
Other income - net	494,332	332,084
(LOSS) INCOME BEFORE INCOME TAXES	(2,295,865)	(5,497,351)
Income tax benefit	(157,385)	67,805
NET (LOSS) INCOME	(2,138,480)
Preferred stock dividend	4,823,987	2,030,295
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (6,962,467)	$ (7,595,451)
Basic and diluted loss per share	$ (0.59)	$ (0.69)
Impact of New Revenue Standard [Member]
NET REVENUE	$ 40,934
Direct operating costs
Selling and marketing	7,986
General and administrative
Research and development
Change in contingent consideration
Depreciation and amortization
Total operating expenses	7,986
OPERATING (LOSS) INCOME	32,948
Interest income
Interest expense
Other income - net
(LOSS) INCOME BEFORE INCOME TAXES	32,948
Income tax benefit
NET (LOSS) INCOME	32,948
Preferred stock dividend
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ 32,948
Basic and diluted loss per share	$ 0
Previous Revenue Standard [Member]
NET REVENUE	$ 50,504,847
Direct operating costs	31,252,535
Selling and marketing	1,603,996
General and administrative	16,264,473
Research and development	1,029,510
Change in contingent consideration	73,271
Depreciation and amortization	2,853,827
Total operating expenses	53,077,612
OPERATING (LOSS) INCOME	(2,572,765)
Interest income	100,788
Interest expense	(351,168)
Other income - net	494,332
(LOSS) INCOME BEFORE INCOME TAXES	(2,328,813)
Income tax benefit	(157,385)
NET (LOSS) INCOME	(2,171,428)
Preferred stock dividend	4,823,987
NET (LOSS) INCOME ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (6,995,415)
Basic and diluted loss per share	$ (0.60)

Acquisitions (Details Narrative

Acquisitions (Details Narrative) - USD ($)	May 07, 2018	Jul. 01, 2017	Dec. 31, 2018	Dec. 31, 2017
Purchase price amount			$ 1,028,249	$ 697,211
Orion Acquisition [Member]
Revenue earned from acquisition			17,800,000
Washington Medical Billing, LLC [Member]
Revenue earned from acquisition			$ 178,000
Washington Medical Billing, LLC [Member] | First Year [Member] | Revenue Collected from WMB Accounts [Member]
Installment payments percentage		22.00%
Washington Medical Billing, LLC [Member] | Second Year [Member] | Revenue Collected from WMB Accounts [Member]
Installment payments percentage		23.00%
Washington Medical Billing, LLC [Member] | Third Year [Member] | Revenue Collected from WMB Accounts [Member]
Installment payments percentage		24.00%
Asset Purchase Agreement [Member]
Purchase price amount	$ 12,600,000
Acquisition-related costs	$ 245,000
Period over which goodwill is deductible for income tax purposes	15 years
Weighted-average amortization period of acquired intangible assets	8 years
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 ($)	Dec. 31, 2018	Dec. 31, 2017
Goodwill	$ 12,593,795	$ 12,263,943
2018 Acquisition [Member]
Customer relationships	6,250,000
Accounts receivable	5,654,919
Contract asset	861,341
Inventory	307,278
Property and equipment	319,352
Goodwill	329,852
Accounts payable	(677,872)
Accrued expenses	(444,870)
Business combination, Net	12,600,000
2017 Acquisition [Member]
Customer relationships	120,000
Goodwill	85,000
Business combination, Net	$ 205,000

Acquisitions - Business Acquisi

Acquisitions - Business Acquisition, Pro Forma Information (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Business Combinations [Abstract]
Net revenue	$ 69,625	$ 74,791
Net loss	(1,571)	(20,711)
Net loss attributable to common shareholders	$ (6,395)	$ (22,741)
Net loss per common share	$ (0.55)	$ (2.07)

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Net (Details Narrative)	12 Months Ended
	Dec. 31, 2018USD ($)Segment	Dec. 31, 2017USD ($)Segment
Goodwill	$ 12,593,795	$ 12,263,943
Number of operating segments | Segment	2	1
Amortization expenses	$ 2,104,183	$ 3,653,165
Weighted-average amortization period	7 years
Practice Management Segment [Member]
Goodwill	$ 90,000

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Net - Schedule of Intangible Assets and Goodwill (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Beginning gross balance	$ 12,263,943	$ 12,178,868
Acquisitions	329,852	85,075
Ending gross balance	$ 12,593,795	$ 12,263,943

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Net - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets [Line Items]
Beginning Balance	$ 19,226,094	$ 18,897,091
Purchase of other intangible assets	108,552	489,295
Translation loss	(129,910)	(280,217)
Allocation from 2018/2017 acquisition	6,250,000	119,925
Ending Balance	25,454,736	19,226,094
Beginning Balance	16,716,550	13,063,385
Amortization expense	2,104,183	3,653,165
Ending Balance	18,820,733	16,716,550
Net book value	$ 6,634,003	2,509,544
Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives	3 years
Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives	4 years
Customer Relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Beginning Balance	$ 16,491,300	16,371,375
Purchase of other intangible assets
Translation loss
Allocation from 2018/2017 acquisition	6,250,000	119,925
Ending Balance	22,741,300	$ 16,491,300
Useful lives		3 years
Beginning Balance	14,685,190	$ 11,497,555
Amortization expense	1,772,688	3,187,635
Ending Balance	16,457,878	14,685,190
Net book value	$ 6,283,422	1,806,110
Customer Relationships [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives	3 years
Customer Relationships [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives	12 years
Non-Compete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Beginning Balance	$ 1,236,377	1,236,377
Purchase of other intangible assets
Translation loss
Allocation from 2018/2017 acquisition
Ending Balance	$ 1,236,377	$ 1,236,377
Useful lives	3 years	3 years
Beginning Balance	$ 1,227,601	$ 1,106,706
Amortization expense	7,173	120,895
Ending Balance	1,234,774	1,227,601
Net book value	1,603	8,776
Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Beginning Balance	1,498,417	1,289,339
Purchase of other intangible assets	108,552	489,295
Translation loss	(129,910)	(280,217)
Allocation from 2018/2017 acquisition
Ending Balance	$ 1,477,059	$ 1,498,417
Useful lives	3 years	3 years
Beginning Balance	$ 803,759	$ 459,124
Amortization expense	324,322	344,635
Ending Balance	1,128,081	803,759
Net book value	$ 348,978	$ 694,658

Goodwill and Intangible Asset_6

Goodwill and Intangible Assets - Net - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
2019	$ 1,823,140
2020	1,009,527
2021	942,226
2022	609,110
2023	300,000
Thereafter	1,950,000
Total	$ 6,634,003	$ 2,509,544

Property and Equipment (Details

Property and Equipment (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 688,000	$ 634,000

Property and Equipment - Schedu

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Total property and equipment	$ 5,085,177	$ 4,459,827
Less accumulated depreciation	(3,252,990)	(3,074,084)
Property and equipment - net	1,832,187	1,385,743
Computer Equipment [Member]
Total property and equipment	2,389,865	1,776,463
Office Furniture and Equipment [Member]
Total property and equipment	1,089,014	1,078,729
Transportation Equipment [Member]
Total property and equipment	828,417	719,947
Leasehold Improvements [Member]
Total property and equipment	727,519	880,273
Assets Not Placed in Service [Member]
Total property and equipment	$ 50,362	$ 4,415

Concentrations (Details Narrati

Concentrations (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Fair value, concentration of risk, cash and cash equivalents	$ 77,000	$ 56,000
United States [Member]
Net assets	161,839	156,535
Intercompany receivables	$ 7,600,000	$ 6,500,000
Customer One [Member] | Accounts Receivable [Member]
Concentration risk percentage	8.00%	8.00%
Customer Two [Member] | Accounts Receivable [Member]
Concentration risk percentage	7.00%	7.00%
One Customer [Member] | Sales Revenue, Net [Member]
Concentration risk percentage	10.00%	9.00%

Concentrations - Schedule of Co

Concentrations - Schedule of Concentration of Risk, by Geographical Risks Factor (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Current assets	$ 26,073,673	$ 8,929,720
Assets	47,623,361	25,525,663
Current liabilities	(8,157,946)	(4,322,015)
United States [Member]
Current assets	156,265	128,932
Non-current assets	1,259,446	1,281,433
Assets	1,415,711	1,410,365
Current liabilities	(1,044,539)	(920,770)
Non-current liabilities	(209,333)	(333,060)
Net assets	$ 161,839	$ 156,535

Net Loss Per Common Share (Deta

Net Loss Per Common Share (Details Narrative) - shares	12 Months Ended
	Dec. 31, 2018	Jun. 30, 2017
Number of warrant issued		2,000,000
Opus Bank [Member]
Antidilutive securities excluded from computation of earning per share, warrants	200,000
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 ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Earnings Per Share [Abstract]
Net loss attributable to common shareholders	$ (6,962,467)	$ (7,595,451)
Weighted-average common shares used to compute basic and diluted loss per share	11,721,232	11,010,432
Net loss attributable to common shareholders per share - Basic and Diluted	$ (0.59)	$ (0.69)

Debt (Details Narrative)

Debt (Details Narrative) - USD ($)	Sep. 02, 2015	Oct. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Sep. 30, 2018	Jun. 30, 2017
Class of warrant or right, number of securities called by warrants or rights						2,000,000
Deferred financing costs written off				$ 463,000
Opus Bank Loan [Member] | Term Loan [Member]
Revision of borrowing limit from SVB Bank	$ 8,000,000
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%
Payable to Managed Practices [Member] | Orion Acquisition [Member]
Non-interest bearing			$ 236,000
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
Total [Member] | Opus Bank Loan [Member]
Revision of borrowing limit from SVB Bank	$ 10,000,000
Percentage of shares secured for debt	65.00%
SVB Credit Facility [Member]
Secured revolving line of credit percentage		200.00%
Unused portion of credit line fee, percentage		1.00%
Percentage of shares in offshore facilities secured for SVB credit line		65.00%
SVB Credit Facility [Member] | Prime Rate [Member]
Revolving line of credit, interest rate		1.50%
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
Prudential Deferred Purchase Price [Member]
Repayment of debt				5,000,000
Accrued interest				$ 270,000

Debt - Schedule of Maturities o

Debt - Schedule of Maturities of Long-term Debt (Details)	Dec. 31, 2018USD ($)
Debt Instrument [Line Items]
2019	$ 277,776
2020	149,475
2021	55,413
2022	12,857
2023	4,655
Total	500,176
Vehicle Financing Notes [Member]
Debt Instrument [Line Items]
2019	71,750
2020	65,475
2021	29,413
2022	12,857
2023	4,655
Total	184,150
Insurance Financing [Member]
Debt Instrument [Line Items]
2019	122,026
2020
2021
2022
2023
Total	122,026
Payable to Managed Practices [Member]
Debt Instrument [Line Items]
2019	84,000
2020	84,000
2021	26,000
2022
2023
Total	$ 194,000

Revenue (Details Narrative)

Revenue (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Contract asset represents revenue	$ 800,000
Contract asset	2,608,631
Deferred commissions	93,000
Orion Acquisition [Member]
Contract asset represents revenue	861,000
Remaining performance obligations	$ 1,800,000
Estimated recognition period for remaining performance obligations	3 months
Orion Acquisition [Member] | Cycle Management [Member]
Revenue from related party	$ 400,000
Orion Acquisition [Member] | Group Purchasing Services [Member]
Revenue from related party	$ 461,000

Revenue - Schedule of Disaggreg

Revenue - Schedule of Disaggregation of Revenue (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Net revenue	$ 50,545,781	$ 31,810,635
Revenue Cycle Management Services [Member]
Net revenue	38,559,180	28,410,557
Professional Services [Member]
Net revenue	1,244,894	281,572
Ancillary Services [Member]
Net revenue	1,594,364	1,002,296
Group Purchasing Services [Member]
Net revenue	654,805
Printing and Mailing Services [Member]
Net revenue	1,344,011	1,372,239
Clearinghouse and EDI Services [Member]
Net revenue	647,446	743,971
Practice Management Services [Member]
Net revenue	$ 6,501,081

Revenue - Schedule of Accounts

Revenue - Schedule of Accounts Receivable, Contract Asset and Deferred Revenue (Details)	12 Months Ended
	Dec. 31, 2018USD ($)
Beginning balance as of January 1, 2018	$ 8,929,720
Ending balance as of December 31, 2018	26,073,673
Deferred Revenue (current) [Member]
Beginning balance as of January 1, 2018	62,104
Orion acquisition
(Decrease) increase, net	(36,749)
Ending balance as of December 31, 2018	25,355
Deferred Revenue (long term) [Member]
Beginning balance as of January 1, 2018	28,615
Orion acquisition
(Decrease) increase, net	(9,666)
Ending balance as of December 31, 2018	18,949
Accounts Receivable [Member]
Beginning balance as of January 1, 2018	3,879,463
Orion acquisition	5,654,919
(Decrease) increase, net	(2,202,908)
Ending balance as of December 31, 2018	7,331,474
Contract Asset [Member]
Beginning balance as of January 1, 2018	1,342,692
Orion acquisition	861,341
(Decrease) increase, net	404,598
Ending balance as of December 31, 2018	$ 2,608,631

Shareholders' Equity (Details N

Shareholders' Equity (Details Narrative) - USD ($)	1 Months Ended	7 Months Ended	12 Months Ended
	May 31, 2017	Dec. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Jun. 30, 2017
Class of Stock [Line Items]
Net proceeds from issuance of common stock				$ 1,972,065
Warrants to purchase shares of common stock					2,000,000
Treasury Stock [Member]
Class of Stock [Line Items]
Stock repurchase program expiration date			Jan. 25, 2017
Stock repurchased during period, shares			740,799
Stock repurchased during period, value			$ 662,000
Common Stock [Member]
Class of Stock [Line Items]
Number of stock shares issued during the period	1,000,000			1,000,000
Shares issued, price per share	$ 2.30
Net proceeds from issuance of common stock	$ 2,000,000
Preferred Stock [Member]
Class of Stock [Line Items]
Number of stock shares issued during the period			1,000,000
Net proceeds from issuance of preferred stock			$ 22,800,000
Cumulative preferred stock dividend per share			$ 2.75
Preferred Stock [Member]
Class of Stock [Line Items]
Number of stock shares issued during the period
Shares issued, price per share		$ 25	25	$ 25
Preferred stock, liquidation preference per share		$ 25		$ 25
Preferred Stock [Member] | November 4, 2020 [Member]
Class of Stock [Line Items]
Preferred stock, redemption price per share			25
Preferred stock, liquidation preference per share			$ 25
Preferred Stock [Member] | Six Public Preferred Stock Offerings [Member]
Class of Stock [Line Items]
Number of stock shares issued during the period		765,000
Net proceeds from issuance of preferred stock		$ 16,400,000
Warrants [Member]
Class of Stock [Line Items]
Warrants to purchase shares of common stock			2,353,489
Remaining warrants outstanding			353,489
Warrants One [Member]
Class of Stock [Line Items]
Warrants to purchase shares of common stock			2,000,000
Warrant exercise price			$ 5
Warrant expiration date			May 31, 2018
Warrants Two [Member]
Class of Stock [Line Items]
Remaining warrants outstanding			100,000
Warrant exercise price			$ 5
Warrant expiration date			Sep. 30, 2022
Warrants Three [Member]
Class of Stock [Line Items]
Remaining warrants outstanding			125,000
Warrant exercise price			$ 3.92
Warrant expiration date			Oct. 31, 2022
Warrants Four [Member]
Class of Stock [Line Items]
Remaining warrants outstanding			100,000
Warrant exercise price			$ 5
Warrant expiration date			Jul. 31, 2023
Warrants Five [Member]
Class of Stock [Line Items]
Remaining warrants outstanding			28,489
Warrant exercise price			$ 5.26
Warrant expiration date			Sep. 30, 2023

Commitments and Contingencies_2

Commitments and Contingencies (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Operating leases expire year	expiring through 2023.
Operating leases, rent expense	$ 1,600,000	$ 935,000
Offshore Lease [Member]
Lease monthly rental payments	$ 19,000
Cancellation period in off shore lease	3 months
Orion Acquisition [Member]
Lease monthly rental payments	$ 47,000

Commitments and Contingencies -

Commitments and Contingencies - Schedule of Future Minimum Lease Payments Under Non-cancelable Operating Leases (Details) - Years Ending December 31 [Member]	Dec. 31, 2018USD ($)
2019	$ 932,068
2020	715,059
2021	510,927
2022	412,585
2023	91,797
Total	$ 2,662,436

Related Parties (Details Narrat

Related Parties (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Revenues	$ 50,545,781	$ 31,810,635
Operating leases, rent expense	1,600,000	935,000
Accrued liability to related party	10,663	10,675
Kashmir Air, Inc [Member]
Operating leases, rent expense	128,000	128,000
Accrued liability to related party	11,000	11,000
Physician [Member]
Revenues	20,000	17,000
Receivable balance due from this customer	1,600	1,900
Executive Chairman [Member]
Operating leases, rent expense	187,000	189,000
Security deposit	13,000	13,000
Prepaid rent	$ 12,000	$ 12,000

Employee Benefit Plans (Details

Employee Benefit Plans (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Sri Lanka [Member] | Contribution Retirement Plan [Member] | Employee [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of employees' gross pay		8.00%
Sri Lanka [Member] | Contribution Retirement Plan [Member] | Employer [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of employees' gross pay		12.00%
United States Postretirement Benefits Plan of US Entity [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined benefit plan, contributions by employer	$ 161,000	$ 137,000
United States Postretirement Benefits Plan of US Entity [Member] | Qualified Compensation Deferred Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of match	100.00%
Percentage of qualified compensation eligible for first matching contribution	3.00%
United States Postretirement Benefits Plan of US Entity [Member] | Qualified Compensation Deferred Plan [Member] | MTBC Health, Inc. [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of match	50.00%
Percentage of qualified compensation eligible for next matching contribution	3.00%
United States Postretirement Benefits Plan of US Entity [Member] | Qualified Compensation Deferred Plan [Member] | MTBC Practice Management, Corp. [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of match
Defined contribution plan, employer matching contribution, percent of employees' gross pay
United States Postretirement Benefits Plan of US Entity [Member] | Deferred Plan [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, employer matching contribution, percent of match	50.00%
Percentage of qualified compensation eligible for next matching contribution	2.00%
Domestic Postretirement Benefit Plan of Foreign Entity [Member] | Pakistan [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined benefit plan, contributions by employer	$ 110,000	123,000
Employee benefit plan, description	The plan provides for monthly contributions by the Company which are the lower of 10% of qualified employees’ basic monthly compensation or 750 Pakistani rupees.
Contribution Retirement Plan [Member] | Sri Lanka [Member]
Defined Contribution Plan Disclosure [Line Items]
Defined benefit plan, contributions by employer	$ 56,000	$ 67,000

Stock-based Compensation (Detai

Stock-based Compensation (Details Narrative) - USD ($)	1 Months Ended	3 Months Ended			12 Months Ended
	May 31, 2017	Sep. 30, 2018	Dec. 31, 2017	Sep. 30, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Apr. 30, 2014
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Accrued compensation			$ 1,137,351		$ 1,731,063	$ 1,137,351
Stock-based compensation expense					$ 2,463,599	$ 1,487,295
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	1,000,000					1,000,000
Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized					40,000
Number of shares added to amended and restated equity incentive plan
Bonus shares			33,000
Stock-based compensation expense						$ 1,000,000
Preferred stock, liquidation value per share			$ 25			$ 25
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					1,000,000
Stock-based compensation expense					$ 1,200,000
Restricted Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Number of shares available for grant			1,211,234			1,211,234
Unrecognized compensation			$ 793,000		$ 2,456,000	$ 793,000
Unvested stock option award, equity					845,167
Restricted stock award classified as liability					84,180
Accrued compensation			41,000		$ 118,000	41,000
Cash settlement			$ 54,000		$ 39,000	$ 54,000
Weighted average grant date fair value			$ 1.73		$ 4.53	$ 1.73
Restricted Shares [Member] | Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Number of shares available for grant			1,211,234		547,790	1,211,234	237,403
Share-based compensation arrangement by share-based payment award, equity instruments other than options, grants in period					707,200	555,500
Restricted Shares [Member] | Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized			33,000			33,000
Number of shares available for grant			27,200		182,400	27,200	67,000
Share-based compensation arrangement by share-based payment award, equity instruments other than options, grants in period					44,800	39,800
Two Employees [Member] | Restricted Shares [Member] | Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized			6,800			6,800
One Employee [Member] | Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized					4,800
2014 Equity Incentive Plan [Member] | Employees Officers Directors and Consultants [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized								1,351,000
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					547,790
Amended and Restated Equity Incentive Plan [Member] | 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					200,000	100,000
Number of shares available for grant					182,400
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
Granted shares vesting period		2 years
Shares vesting percentage		25.00%
Shares vesting period				2 years
Amended and Restated Equity Incentive Plan [Member] | Officers and Employees [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		308,000
Granted shares vesting period		3 years
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
Shares vesting period				2 years

Stock-Based Compensation - Disc

Stock-Based Compensation - Disclosure of Share-based Compensation Arrangements by Share-based Payment Award (Details) - Restricted Shares [Member] - shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	605,969	406,959
Granted	707,200	555,500
Vested	(340,066)	(327,159)
Forfeited	(43,756)	(29,331)
Outstanding and unvested at ending	929,347	605,969
Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	39,800	33,000
Granted	44,800	39,800
Vested	(39,800)	(33,000)
Forfeited
Outstanding and unvested at ending	44,800	39,800

Stock-based Compensation - Sche

Stock-based Compensation - Schedule of Share-based Compensation, Restricted Stock Units Award Activity (Details) - Restricted Shares [Member] - shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Shares available for grant, beginning	1,211,234
Shares available for grant, ending		1,211,234
Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Shares available for grant, beginning	1,211,234	237,403
Additional shares available for grant		1,500,000
RSUs granted	(707,200)	(555,500)
RSUs forfeited	43,756	29,331
Shares available for grant, ending	547,790	1,211,234
Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Shares available for grant, beginning	27,200	67,000
Additional shares available for grant	200,000
RSUs granted	(44,800)	(39,800)
RSUs forfeited
Shares available for grant, ending	182,400	27,200

Stock-Based Compensation - Sc_2

Stock-Based Compensation - Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 2,463,599	$ 1,487,295
Direct Operating Costs [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	88,195	9,849
General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	2,352,850	1,419,068
Research and Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	14,506	8,378
Selling and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total share-based compensation expense	$ 8,048	$ 50,000

Income Taxes (Details Narrative

Income Taxes (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Goodwill amortization period for tax purposes	15 years
Deferred tax asset net operating loss	$ 208,000
Federal statutory income tax rate	21.00%	34.00%
Income tax examination description	reducing the U.S. federal corporate tax rate from 35% to 21%
Deferred tax asset revaluation		$ 3,300,000
Change in amortization of goodwill for tax purposes	$ 196,000
January 1, 2018 [Member]
Federal statutory income tax rate	21.00%
Federal [Member]
Net operating loss carry forwards	$ 18,000,000
Net operating loss carry forwards expiration period	between 2034 and 2037
Federal [Member] | Between 2034 and 2037 [Member]
Net operating loss carry forwards	$ 15,800,000
Federal [Member] | Indefinite Life [Member]
Net operating loss carry forwards	2,200,000
State [Member]
Net operating loss carry forwards	$ 34,900,000
State [Member] | Minimum [Member]
Tax expiration period	2034
State [Member] | Maximum [Member]
Tax expiration period	2038
New Jersey [Member]
Net operating loss carry forwards	$ 17,600,000
Pakistan [Member]
Federal statutory income tax rate	21.00%	34.00%
Pakistan statutory corporate tax rate	30.00%

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Valuation Allowance (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Beginning balance	$ 6,620,464	$ 7,221,443
Provision/ (Benefit)	400,158	(648,281)
Adjustments/true-ups	155,769	47,302
Ending balance	$ 7,176,391	$ 6,620,464

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income before Income Tax, Domestic and Foreign (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
United States	$ (4,111,539)	$ (6,949,433)
Foreign	1,815,674	1,452,082
Total	$ (2,295,865)	$ (5,497,351)

Income Taxes - Schedule of Comp

Income Taxes - Schedule of Components of Income Tax Expense (Benefit) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Current tax, Federal
Current tax, State	49,000	31,028
Current tax, Foreign	1,341	10,235
Current Income Tax Expense (Benefit)	50,341	41,263
Deferred Tax, Federal	(225,347)	7,183
Deferred Tax, State	17,621	19,359
Deferred Income Tax Expense (Benefit)	(207,726)	26,542
Total income tax (benefit) provision	$ (157,385)	$ 67,805

Income Taxes - Schedule of De_2

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Allowance for doubtful accounts	$ 46,492	$ 45,944
Deferred revenue	4,664	7,121
Deferred rent	4,275	1,857
Property and intangible assets	2,336,221	2,227,454
State net operating loss ("NOL") carryforwards	636,578	569,847
Federal net operating loss ("NOL") carryforwards	3,789,618	3,245,846
Section 163(j) interest limitation	51,319
Cumulative translation adjustment	349,834	179,510
Stock based compensation	335,785	325,243
Other	(24,654)	17,642
Valuation allowance	(7,176,391)	(6,620,464)
Total deferred tax assets	353,741
Deferred tax liabilities:
Goodwill amortization	(518,087)	(372,072)
Net deferred tax liability	$ (164,346)	$ (372,072)

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Federal benefit at statutory rate	$ (482,132)	$ (1,869,100)
Increase (decrease) in income taxes resulting from:
State tax expense, net of federal benefit	29,646	27,733
Non-deductible items	15,332	18,168
Impact of foreign operations	(525,583)	(733,043)
Deferred tax impact from rate change		3,105,106
Subpart F GILTI inclusion	360,742
Deferred true-up	(142,869)	(42,453)
Valuation allowance	555,927	(600,978)
Additional tax goodwill/contingent consideration	31,553	162,372
Total income tax (benefit) provision	$ (157,385)	$ 67,805

Other Income - Net - Schedule o

Other Income - Net - Schedule of Other Income Net (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Other Income and Expenses [Abstract]
Foreign exchange gains	$ 434,806	$ 248,517
Other	59,526	83,567
Other income - net	$ 494,332	$ 332,084

Segment Reporting (Details Narr

Segment Reporting (Details Narrative) - Segment	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting [Abstract]
Number of operating segments	2	1

Segment Reporting - Schedule of

Segment Reporting - Schedule of Revenues, Operating Expenses and Operating Income by Reportable Segment (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Net revenue	$ 50,545,781	$ 31,810,635
Direct operating costs	31,252,535	17,679,070
Selling and marketing	1,611,982	1,106,698
General and administrative	16,264,473	11,738,201
Research and development	1,029,510	1,081,832
Change in contingent consideration	73,271	151,423
Depreciation and amortization	2,853,827	4,299,943
Total operating expenses	53,085,598	36,332,795
Operating income (loss)	(2,539,817)	$ (4,522,160)
Healthcare IT [Member]
Net revenue	44,044,700
Direct operating costs	26,289,770
Selling and marketing	1,593,052
General and administrative	9,834,749
Research and development	1,029,510
Change in contingent consideration	73,271
Depreciation and amortization	2,700,577
Total operating expenses	41,520,929
Operating income (loss)	2,523,771
Practice Management Segment [Member]
Net revenue	6,501,081
Direct operating costs	4,962,765
Selling and marketing	18,930
General and administrative	1,164,505
Research and development
Change in contingent consideration
Depreciation and amortization	153,250
Total operating expenses	6,299,450
Operating income (loss)	201,631
Unallocated Corporate Expenses [Member]
Net revenue
Direct operating costs
Selling and marketing
General and administrative	5,265,219
Research and development
Change in contingent consideration
Depreciation and amortization
Total operating expenses	5,265,219
Operating income (loss)	$ (5,265,219)

Fair Value of Financial Instr_3

Fair Value of Financial Instruments (Details Narrative) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Fair Value, Input, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	$ 526,000	$ 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 ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance, beginning	$ 603,411	$ 929,549
Change in fair value	73,271	151,423
Settlement in the form of shares issued		(331,676)
Payments	(150,250)	(145,885)
Balance, ending	$ 526,432	$ 603,411