CareCloud (CCLD) 10-Q 6 Nov 19 2019 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2019	Oct. 31, 2019
Document And Entity Information
Entity Registrant Name	MTBC, Inc.
Entity Central Index Key	0001582982
Document Type	10-Q
Document Period End Date	Sep. 30, 2019
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	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 Common Stock, Shares Outstanding		12,219,148
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2019

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($)	Sep. 30, 2019	Dec. 31, 2018
CURRENT ASSETS:
Cash	$ 13,987,197	$ 14,472,483
Accounts receivable - net of allowance for doubtful accounts of $265,000 and $189,000 at September 30, 2019 and December 31, 2018, respectively	7,900,078	7,331,474
Contract asset	2,696,193	2,608,631
Inventory	375,300	444,437
Current assets - related party	13,200	25,203
Prepaid expenses and other current assets	1,092,616	1,191,445
Total current assets	26,064,584	26,073,673
Property and equipment - net	2,039,777	1,832,187
Operating lease right-of-use assets	4,261,709
Intangible assets - net	6,165,273	6,634,003
Goodwill	12,633,696	12,593,795
Other assets	392,642	489,703
TOTAL ASSETS	51,557,681	47,623,361
CURRENT LIABILITIES:
Accounts payable	2,904,181	2,438,267
Accrued compensation	1,999,001	1,731,063
Accrued expenses	2,450,523	1,589,009
Deferred rent (current portion)		90,657
Operating lease liability (current portion)	1,962,064
Deferred revenue (current portion)	16,439	25,355
Accrued liability to related party	663	10,663
Notes payable (current portion)	383,691	277,776
Contingent consideration		526,432
Dividend payable	1,586,528	1,468,724
Total current liabilities	11,303,090	8,157,946
Notes payable	121,511	222,400
Deferred rent		189,366
Operating lease liability	2,501,112
Deferred revenue	16,308	18,949
Deferred tax liability	198,931	164,346
Total liabilities	14,140,952	8,753,007
COMMITMENTS AND CONTINGENCIES
SHAREHOLDERS' EQUITY:
Preferred stock, $0.001 par value - authorized 7,000,000 and 4,000,000 shares at September 30, 2019 and December 31, 2018, respectively; issued and outstanding 2,307,633 and 2,136,289 shares at September 30, 2019 and December 31, 2018, respectively	2,308	2,136
Common stock, $0.001 par value - authorized 29,000,000 and 19,000,000 shares at September 30, 2019 and December 31, 2018, respectively; issued 12,953,122 and 12,570,557 shares at September 30, 2019 and December 31, 2018, respectively; outstanding 12,212,323 and 11,829,758 shares at September 30, 2019 and December 31, 2018, respectively	12,953	12,571
Additional paid-in capital	64,743,714	65,142,460
Accumulated deficit	(25,407,952)	(24,203,745)
Accumulated other comprehensive loss	(1,272,294)	(1,421,068)
Less: 740,799 common shares held in treasury, at cost at September 30, 2019 and December 31, 2018	(662,000)	(662,000)
Total shareholders' equity	37,416,729	38,870,354
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$ 51,557,681	$ 47,623,361

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Allowance for doubtful accounts receivable	$ 265,000	$ 189,000
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	7,000,000	4,000,000
Preferred stock, shares issued	2,307,633	2,136,289
Preferred stock, shares outstanding	2,307,633	2,136,289
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	29,000,000	19,000,000
Common stock, shares issued	12,953,122	12,570,557
Common stock, shares outstanding	12,212,323	11,829,758
Treasury stock, shares	740,799	740,799

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Statement [Abstract]
NET REVENUE	$ 16,851,328	$ 17,044,526	$ 48,681,038	$ 34,034,788
OPERATING EXPENSES:
Direct operating costs	10,535,629	12,123,907	31,779,564	20,941,535
Selling and marketing	347,568	461,512	1,091,524	1,169,583
General and administrative	4,451,975	5,131,295	13,757,805	10,786,234
Research and development	175,758	263,717	648,822	768,517
Change in contingent consideration	(279,565)	25,473	(343,768)	68,253
Depreciation and amortization	814,210	822,098	2,407,111	1,972,565
Restructuring and impairment charges	136,332		136,332
Total operating expenses	16,181,907	18,828,002	49,477,390	35,706,687
OPERATING INCOME (LOSS)	669,421	(1,783,476)	(796,352)	(1,671,899)
OTHER:
Interest income	57,272	24,544	202,969	59,768
Interest expense	(88,925)	(104,872)	(284,883)	(253,120)
Other (expense) income - net	(688,342)	(218,721)	(224,151)	151,242
LOSS BEFORE INCOME TAXES	(50,574)	(2,082,525)	(1,102,417)	(1,714,009)
Income tax provision (benefit)	86,970	(250,072)	101,790	(151,872)
NET LOSS	(137,544)	(1,832,453)	(1,204,207)	(1,562,137)
Preferred stock dividend	1,602,833	1,056,214	4,582,239	3,080,263
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS	$ (1,740,377)	$ (2,888,667)	$ (5,786,446)	$ (4,642,400)
Net loss per common share: basic and diluted	$ (0.14)	$ (0.25)	$ (0.48)	$ (0.40)
Weighted-average common shares used to compute basic and diluted loss per share	12,146,110	11,770,178	12,038,819	11,684,659

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Income (Loss) (Unaudited) - USD ($)		3 Months Ended		9 Months Ended
		Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Statement of Comprehensive Income [Abstract]
NET LOSS		$ (137,544)	$ (1,832,453)	$ (1,204,207)	$ (1,562,137)
OTHER COMPREHENSIVE INCOME (LOSS), NET OF TAX
Foreign currency translation adjustment (a)	[1]	701,992	175,032	148,774	(255,372)
COMPREHENSIVE INCOME (LOSS)		$ 564,448	$ (1,657,421)	$ (1,055,433)	$ (1,817,509)
[1]	No tax effect has been recorded as the Company recorded a valuation allowance against the tax benefit from its foreign currency translation adjustments.

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Shareholders' Equity (Unaudited) - USD ($)		Preferred Stock [Member]	Common Stock [Member]	Additional Paid-In Capital [Member]	Accumulated Deficit [Member]	Accumulated Other Comprehensive Loss [Member]	Treasury (Common) Stock [Member]	Total
Balance at Dec. 29, 2017		$ 1,087	$ 12,272	$ 45,129,517	$ (23,509,386)	$ (721,070)	$ (662,000)	$ 20,250,420
Balance, shares at Dec. 29, 2017		1,086,739	12,271,390
Cumulative effect of adopting ASC 606					1,444,121			1,444,121
Balance at Jan. 02, 2018		$ 1,087	$ 12,272	45,129,517	(22,065,265)	(721,070)	(662,000)	21,694,541
Balance, shares at Jan. 02, 2018		1,086,739	12,271,390
Net income (loss)					75,036			75,036
Foreign currency translation adjustment						(203,146)		(203,146)
Issuance of stock under the equity incentive plan		$ 29	$ 134	(163)
Issuance of stock under the equity incentive plan, shares		29,550	134,583
Stock-based compensation, net of cash settlements				112,090				112,090
Tax withholding obligations on stock issued to employees				(226,250)				(226,250)
Preferred stock dividends				(775,332)				(775,332)
Balance at Mar. 31, 2018		$ 1,116	$ 12,406	44,239,862	(21,990,229)	(924,216)	(662,000)	20,676,939
Balance, shares at Mar. 31, 2018		1,116,289	12,405,973
Net income (loss)					195,280			195,280
Foreign currency translation adjustment						(227,258)		(227,258)
Stock-based compensation, net of cash settlements				364,710				364,710
Preferred stock dividends				(1,248,717)				(1,248,717)
Issuance of preferred stock, net of fees and expenses		$ 420		9,354,490				9,354,910
Issuance of preferred stock, shares		420,000
Balance at Jun. 30, 2018		$ 1,536	$ 12,406	52,710,345	(21,794,949)	(1,151,474)	(662,000)	29,115,864
Balance, shares at Jun. 30, 2018		1,536,289	12,405,973
Net income (loss)					(1,832,453)			(1,832,453)
Foreign currency translation adjustment						175,032		175,032	[1]
Issuance of stock under the equity incentive plan			$ 165	(165)
Issuance of stock under the equity incentive plan, shares			164,584
Stock-based compensation, net of cash settlements				881,605				881,605
Tax withholding obligations on stock issued to employees				(119,250)				(119,250)
Preferred stock dividends				(1,056,214)				(1,056,214)
Issuance of preferred stock, shares
Common stock warrants issued				101,989				101,989
Balance at Sep. 30, 2018		$ 1,536	$ 12,571	52,518,310	(23,627,402)	(976,442)	(662,000)	27,266,573
Balance, shares at Sep. 30, 2018		1,536,289	12,570,557
Balance at 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
Net income (loss)					(295,691)			(295,691)
Foreign currency translation adjustment						209,345		209,345
Issuance of stock under the equity incentive plan		$ 26	$ 180	(206)
Issuance of stock under the equity incentive plan, shares		26,160	179,984
Stock-based compensation, net of cash settlements				523,556				523,556
Tax withholding obligations on stock issued to employees				(800,271)				(800,271)
Preferred stock dividends				(1,492,700)				(1,492,700)
Balance at Mar. 31, 2019		$ 2,162	$ 12,751	63,372,839	(24,499,436)	(1,211,723)	(662,000)	37,014,593
Balance, shares at Mar. 31, 2019		2,162,449	12,750,541
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
Net income (loss)								(1,204,207)
Foreign currency translation adjustment	[1]							148,774
Balance at Sep. 30, 2019		$ 2,308	$ 12,953	64,743,714	(25,407,952)	(1,272,294)	(662,000)	37,416,729
Balance, shares at Sep. 30, 2019		2,307,633	12,953,122
Balance at Mar. 31, 2019		$ 2,162	$ 12,751	63,372,839	(24,499,436)	(1,211,723)	(662,000)	37,014,593
Balance, shares at Mar. 31, 2019		2,162,449	12,750,541
Net income (loss)					(770,972)			(770,972)
Foreign currency translation adjustment						(762,563)		(762,563)
Issuance of stock under the equity incentive plan			$ 18	(18)
Issuance of stock under the equity incentive plan, shares			18,500
Stock-based compensation, net of cash settlements				473,387				473,387
Tax withholding obligations on stock issued to employees				(58,536)				(58,536)
Preferred stock dividends				(1,486,706)				(1,486,706)
Balance at Jun. 30, 2019		$ 2,162	$ 12,769	62,300,966	(25,270,408)	(1,974,286)	(662,000)	34,409,203
Balance, shares at Jun. 30, 2019		2,162,449	12,769,041
Net income (loss)					(137,544)			(137,544)
Foreign currency translation adjustment						701,992		701,992	[1]
Issuance of stock under the equity incentive plan			$ 184	(184)
Issuance of stock under the equity incentive plan, shares			184,081
Stock-based compensation, net of cash settlements				326,803				326,803
Preferred stock dividends				(1,602,831)				(1,602,831)
Issuance of preferred stock, net of fees and expenses		$ 146		3,718,960				3,719,106
Issuance of preferred stock, shares		145,184
Balance at Sep. 30, 2019		$ 2,308	$ 12,953	$ 64,743,714	$ (25,407,952)	$ (1,272,294)	$ (662,000)	$ 37,416,729
Balance, shares at Sep. 30, 2019		2,307,633	12,953,122
[1]	No tax effect has been recorded as the Company recorded a valuation allowance against the tax benefit from its foreign currency translation adjustments.

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
OPERATING ACTIVITIES:
Net loss	$ (1,204,207)	$ (1,562,137)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	2,457,183	2,015,508
Deferred rent		(49,608)
Lease amortization	1,440,066
Deferred revenue	(11,557)	(40,873)
Provision for doubtful accounts	105,315	261,541
Provision (benefit) for deferred income taxes	34,585	(187,072)
Foreign exchange loss (gain)	408,057	(105,418)
Interest accretion	381,827	143,030
Gain on sale of assets	(26,213)
Stock-based compensation expense	2,324,799	1,523,682
Change in contingent consideration	(343,768)	68,253
Changes in operating assets and liabilities, net of businesses acquired:
Accounts receivable	(126,542)	901,683
Contract asset	51,607	(464,470)
Inventory	69,137	(148,858)
Other assets	(108,080)	(24,869)
Accounts payable and other liabilities	(698,408)	2,418,110
Net cash provided by operating activities	4,753,801	4,748,502
INVESTING ACTIVITIES:
Capital expenditures, net	(1,326,650)	(743,115)
Cash paid for acquisitions	(1,600,000)	(12,600,000)
Net cash used in investing activities	(2,926,650)	(13,343,115)
FINANCING ACTIVITIES:
Proceeds from issuance of preferred stock, net of fees and expenses	3,719,106	9,354,910
Preferred stock dividends paid	(4,464,435)	(2,771,192)
Settlement of tax withholding obligations on stock issued to employees	(1,320,650)	(333,007)
Proceeds from line of credit		6,625,000
Repayments of line of credit		(6,625,000)
Repayments of notes payable, net	(290,164)	(329,426)
Contingent consideration payments	(182,664)	(111,495)
Other financing activities		(33,150)
Net cash (used in) provided by financing activities	(2,538,807)	5,776,640
EFFECT OF EXCHANGE RATE CHANGES ON CASH	226,370	(284,685)
NET DECREASE IN CASH	(485,286)	(3,102,658)
CASH - beginning of the period	14,472,483	4,362,232
CASH - end of the period	13,987,197	1,259,574
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES:
Vehicle financing obtained	24,909	90,284
Dividends declared, not paid	1,586,528	1,056,218
Purchase of prepaid insurance through assumption of note	301,359	271,248
Warrants issued		101,989
SUPPLEMENTAL INFORMATION - Cash paid during the period for:
Income taxes	95,822	29,673
Interest	$ 46,089	$ 45,083

Organization and Business

Organization and Business	9 Months Ended
	Sep. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Business	1. Organization and Business MTBC, Inc., (and together with its consolidated subsidiaries “MTBC” or the “Company”) is a healthcare information technology company that offers an integrated suite of proprietary cloud-based electronic health records and practice management solutions, together with related business services, to healthcare providers. The Company’s integrated services are designed to help customers increase revenues, streamline workflows and make better business and clinical decisions, while reducing administrative burdens and operating costs. The Company’s services include full-scale revenue cycle management, electronic health records, and other technology-driven practice management services for private and hospital-employed healthcare providers. MTBC has its corporate offices in Somerset, New Jersey and maintains client support teams throughout the U.S., Pakistan and Sri Lanka. MTBC was founded in 1999 and incorporated under the laws of the State of Delaware in 2001. In 2004, MTBC formed MTBC Private Limited (or “MTBC Pvt. Ltd.”), a 99.9% majority-owned subsidiary of MTBC based in Pakistan. The remaining 0.01% of the shares of MTBC Pvt. Ltd. is owned by the founder and Executive Chairman of MTBC. In 2016, MTBC formed MTBC Acquisition Corp. (“MAC”), a Delaware corporation, in connection with its acquisition of substantially all of the assets of MediGain, LLC and its subsidiary, Millennium Practice Management Associates, LLC (together “MediGain). MAC has a wholly owned subsidiary in Sri Lanka, RCM MediGain Colombo, Pvt. Ltd. In May 2018, MTBC formed MTBC Health, Inc. (“MHI”) and MTBC Practice Management, Corp. (“MPM”), each a Delaware corporation in connection with 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 March 2019, MTBC formed MTBC-Med, Inc. (“MED”), a Delaware corporation, in connection with its acquisition of substantially all of the assets of Etransmedia Technology, Inc. and its subsidiaries (“ETM”). See Note 3.

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2019
Accounting Policies [Abstract]
Basis of Presentation	2. BASIS OF PRESENTATION The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial reporting and as required by Regulation S-X, Rule 8-03. Accordingly, they do not include all of the information and notes required by GAAP for complete financial statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting of items of a normal and recurring nature) necessary to present fairly the Company’s financial position as of September 30, 2019, the results of operations for the three and nine months ended September 30, 2019 and 2018 and cash flows for the nine months ended September 30, 2019 and 2018. When preparing financial statements in conformity with GAAP, the Company must make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ significantly from those estimates. The condensed consolidated balance sheet as of December 31, 2018 was derived from our audited consolidated financial statements. The accompanying unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements for the year ended December 31, 2018, which are included in the Company’s Annual Report on Form 10-K, filed with the SEC on March 20, 2019. Recent Accounting Pronouncements Leases (Topic 842). We adopted the standard on January 1, 2019 using the optional transition adjustment method. As part of the adoption of ASC 842, we performed an assessment of the impact that the new lease recognition standard has on the condensed consolidated financial statements. All of our leases, which consist of facility and equipment leases, have been classified as operating leases. The Company does not have any financing leases. We adopted the requirements of the new standard without restating the prior periods. There was no impact to the accumulated deficit as of the date of adoption. For leases in place at the transition date, we adopted 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 have also adopted the practical expedients that allow 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 did not recognize ROU asset or lease liabilities as part of the transition adjustment. As of January 1, 2019, the impact on the consolidated assets was approximately $4.2 million and the impact on the consolidated liabilities was approximately $4.4 million. The adoption of ASC 842 did not have a material effect on the Company’s results of operations, stockholders’ equity, or statement of cash flows. We have also evaluated, documented, and implemented required changes in internal control as part of our adoption of the new lease recognition standard. These changes include implementing updated accounting policies affected by ASC 842 and implementing a new information technology application to calculate our right-of-use assets, lease liabilities and required disclosures.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2019
Business Combinations [Abstract]
Acquisitions	3. ACQUISITIONS 2019 Acquisition On April 3, 2019, the Company executed an asset purchase agreement (“APA”) to acquire substantially all of the assets of ETM. The purchase price was $1.6 million and the assumption of certain liabilities, excluding acquisition-related costs of approximately $125,000. Per the APA, the acquisition had an effective date of April 1, 2019. The acquisition has been accounted for as a business combination. The ETM acquisition added additional 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 purchase price allocation for ETM was performed by the Company and is summarized as follows: Customer relationships $ 856,000 Accounts receivable 547,377 Contract asset 139,169 Operating lease right-of-use assets 1,224,480 Property and equipment 91,277 Goodwill 39,901 Operating lease liabilities (1,224,480 ) Accrued expenses (73,724 ) Total $ 1,600,000 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 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 and operational synergies that we expect to achieve that would not be available to other market participants. The weighted-average amortization period of the acquired intangible assets is four years. Revenue earned from the clients obtained from the ETM acquisition was approximately $1.7 million and $3.7 million, respectively during the three and nine months ended September 30, 2019. 2018 Acquisition On May 7, 2018, the Company executed an 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. 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 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 ) Total $ 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 seven years. Pro forma financial information (Unaudited) The unaudited pro forma information below represents condensed consolidated results of operations as if the Orion and ETM acquisitions occurred on January 1, 2018. The pro forma information has been included for comparative purposes and is not indicative of results of operations that the Company would have had if the acquisitions occurred on the above date, nor is it necessarily indicative of future results. The unaudited pro forma information reflects material, non-recurring pro forma adjustments directly attributable to the business combinations. The difference between the actual revenue and the pro forma revenue is approximately $19.1 million of additional revenue recorded by Orion and approximately $9.3 million of additional revenue recorded by ETM for the nine months ended September 30, 2018. Three Months Ended Nine Months Ended September 30, September 30, 2019 2018 2019 2018 ($ in thousands except per share amounts) Total revenue $ 16,851 $ 19,807 $ 50,748 $ 62,416 Net loss $ (84 ) $ (4,008 ) $ (2,752 ) $ (9,961 ) Net loss attributable to common shareholders $ (1,686 ) $ (5,064 ) $ (7,334 ) $ (13,041 ) Net loss per common share $ (0.14 ) $ (0.43 ) $ (0.61 ) $ (1.12 )

Goodwill and Intangible Assets-

Goodwill and Intangible Assets-Net	9 Months Ended
	Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets-Net	4. GOODWILL AND INTANGIBLE ASSETS-NET Goodwill consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. The following is the summary of the changes to the carrying amount of goodwill for the nine months ended September 30, 2019 and the year ended December 31, 2018: Nine Months Ended Year Ended September 30, 2019 December 31, 2018 Beginning gross balance $ 12,593,795 $ 12,263,943 Acquisitions 39,901 329,852 Ending gross balance $ 12,633,696 $ 12,593,795 Of the total goodwill, approximately $90,000 is allocated to the Practice Management segment and the balance is allocated to the Healthcare IT segment. Intangible assets include customer contracts and relationships and covenants not-to-compete acquired in connection with acquisitions, as well as trademarks acquired and software costs. Intangible assets - net as of September 30, 2019 and December 31, 2018 consist of the following: September 30, 2019 December 31, 2018 Contracts and relationships acquired $ 23,597,300 $ 22,741,300 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,852,852 1,477,059 Total intangible assets 26,686,529 25,454,736 Less: Accumulated amortization 20,521,256 18,820,733 Intangible assets - net $ 6,165,273 $ 6,634,003 Amortization expense was approximately $1.7 million and $1.5 million for the nine months ended September 30, 2019 and 2018 and approximately $577,000 and $633,000 for the three months ended September 30, 2019 and 2018, respectively. The weighted-average amortization period is currently seven years. As of September 30, 2019, future amortization scheduled to be expensed is as follows: Years ending December 31 2019 (three months) $ 387,892 2020 1,380,325 2021 1,235,554 2022 872,973 2023 338,529 Thereafter 1,950,000 Total $ 6,165,273

Net Loss Per Common Share

Net Loss Per Common Share	9 Months Ended
	Sep. 30, 2019
Earnings Per Share [Abstract]
Net Loss Per Common Share	5. NET LOss per COMMON share The following table reconciles the weighted-average shares outstanding for basic and diluted net loss per share for the three and nine months ended September 30, 2019 and 2018: Three Months Ended Nine Months Ended September 30, September 30, 2019 2018 2019 2018 Basic and Diluted: Net loss attributable to common shareholders $ (1,740,377 ) $ (2,888,667 ) $ (5,786,446 ) $ (4,642,400 ) Weighted-average common shares used to compute basic and diluted loss per share 12,146,110 11,770,178 12,038,819 11,684,659 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.14 ) $ (0.25 ) $ (0.48 ) $ (0.40 ) All unvested restricted stock units (“RSUs”), the 200,000 warrants granted to Opus Bank (“Opus”) and the 153,489 warrants granted to Silicon Valley Bank (“SVB”) have been excluded from the above calculations as they were anti-dilutive. Vested RSUs and vested restricted shares have been included in the above calculations.

Debt

Debt	9 Months Ended
	Sep. 30, 2019
Debt Disclosure [Abstract]
Debt	6. Debt SVB Vehicle Financing Notes Insurance Financing

Leases

Leases	9 Months Ended
	Sep. 30, 2019
Leases [Abstract]
Leases	7. leases We determine if an arrangement is a lease at inception. Operating leases are included in operating lease right-of-use (“ROU”) assets, current operating lease liability and non-current operating lease liability in our condensed consolidated balance sheet as of September 30, 2019. The Company does not have any finance leases. ROU assets represent our right to use an underlying asset for the lease term and lease liabilities represent our obligation to make lease payments arising from the lease. ROU assets and liabilities are recognized at the lease commencement date based on the estimated present value of lease payments over the lease term. We use our estimated incremental borrowing rates, which are derived from information available at the lease commencement date, in determining the present value of lease payments. For leases in existence at the adoption of ASC 842, we used the incremental borrowing rate as of January 1, 2019. We give consideration to our bank financing arrangements, geographical location and collateralization of assets when calculating our incremental borrowing rates. Our lease terms include options to extend the lease when it is reasonably certain that we will exercise that option. Leases with a term of less than 12 months are not recorded in the condensed consolidated balance sheet. Our lease agreements do not contain any residual value guarantees. For real estate leases, we account for the lease and non-lease components as a single lease component. Some leases include escalation clauses and termination options that are factored in the determination of the lease payments when appropriate. If a lease is modified after the effective date, the operating lease ROU asset and liability is re-measured using the current incremental borrowing rate. During the three months ended September 30, 2019, a lease impairment of approximately $87,000 was recorded since the Company is no longer using one of its leased facilities and is currently in the process of subleasing the space. Restructuring charges of approximately $49,000 were recorded in the three months ended September 30, 2019 which represent the remaining lease costs for another leased facility that was closed and the employees were transferred to another Company facility. We lease all of our facilities and some equipment. Lease expense is included in direct operating costs and general and administrative expenses in the condensed consolidated statements of operations based on the nature of the expense. As of September 30, 2019, we had 32 leased properties, five in Practice Management and 27 in Healthcare IT, with remaining terms ranging from less than one year to four years. Our lease terms are determined taking into account lease renewal options, the Company’s anticipated operating plans and leases that are on a month-to-month basis. We also have some related party leases – see Note 9. The components of lease expense were as follows: Three Months Ended September 30, 2019 Nine Months Ended September 30, 2019 Operating lease cost $ 572,516 $ 1,677,137 Short-term lease cost 51,353 189,329 Variable lease cost 6,873 25,906 Total- net lease cost $ 630,742 $ 1,892,372 Short-term lease cost represents leases that were not capitalized as the lease term as of the later of January 1, 2019 or the beginning of the lease was less than 12 months. Variable lease costs include utilities, real estate taxes and common area maintenance costs. Supplemental balance sheet information related to leases was as follows: September 30, 2019 Operating leases: Operating lease ROU assets, net $ 4,261,709 Current operating lease liabilities $ 1,962,064 Non-current operating lease liabilities 2,501,112 Total operating lease liabilities $ 4,463,176 Operating leases: ROU assets, gross $ 5,760,741 Asset lease expense (1,440,066 ) Foreign exchange loss (58,966 ) ROU assets, net $ 4,261,709 Weighted average remaining lease term (in years): Operating leases 2.55 Weighted average discount rate: Operating leases 7.06 % Supplemental cash flow and other information related to leases was as follows: Three Months Ended September 30, 2019 Nine Months Ended September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 611,249 $ 1,736,133 ROU assets obtained in exchange for lease liabilities: Operating leases, net of restructuring, impairment and terminations $ (119,052 ) $ 1,514,989 Maturities of lease liabilities are as follows: Operating leases 2019 (three months) $ 642,614 2020 2,050,239 2021 1,407,800 2022 572,984 2023 153,330 2024 4,226 Total lease payments 4,831,193 Less: imputed interest (368,017 ) Total lease obligations 4,463,176 Less: current obligations (1,962,064 ) Long-term lease obligations $ 2,501,112 As of September 30, 2019, we have one operating lease commitment with a six year term that commences on January 1, 2020 aggregating approximately $1.2 million. Disclosures related to periods prior to adoption of ASC 842 Operating lease rent expense was approximately $591,000 and $1.0 million for the three and nine months ended September 30, 2018, respectively. Month-to-month leases and cancellable leases are not included in the table below. Certain leases are maintained on a month-to-month basis. This includes leases for the US corporate facility and other locations with the Executive Chairman (see Note 9). As of December 31, 2018, future lease payment obligations under non-cancellable operating leases were as follows: Operating leases 2019 $ 932,068 2020 715,059 2021 510,927 2022 412,585 2023 91,797 Total $ 2,662,436

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	8. Commitments and Contingencies Legal Proceedings On April 23, 2019, the Appellate Division reversed the Chancery Court’s ruling that MTBC is required to participate in the Arbitration and remanded the case for further proceedings before the Chancery Court on that issue. The Appellate Division upheld the Chancery Court’s ruling that MAC was required to participate in the Arbitration. Discovery is currently ongoing in the remanded matter. RPRWC seeks compensatory damages of $6.6 million, plus costs, for MPMA’s alleged breach of the billing services agreement. RPRWC’s breach of contract and compensatory damages claims have not been the subject of the ongoing court proceedings, which have focused solely on whether RPRWC can compel MTBC and MAC to arbitrate its claim. Thus, RPRWC has not yet provided MTBC and MAC with information sufficient to enable them to estimate a range of possible losses that may arise from the Arbitration. ​If MTBC is compelled to arbitrate RPRWC’s claims it plans to mount a vigorous defense. Likewise, MAC intends to vigorously defend against RPRWC’s claims. If ​RPRWC is successful in the Arbitration, MTBC and MAC anticipate the award would be substantially less than the amount claimed.

Related Parties

Related Parties	9 Months Ended
	Sep. 30, 2019
Related Party Transactions [Abstract]
Related Parties	9. 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 $14,000 and $15,000 for the nine months ended September 30, 2019 and 2018, and $5,000 and $6,000 for the three months ended September 30, 2019 and 2018, respectively. As of September 30, 2019, and December 31, 2018, the receivable balance due from this customer was approximately $2,000 and $1,600, respectively. The Company is a party to a nonexclusive aircraft dry lease agreement with Kashmir Air, Inc. (“KAI”), which is owned by the Executive Chairman. The Company recorded an expense of approximately $86,000 and $96,000 for the nine month periods ended September 30, 2019 and 2018, and $32,000 for both the three months ended September 30, 2019 and 2018. As of September 30, 2019 and December 31, 2018, the Company had a liability outstanding to KAI of approximately $1,000 and $11,000, respectively, which is included in accrued liability to related party in the condensed consolidated balance sheets. The original aircraft lease expired on March 31, 2019 and was not included in the ROU asset at January 1, 2019 or March 31, 2019. A lease for a different aircraft at the same lease rate was entered into as of April 1, 2019 and has been included in the ROU asset and operating lease liability at September 30, 2019. 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 nine months ended September 30, 2019 and 2018 was approximately $144,000 and $141,000, respectively, and for three months ended September 30, 2019 and 2018 was approximately $47,000 and $46,000, respectively and is included in direct operating costs and general and administrative expense in the consolidated statements of operations. During the three months ended September 30, 2019, the Company spent approximately $37,000 to upgrade one of the leased facilities. The Company estimates it will spend approximately an additional $21,000 to upgrade the facility in the following quarter. Current assets-related party in the condensed consolidated balance sheets includes security deposits and prepaid rent related to the leases of the Company’s corporate offices in the amount of approximately $13,000 and $25,000 as of September 30, 2019 and December 31, 2018, respectively. Included in the ROU asset at September 30, 2019 is approximately $505,000 applicable to the related party leases. Included in the current and non-current operating lease liability at September 30, 2019 is approximately $281,000 and $230,000, respectively applicable to the related party leases.

Revenue

Revenue	9 Months Ended
	Sep. 30, 2019
Revenue from Contract with Customer [Abstract]
Revenue	10. 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, which approximates the stand alone selling price. We apply the portfolio approach as permitted by ASC 606 as a practical expedient to contracts with similar characteristics and we use estimates and assumptions when accounting for those portfolios. Our contracts generally include standard commercial payment terms. We have no significant obligations for refunds, warranties or similar obligations and our revenue does not include taxes collected from our customers. Disaggregation of Revenue from Contracts with Customers We derive revenue from seven primary sources: revenue cycle management services, practice management services, professional services, ancillary services, group purchasing services, printing and mailing services, and clearinghouse and EDI (electronic data interchange) services. The following table represents a disaggregation of revenue for the three and nine months ended September 30: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Healthcare IT: Revenue cycle management services $ 10,808,438 $ 11,695,675 $ 32,798,563 $ 26,954,715 Professional services 376,189 532,763 1,094,960 717,031 Ancillary services 873,841 530,285 2,303,118 1,092,376 Group purchasing services 295,850 477,168 700,963 477,168 Printing and mailing services 436,735 335,999 1,186,834 985,522 Clearinghouse and EDI services 146,989 158,214 433,923 493,554 Practice Management: Practice management services 3,913,286 3,314,422 10,162,677 3,314,422 Total $ 16,851,328 $ 17,044,526 $ 48,681,038 $ 34,034,788 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 certain customers and records revenue monthly on a time and materials or a fixed rate basis. The performance obligation is satisfied over time as the implementation or professional services are rendered. Ancillary services represent services such as coding, credentialing 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, credentialing or transcription transaction processed represents a performance obligation, which is satisfied over time as that individual service is rendered. The Company 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. Referral fees from the pharmaceutical companies are paid to MTBC 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. Other than the group purchasing services, each of the Company’s services are substantially the same and have the same periodic pattern of transfer to the customer. Each service provided by the Company 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. The Company also provides accounting services and a practice manager to one additional medical practice for which it receives monthly fees. 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: The contract asset in the condensed consolidated balance sheets 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. As of September 30, 2019, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management performance obligations outstanding was approximately $2.0 million. We expect to recognize substantially all of the revenue for the remaining performance obligations over the next three months. Approximately $700,000 of the contract asset represents revenue earned, not paid, from the group purchasing services. Accounts receivable are shown separately at their net realizable value in our condensed consolidated balance sheets. Amounts that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end of each month when the services have been provided. The contract asset results from our revenue cycle management services and is due to the timing of revenue recognition, submission of claims from our customers and payments from the insurance providers. The contract asset includes our right to payment for services already transferred to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for revenue cycle management services where we recognize revenue over time but do not have a contractual right to payment until the customer receives payment of their claim from the insurance provider. The contract asset also includes the revenue accrued, not received, for the group purchasing services. The contract asset was approximately $2.7 million and $2.5 million as of September 30, 2019 and September 30, 2018, respectively. Changes in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. Deferred revenue represents sign-up fees received from customers that are amortized over three years. The opening and closing balances of the Company’s accounts receivable, contract asset and deferred revenue are as follows for the nine months ended September 30, 2019 and 2018: Accounts Receivable, Net Contract Asset Deferred Revenue (current) Deferred Revenue (long term) Balance as of January 1, 2019 $ 7,331,474 $ 2,608,631 $ 25,355 $ 18,949 ETM acquisition - 139,169 - - Increase (decrease), net 568,604 (51,607 ) (8,916 ) (2,641 ) Balance as of September 30, 2019 $ 7,900,078 $ 2,696,193 $ 16,439 $ 16,308 Balance as of January 1, 2018 $ 3,879,463 $ 1,342,692 $ 62,104 $ 28,615 Orion acquisition 5,727,618 673,317 - - (Decrease) increase, net (1,163,224 ) 464,470 (31,890 ) (8,983 ) Balance as of September 30, 2018 $ 8,443,857 $ 2,480,479 $ 30,214 $ 19,632 Deferred commissions: Our sales incentive plans include commissions payable to employees and third parties at the time of initial contract execution that are capitalized as incremental costs to obtain a contract. The capitalized commissions are amortized over the period the related services are transferred. As we do not offer commissions on contract renewals, we have determined the amortization period to be the estimated client life, which is three years. Deferred commissions were approximately $44,000 and $108,000 at September 30, 2019 and 2018, respectively, and are included in the other assets amounts in the condensed consolidated balance sheets.

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	11. STOCK-BASED COMPENSATION In April 2014, the Company adopted its Equity Incentive Plan (the “Plan”), reserving 1,351,000 shares of common stock for grants to employees, officers, directors and consultants. During April 2017, the Plan was amended and restated whereby an additional 1,500,000 shares of common stock and 100,000 shares of Series A Preferred Stock were added to the plan for future issuance. During June 2018, the Company’s shareholders approved the addition of 200,000 preferred shares to the Plan for future grants. As of September 30, 2019, 398,404 shares of common stock and 138,400 shares of Series A Preferred Stock are available for grant under the Plan. Permissible awards include incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock, RSUs, performance stock and cash-settled awards and other stock-based awards in the discretion of the Compensation Committee of the Board of Directors including unrestricted stock grants. The common stock equity-based RSUs contain a common provision in which the units shall immediately vest and become converted into common shares at the rate of one share per RSU, immediately after a change in control, as defined in the award agreement. The preferred stock RSUs contain a similar provision, which vest and convert to Series A Preferred Stock upon a change in control. Common and preferred stock RSUs In February 2019, the Compensation Committee approved executive bonuses to be paid in shares of Series A Preferred Stock, with the number of shares and the amount based on specified criteria being achieved during the year 2019. The actual amount will be settled in early 2020 based on the achievement of the specified criteria. For the three and nine months ended September 30, 2019, an expense of approximately $301,000 and $904,000, respectively, was recorded for these bonuses based on the value of the shares at the grant date and recognized over the service period. The portion of the stock compensation expense to be used for the payment of withholding and payroll taxes is included in accrued compensation in the condensed consolidated balance sheets. The balance of the stock compensation expense has been recorded as additional paid-in capital. The following table summarizes the RSU transactions related to the common and preferred stock under the Equity Incentive Plan for the nine months ended September 30, 2019: Common Stock Preferred Stock Outstanding and unvested shares at January 1, 2019 929,347 44,800 Granted 176,000 44,000 Vested (581,065 ) (44,800 ) Forfeited (26,614 ) - Outstanding and unvested shares at September 30, 2019 497,668 44,000 Of the total outstanding and unvested common stock RSUs at September 30, 2019, 464,335 RSUs are classified as equity and 33,333 RSUs are classified as a liability. All of the preferred stock RSUs are classified as equity. 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 and includes the related taxes. For stock awards classified as a liability, the earned amount is marked to market based on the end of period common stock price. The liability for the cash-settled awards was approximately $550,000 and $118,000 at September 30, 2019 and December 31, 2018, respectively, and is included in accrued compensation in the condensed consolidated balance sheets. The following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2019 and 2018: Stock-based compensation included in the condensed consolidated statements of operations: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Direct operating costs $ 49,590 $ 39,703 $ 146,448 $ 49,562 General and administrative 693,138 935,159 2,100,609 1,457,759 Research and development 9,044 8,208 18,878 13,152 Selling and marketing 22,839 3,209 58,864 3,209 Total stock-based compensation expense $ 744,611 $ 986,279 $ 2,324,799 $ 1,523,682

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Income Taxes	12. INCOME TAXES The income tax expense for the three months ended September 30, 2019 was approximately $87,000, comprised of a current tax expense of $37,000 and deferred tax expense of $50,000. The current and deferred income tax provisions for the nine months ended September 30, 2019 were approximately $67,000 and $35,000, respectively. The current income tax provision for the three and nine months ended September 30, 2019 and 2018 primarily relates to state minimum taxes and foreign income taxes. The deferred tax provision for the three and nine months ended September 30, 2019 and 2018 relates to the book and tax difference of amortization on indefinite-lived intangibles, primarily goodwill. Although the Company is forecasting a return to profitability, it has incurred cumulative losses which make realization of deferred tax asset difficult to support in accordance with ASC 740. Accordingly, a valuation allowance has been recorded against the Federal and state deferred tax assets as of September 30, 2019 and December 31, 2018.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 30, 2019
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	13. FAIR VALUE OF FINANCIAL INSTRUMENTS As of September 30, 2019, and December 31, 2018, 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 as of December 31, 2018 is a Level 3 liability. The fair value of the contingent consideration at December 31, 2018 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. The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): Fair Value Measurement at Reporting Date Using Significant Unobservable Inputs, Level 3 Nine Months Ended September 30, 2019 2018 Balance - January 1, $ 526,432 $ 603,411 Change in fair value (343,768 ) 68,253 Payments (182,664 ) (111,495 ) Balance - September 30, $ - $ 560,169 As of September 30, 2019, all contingent consideration liabilities were settled. The change in fair value for the nine months ended September 30, 2019 represents the favorable settlement of the contingent consideration liabilities.

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 30, 2019
Segment Reporting [Abstract]
Segment Reporting	14. SEGMENT REPORTING Both our Chief Executive Officer and Executive Chairman serve as the Chief Operating Decision Maker (“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 and starting April 1, 2019, certain practice management services are being provided to a fourth practice. 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 Company’s Annual Report on Form 10-K for the year ended December 31, 2018 filed with the SEC on March 20, 2019. The following tables present revenues, operating expenses and operating income (loss) by reportable segment: Nine Months Ended September 30, 2019 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 38,518,361 $ 10,162,677 $ - $ 48,681,038 Operating expenses: Direct operating costs 23,912,120 7,867,444 - 31,779,564 Selling and marketing 1,065,750 25,774 - 1,091,524 General and administrative 8,549,122 1,504,506 3,704,177 13,757,805 Research and development 648,822 - - 648,822 Change in contingent consideration (343,768 ) - - (343,768 ) Depreciation and amortization 2,170,204 236,907 - 2,407,111 Restructuring and impairment charges 136,332 - - 136,332 Total operating expenses 36,138,582 9,634,631 3,704,177 49,477,390 Operating income (loss) $ 2,379,779 $ 528,046 $ (3,704,177 ) $ (796,352 ) Three Months Ended September 30, 2019 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 12,938,042 $ 3,913,286 $ - $ 16,851,328 Operating expenses: Direct operating costs 7,508,208 3,027,421 - 10,535,629 Selling and marketing 339,603 7,965 - 347,568 General and administrative 2,791,573 548,746 1,111,656 4,451,975 Research and development 175,758 - - 175,758 Change in contingent consideration (279,565 ) - - (279,565 ) Depreciation and amortization 735,133 79,077 - 814,210 Restructuring and impairment charges 136,332 - - 136,332 Total operating expenses 11,407,042 3,663,209 1,111,656 16,181,907 Operating income (loss) $ 1,531,000 $ 250,077 $ (1,111,656 ) $ 669,421 Nine Months Ended September 30, 2018 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 30,720,367 $ 3,314,421 $ - $ 34,034,788 Operating expenses: Direct operating costs 18,303,270 2,638,265 - 20,941,535 Selling and marketing 1,159,943 9,640 - 1,169,583 General and administrative 6,591,165 552,514 3,642,555 10,786,234 Research and development 768,517 - - 768,517 Change in contingent consideration 68,253 - - 68,253 Depreciation and amortization 1,890,809 81,756 - 1,972,565 Total operating expenses 28,781,957 3,282,175 3,642,555 35,706,687 Operating income (loss) $ 1,938,410 $ 32,246 $ (3,642,555 ) $ (1,671,899 ) Three Months Ended September 30, 2018 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 13,730,105 $ 3,314,421 $ - $ 17,044,526 Operating expenses: Direct operating costs 9,485,642 2,638,265 - 12,123,907 Selling and marketing 451,872 9,640 - 461,512 General and administrative 2,730,595 552,514 1,848,186 5,131,295 Research and development 263,717 - - 263,717 Change in contingent consideration 25,473 - - 25,473 Depreciation and amortization 740,342 81,756 - 822,098 Total operating expenses 13,697,641 3,282,175 1,848,186 18,828,002 Operating income (loss) $ 32,464 $ 32,246 $ (1,848,186 ) $ (1,783,476 )

Basis of Presentation (Policies

Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2019
Accounting Policies [Abstract]
Recent Accounting Pronouncements	Recent Accounting Pronouncements Leases (Topic 842). We adopted the standard on January 1, 2019 using the optional transition adjustment method. As part of the adoption of ASC 842, we performed an assessment of the impact that the new lease recognition standard has on the condensed consolidated financial statements. All of our leases, which consist of facility and equipment leases, have been classified as operating leases. The Company does not have any financing leases. We adopted the requirements of the new standard without restating the prior periods. There was no impact to the accumulated deficit as of the date of adoption. For leases in place at the transition date, we adopted 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 have also adopted the practical expedients that allow 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 did not recognize ROU asset or lease liabilities as part of the transition adjustment. As of January 1, 2019, the impact on the consolidated assets was approximately $4.2 million and the impact on the consolidated liabilities was approximately $4.4 million. The adoption of ASC 842 did not have a material effect on the Company’s results of operations, stockholders’ equity, or statement of cash flows. We have also evaluated, documented, and implemented required changes in internal control as part of our adoption of the new lease recognition standard. These changes include implementing updated accounting policies affected by ASC 842 and implementing a new information technology application to calculate our right-of-use assets, lease liabilities and required disclosures.

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2019
Schedule of Business Acquisition, Pro Forma Information	Three Months Ended Nine Months Ended September 30, September 30, 2019 2018 2019 2018 ($ in thousands except per share amounts) Total revenue $ 16,851 $ 19,807 $ 50,748 $ 62,416 Net loss $ (84 ) $ (4,008 ) $ (2,752 ) $ (9,961 ) Net loss attributable to common shareholders $ (1,686 ) $ (5,064 ) $ (7,334 ) $ (13,041 ) Net loss per common share $ (0.14 ) $ (0.43 ) $ (0.61 ) $ (1.12 )
2019 Acquisition [Member]
Schedule of Assets Acquired and Liabilities Assumed	The purchase price allocation for ETM was performed by the Company and is summarized as follows: Customer relationships $ 856,000 Accounts receivable 547,377 Contract asset 139,169 Operating lease right-of-use assets 1,224,480 Property and equipment 91,277 Goodwill 39,901 Operating lease liabilities (1,224,480 ) Accrued expenses (73,724 ) Total $ 1,600,000
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 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 ) Total $ 12,600,000

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets-Net (Tables)	9 Months Ended
	Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets and Goodwill	The following is the summary of the changes to the carrying amount of goodwill for the nine months ended September 30, 2019 and the year ended December 31, 2018: Nine Months Ended Year Ended September 30, 2019 December 31, 2018 Beginning gross balance $ 12,593,795 $ 12,263,943 Acquisitions 39,901 329,852 Ending gross balance $ 12,633,696 $ 12,593,795
Schedule of Finite-Lived Intangible Assets	Intangible assets - net as of September 30, 2019 and December 31, 2018 consist of the following: September 30, 2019 December 31, 2018 Contracts and relationships acquired $ 23,597,300 $ 22,741,300 Non-compete agreements 1,236,377 1,236,377 Other intangible assets 1,852,852 1,477,059 Total intangible assets 26,686,529 25,454,736 Less: Accumulated amortization 20,521,256 18,820,733 Intangible assets - net $ 6,165,273 $ 6,634,003
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	As of September 30, 2019, future amortization scheduled to be expensed is as follows: Years ending December 31 2019 (three months) $ 387,892 2020 1,380,325 2021 1,235,554 2022 872,973 2023 338,529 Thereafter 1,950,000 Total $ 6,165,273

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2019
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 share for the three and nine months ended September 30, 2019 and 2018: Three Months Ended Nine Months Ended September 30, September 30, 2019 2018 2019 2018 Basic and Diluted: Net loss attributable to common shareholders $ (1,740,377 ) $ (2,888,667 ) $ (5,786,446 ) $ (4,642,400 ) Weighted-average common shares used to compute basic and diluted loss per share 12,146,110 11,770,178 12,038,819 11,684,659 Net loss attributable to common shareholders per share - Basic and Diluted $ (0.14 ) $ (0.25 ) $ (0.48 ) $ (0.40 )

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2019
Leases [Abstract]
Schedule of Lease Expense	The components of lease expense were as follows: Three Months Ended September 30, 2019 Nine Months Ended September 30, 2019 Operating lease cost $ 572,516 $ 1,677,137 Short-term lease cost 51,353 189,329 Variable lease cost 6,873 25,906 Total- net lease cost $ 630,742 $ 1,892,372
Schedule of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to leases was as follows: September 30, 2019 Operating leases: Operating lease ROU assets, net $ 4,261,709 Current operating lease liabilities $ 1,962,064 Non-current operating lease liabilities 2,501,112 Total operating lease liabilities $ 4,463,176 Operating leases: ROU assets, gross $ 5,760,741 Asset lease expense (1,440,066 ) Foreign exchange loss (58,966 ) ROU assets, net $ 4,261,709 Weighted average remaining lease term (in years): Operating leases 2.55 Weighted average discount rate: Operating leases 7.06 %
Schedule of Supplemental Cash Flow and Other Information Related to Leases	Supplemental cash flow and other information related to leases was as follows: Three Months Ended September 30, 2019 Nine Months Ended September 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 611,249 $ 1,736,133 ROU assets obtained in exchange for lease liabilities: Operating leases, net of restructuring, impairment and terminations $ (119,052 ) $ 1,514,989
Schedule of Maturities of Lease Liabilities	Maturities of lease liabilities are as follows: Operating leases 2019 (three months) $ 642,614 2020 2,050,239 2021 1,407,800 2022 572,984 2023 153,330 2024 4,226 Total lease payments 4,831,193 Less: imputed interest (368,017 ) Total lease obligations 4,463,176 Less: current obligations (1,962,064 ) Long-term lease obligations $ 2,501,112
Schedule of Future Minimum Lease Payments Under Non-cancellable Operating Leases	As of December 31, 2018, future lease payment obligations under non-cancellable operating leases were as follows: Operating leases 2019 $ 932,068 2020 715,059 2021 510,927 2022 412,585 2023 91,797 Total $ 2,662,436

Revenue (Tables)

Revenue (Tables)	9 Months Ended
	Sep. 30, 2019
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following table represents a disaggregation of revenue for the three and nine months ended September 30: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Healthcare IT: Revenue cycle management services $ 10,808,438 $ 11,695,675 $ 32,798,563 $ 26,954,715 Professional services 376,189 532,763 1,094,960 717,031 Ancillary services 873,841 530,285 2,303,118 1,092,376 Group purchasing services 295,850 477,168 700,963 477,168 Printing and mailing services 436,735 335,999 1,186,834 985,522 Clearinghouse and EDI services 146,989 158,214 433,923 493,554 Practice Management: Practice management services 3,913,286 3,314,422 10,162,677 3,314,422 Total $ 16,851,328 $ 17,044,526 $ 48,681,038 $ 34,034,788
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 for the nine months ended September 30, 2019 and 2018: Accounts Receivable, Net Contract Asset Deferred Revenue (current) Deferred Revenue (long term) Balance as of January 1, 2019 $ 7,331,474 $ 2,608,631 $ 25,355 $ 18,949 ETM acquisition - 139,169 - - Increase (decrease), net 568,604 (51,607 ) (8,916 ) (2,641 ) Balance as of September 30, 2019 $ 7,900,078 $ 2,696,193 $ 16,439 $ 16,308 Balance as of January 1, 2018 $ 3,879,463 $ 1,342,692 $ 62,104 $ 28,615 Orion acquisition 5,727,618 673,317 - - (Decrease) increase, net (1,163,224 ) 464,470 (31,890 ) (8,983 ) Balance as of September 30, 2018 $ 8,443,857 $ 2,480,479 $ 30,214 $ 19,632

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
Disclosure of Share-based Compensation Arrangements by Share-based Payment Award	The following table summarizes the RSU transactions related to the common and preferred stock under the Equity Incentive Plan for the nine months ended September 30, 2019: Common Stock Preferred Stock Outstanding and unvested shares at January 1, 2019 929,347 44,800 Granted 176,000 44,000 Vested (581,065 ) (44,800 ) Forfeited (26,614 ) - Outstanding and unvested shares at September 30, 2019 497,668 44,000
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs	The following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2019 and 2018: Stock-based compensation included in the condensed consolidated statements of operations: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Direct operating costs $ 49,590 $ 39,703 $ 146,448 $ 49,562 General and administrative 693,138 935,159 2,100,609 1,457,759 Research and development 9,044 8,208 18,878 13,152 Selling and marketing 22,839 3,209 58,864 3,209 Total stock-based compensation expense $ 774,611 $ 986,279 $ 2,324,799 $ 1,523,682

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2019
Fair Value Disclosures [Abstract]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	The following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value using significant unobservable inputs (Level 3): Fair Value Measurement at Reporting Date Using Significant Unobservable Inputs, Level 3 Nine Months Ended September 30, 2019 2018 Balance - January 1, $ 526,432 $ 603,411 Change in fair value (343,768 ) 68,253 Payments (182,664 ) (111,495 ) Balance - September 30, $ - $ 560,169

Segment Reporting (Tables)

Segment Reporting (Tables)	9 Months Ended
	Sep. 30, 2019
Segment Reporting [Abstract]
Schedule of Revenues, Operating Expenses and Operating Income (Loss) by Reportable Segment	The following tables present revenues, operating expenses and operating income (loss) by reportable segment: Nine Months Ended September 30, 2019 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 38,518,361 $ 10,162,677 $ - $ 48,681,038 Operating expenses: Direct operating costs 23,912,120 7,867,444 - 31,779,564 Selling and marketing 1,065,750 25,774 - 1,091,524 General and administrative 8,549,122 1,504,506 3,704,177 13,757,805 Research and development 648,822 - - 648,822 Change in contingent consideration (343,768 ) - - (343,768 ) Depreciation and amortization 2,170,204 236,907 - 2,407,111 Restructuring and impairment charges 136,332 - - 136,332 Total operating expenses 36,138,582 9,634,631 3,704,177 49,477,390 Operating income (loss) $ 2,379,779 $ 528,046 $ (3,704,177 ) $ (796,352 ) Three Months Ended September 30, 2019 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 12,938,042 $ 3,913,286 $ - $ 16,851,328 Operating expenses: Direct operating costs 7,508,208 3,027,421 - 10,535,629 Selling and marketing 339,603 7,965 - 347,568 General and administrative 2,791,573 548,746 1,111,656 4,451,975 Research and development 175,758 - - 175,758 Change in contingent consideration (279,565 ) - - (279,565 ) Depreciation and amortization 735,133 79,077 - 814,210 Restructuring and impairment charges 136,332 - - 136,332 Total operating expenses 11,407,042 3,663,209 1,111,656 16,181,907 Operating income (loss) $ 1,531,000 $ 250,077 $ (1,111,656 ) $ 669,421 Nine Months Ended September 30, 2018 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 30,720,367 $ 3,314,421 $ - $ 34,034,788 Operating expenses: Direct operating costs 18,303,270 2,638,265 - 20,941,535 Selling and marketing 1,159,943 9,640 - 1,169,583 General and administrative 6,591,165 552,514 3,642,555 10,786,234 Research and development 768,517 - - 768,517 Change in contingent consideration 68,253 - - 68,253 Depreciation and amortization 1,890,809 81,756 - 1,972,565 Total operating expenses 28,781,957 3,282,175 3,642,555 35,706,687 Operating income (loss) $ 1,938,410 $ 32,246 $ (3,642,555 ) $ (1,671,899 ) Three Months Ended September 30, 2018 Healthcare IT Practice Management Unallocated Corporate Expenses Total Net revenue $ 13,730,105 $ 3,314,421 $ - $ 17,044,526 Operating expenses: Direct operating costs 9,485,642 2,638,265 - 12,123,907 Selling and marketing 451,872 9,640 - 461,512 General and administrative 2,730,595 552,514 1,848,186 5,131,295 Research and development 263,717 - - 263,717 Change in contingent consideration 25,473 - - 25,473 Depreciation and amortization 740,342 81,756 - 822,098 Total operating expenses 13,697,641 3,282,175 1,848,186 18,828,002 Operating income (loss) $ 32,464 $ 32,246 $ (1,848,186 ) $ (1,783,476 )

Organization and Business (Deta

Organization and Business (Details Narrative)	Dec. 31, 2004
Executive Chairman [Member]
Equity method investment, ownership percentage in majority-owned subsidiary based in Pakistan	0.01%
MTBC Private Limited [Member]
Equity method investment, ownership percentage in majority-owned subsidiary based in Pakistan	99.90%

Basis of Presentation (Details

Basis of Presentation (Details Narrative) - USD ($)	Sep. 30, 2019	Jan. 02, 2019	Dec. 31, 2018
Operating lease right-of-use assets	$ 4,261,709
Liabilities	$ 4,463,176
ASC 842 [Member]
Operating lease right-of-use assets		$ 4,200,000
Liabilities		$ 4,400,000

Acquisitions (Details Narrative

Acquisitions (Details Narrative) - USD ($)	Apr. 03, 2019	May 07, 2018	Sep. 30, 2019	Sep. 30, 2019	Sep. 30, 2018
ETM Acquisition [Member]
Revenue earned from acquisition			$ 1,700,000	$ 3,700,000
Amount of difference between actual revenue and pro forma revenue					$ 9,300,000
Orion Acquisition [Member]
Amount of difference between actual revenue and pro forma revenue					$ 19,100,000
Asset Purchase Agreement [Member]
Purchase price amount	$ 1,600,000	$ 12,600,000
Acquisition-related costs	$ 125,000	$ 245,000
Period over which goodwill is deductible for income tax purposes		15 years
Weighted-average amortization period of acquired intangible assets	4 years	7 years

Acquisitions - Schedule of Asse

Acquisitions - Schedule of Assets Acquired and Liabilities Assumed (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Goodwill	$ 12,633,696	$ 12,593,795
2019 Acquisition [Member]
Customer relationships	856,000
Accounts receivable	547,377
Contract asset	139,169
Operating lease right-of-use assets	1,224,480
Property and equipment	91,277
Goodwill	39,901
Operating lease liabilities	(1,224,480)
Accrued expenses	(73,724)
Business combination, net	1,600,000
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

Acquisitions - Schedule of Busi

Acquisitions - Schedule of Business Acquisition, Pro Forma Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Business Combinations [Abstract]
Total revenue	$ 16,851	$ 19,807	$ 50,748	$ 62,416
Net loss	(84)	(4,008)	(2,752)	(9,961)
Net loss attributable to common shareholders	$ (1,686)	$ (5,064)	$ (7,334)	$ (13,041)
Net loss per common share	$ (0.14)	$ (0.43)	$ (0.61)	$ (1.12)

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets-Net (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Goodwill	$ 12,633,696		$ 12,633,696		$ 12,593,795
Amortization expenses	577,000	$ 633,000	$ 1,700,000	$ 1,500,000
Weighted-average amortization period			7 years
Practice Management Segment and Healthcare IT Segment [Member]
Goodwill	$ 90,000		$ 90,000

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets-Net - Schedule of Intangible Assets and Goodwill (Details) - USD ($)	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Beginning gross balance	$ 12,593,795	$ 12,263,943
Acquisitions	39,901	329,852
Ending gross balance	$ 12,633,696	$ 12,593,795

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	$ 26,686,529	$ 25,454,736
Less: Accumulated amortization	20,521,256	18,820,733
Intangible assets - net	6,165,273	6,634,003
Contracts and Relationships Acquired [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	23,597,300	22,741,300
Non-Compete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	1,236,377	1,236,377
Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets, gross	$ 1,852,852	$ 1,477,059

Goodwill and Intangible Asset_6

Goodwill and Intangible Assets-Net - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
2019 (three months)	$ 387,892
2020	1,380,325
2021	1,235,554
2022	872,973
2023	338,529
Thereafter	1,950,000
Total	$ 6,165,273	$ 6,634,003

Net Loss Per Common Share (Deta

Net Loss Per Common Share (Details Narrative)	9 Months Ended
	Sep. 30, 2019shares
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 ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Earnings Per Share [Abstract]
Net loss attributable to common shareholders	$ (1,740,377)	$ (2,888,667)	$ (5,786,446)	$ (4,642,400)
Weighted-average common shares used to compute basic and diluted loss per share	12,146,110	11,770,178	12,038,819	11,684,659
Net loss attributable to common shareholders per share - Basic and Diluted	$ (0.14)	$ (0.25)	$ (0.48)	$ (0.40)

Debt (Details Narrative)

Debt (Details Narrative) - USD ($)	1 Months Ended	9 Months Ended
	Oct. 31, 2017	Sep. 30, 2019	Sep. 30, 2018
Vehicle Financing Notes [Member]
Vehicle financing in United stated and Pakistan		three to six years terms
Insurance Financing [Member]
Debt instrument interest rate		4.52%
SVB Credit Facility [Member]
Secured revolving line of credit percentage	200.00%
Initial borrowing limited from SVB Bank			$ 5,000,000
Revision of borrowing limit from SVB Bank			$ 10,000,000
Unused portion of credit line fee percentage, description	There is also a fee of one-half of 1% annually for the unused portion of the credit line.
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%

Leases (Details Narrative)

Leases (Details Narrative)	3 Months Ended	9 Months Ended
	Sep. 30, 2018USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2018USD ($)Integer
Lease term, description		Leases with a term of less than 12 months are not recorded in the condensed consolidated balance sheet.
Lease impairment	$ 87,000
Restructuring charges	49,000
Operating lease term		6 years
Number of operating lease commitment | Integer			1
Operating lease commitment, amount		$ 1,200,000
Operating lease rent expense	$ 591,000		$ 1,000,000
Minimum [Member]
Operating lease term		1 year
Maximum [Member]
Operating lease term		4 years

Leases - Schedule of Lease Expe

Leases - Schedule of Lease Expense (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2019
Leases [Abstract]
Operating lease cost	$ 572,516	$ 1,677,137
Short-term lease cost	51,353	189,329
Variable lease cost	6,873	25,906
Total- net lease cost	$ 630,742	$ 1,892,372

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Leases [Abstract]
Operating lease ROU assets, net	$ 4,261,709
Current operating lease liabilities	1,962,064
Non-current operating lease liabilities	2,501,112
Total operating lease liabilities	4,463,176
ROU assets, gross	5,760,741
Asset lease expense	(1,440,066)
Foreign exchange loss	(58,966)
ROU assets, net	$ 4,261,709
Weighted average remaining lease term (in years): Operating leases	2 years 6 months 18 days
Weighted average discount rate: Operating leases	7.06%

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Cash Flow and Other Information Related to Leases (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2019
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases	$ 611,249	$ 1,736,133
ROU assets obtained in exchange for lease liabilities: Operating leases, net of restructuring, impairment and terminations	$ (119,052)	$ 1,514,989

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Lease Liabilities (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Leases [Abstract]
2019 (three months)	$ 642,614
2020	2,050,239
2021	1,407,800
2022	572,984
2023	153,330
2024	4,226
Total lease payments	4,831,193
Less: imputed interest	(368,017)
Total lease obligations	4,463,176
Less: current obligations	(1,962,064)
Long-term lease obligations	$ 2,501,112

Leases - Schedule of Future Min

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

Commitments and Contingencies (

Commitments and Contingencies (Details Narrative)	May 30, 2018USD ($)
Commitments and Contingencies Disclosure [Abstract]
Compensatory damages description	RPRWC seeks compensatory damages of $6.6 million, plus costs, for MPMA's alleged breach of the billing services agreement.
Compensatory damages	$ 6,600,000

Related Parties (Details Narrat

Related Parties (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Net revenue	$ 16,851,328	$ 17,044,526	$ 48,681,038	$ 34,034,788
Upgradation lease facilities	630,742		1,892,372
Operating lease right-of-use assets	4,261,709		4,261,709
Current operating lease liability	1,962,064		1,962,064
Non-current operating lease liabilities	2,501,112		2,501,112
Related Party Leases [Member]
Operating lease right-of-use assets	505,000		505,000
Current operating lease liability	281,000		281,000
Non-current operating lease liabilities	230,000		$ 230,000
Nonexclusive Aircraft Dry Lease Agreement [Member]
Original lease expired			Mar. 31, 2019
Nonexclusive Aircraft Dry Lease Agreement [Member] | Kashmir Air, Inc [Member]
Operating leases, rent expense	32,000	32,000	$ 86,000	96,000
Accrued liability to related party	1,000		1,000		11,000
Physician [Member]
Net revenue	5,000	6,000	14,000	15,000
Receivable balance due from customer	2,000		2,000		1,600
Executive Chairman [Member]
Operating leases, rent expense	47,000	$ 46,000	144,000	$ 141,000
Upgradation lease facilities	37,000
Estimated upgradation lease facilities	21,000
Security deposit and prepaid rent	$ 13,000		$ 13,000		$ 25,000

Revenue (Details Narrative)

Revenue (Details Narrative) - USD ($)	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Contract asset	$ 2,696,193	$ 2,500,000	$ 2,608,631
Capitalized amortization period to estimated client life	3 years
Deferred commissions	$ 44,000	$ 108,000
Revenue Cycle Management and Orion Acquisition [Member]
Remaining performance obligations	2,000,000
Orion Acquisition [Member]
Contract asset represents revenue earned, not paid from group purchasing services	$ 700,000

Revenue - Schedule of Disaggreg

Revenue - Schedule of Disaggregation of Revenue (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Total	$ 16,851,328	$ 17,044,526	$ 48,681,038	$ 34,034,788
Healthcare IT [Member]
Total	12,938,042	13,730,105	38,518,361	30,720,367
Healthcare IT [Member] | Revenue Cycle Management Services [Member]
Total	10,808,438	11,695,675	32,798,563	26,954,715
Healthcare IT [Member] | Professional Services [Member]
Total	376,189	532,763	1,094,960	717,031
Healthcare IT [Member] | Ancillary Services [Member]
Total	873,841	530,285	2,303,118	1,092,376
Healthcare IT [Member] | Group Purchasing Services [Member]
Total	295,850	477,168	700,963	477,168
Healthcare IT [Member] | Printing and Mailing Services [Member]
Total	436,735	335,999	1,186,834	985,522
Healthcare IT [Member] | Clearinghouse and EDI Services [Member]
Total	146,989	158,214	433,923	493,554
Practice Management [Member]
Total	3,913,286	3,314,421	10,162,677	3,314,421
Practice Management [Member] | Practice Management Services [Member]
Total	$ 3,913,286	$ 3,314,422	$ 10,162,677	$ 3,314,422

Revenue - Schedule of Accounts

Revenue - Schedule of Accounts Receivable, Contract Asset and Deferred Revenue (Details) - USD ($)	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Beginning balance	$ 26,073,673
Ending balance	26,064,584
Deferred Revenue (Current) [Member]
Beginning balance	25,355	$ 62,104
ETM acquisition
Orion acquisition
Increase (decrease), net	(8,916)	(31,890)
Ending balance	16,439	30,214
Deferred Revenue (Long Term) [Member]
Beginning balance	18,949	28,615
ETM acquisition
Orion acquisition
Increase (decrease), net	(2,641)	(8,983)
Ending balance	16,308	19,632
Accounts Receivable, Net [Member]
Beginning balance	7,331,474	3,879,463
ETM acquisition
Orion acquisition		5,727,618
Increase (decrease), net	568,604	(1,163,224)
Ending balance	7,900,078	8,443,857
Contract Asset [Member]
Beginning balance	2,608,631	1,342,692
ETM acquisition	139,169
Orion acquisition		673,317
Increase (decrease), net	(51,607)	464,470
Ending balance	$ 2,696,193	$ 2,480,479

Stock-Based Compensation (Detai

Stock-Based Compensation (Details Narrative) - USD ($)	1 Months Ended		3 Months Ended	9 Months Ended
	Jun. 30, 2018	Apr. 30, 2017	Sep. 30, 2019	Sep. 30, 2019	Dec. 31, 2018	Apr. 30, 2014
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Liability for cash settled amount			$ 550,000	$ 550,000	$ 118,000
Restricted Shares [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Amount recorded for bonus			$ 301,000	$ 904,000
Unvested stock option award, equity			464,335	464,335
Restricted stock award classified as liability			33,333	33,333
2014 Equity Incentive Plan [Member] | Employees, Officers. Directors and Consultants [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [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] | Series A Preferred Stock [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Number of shares added to amended and restated equity incentive plan		100,000
Number of shares available for grant			138,400	138,400
Amended and Restated Equity Incentive Plan [Member] | Common Stock [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Number of shares added to amended and restated equity incentive plan		1,500,000
Number of shares available for grant			398,404	398,404
Amended and Restated Equity Incentive Plan [Member] | Preferred Stock [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Number of shares added to amended and restated equity incentive plan	200,000

Stock-Based Compensation - Disc

Stock-Based Compensation - Disclosure of Share-based Compensation Arrangements by Share-based Payment Award (Details) - Restricted Shares [Member]	9 Months Ended
	Sep. 30, 2019shares
Common Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	929,347
Granted	176,000
Vested	(581,065)
Forfeited	(26,614)
Outstanding and unvested at ending	497,668
Preferred Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding and unvested at beginning	44,800
Granted	44,000
Vested	(44,800)
Forfeited
Outstanding and unvested at ending	44,000

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation expense	$ 774,611	$ 986,279	$ 2,324,799	$ 1,523,682
Direct Operating Costs [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation expense	49,590	39,703	146,448	49,562
General and Administrative [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation expense	693,138	935,159	2,100,609	1,457,759
Research and Development [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation expense	9,044	8,208	18,878	13,152
Selling and Marketing [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation expense	$ 22,839	$ 3,209	$ 58,864	$ 3,209

Income Taxes (Details Narrative

Income Taxes (Details Narrative) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income tax provision	$ 86,970	$ (250,072)	$ 101,790	$ (151,872)
Current income tax provision	37,000		67,000
Deferred income tax provision	$ 50,000		$ 34,585	$ (187,072)

Fair Value of Financial Instr_3

Fair Value of Financial Instruments (Details Narrative)	Dec. 31, 2018USD ($)
Fair Value, Input, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	$ 526,000

Fair Value of Financial Instr_4

Fair Value of Financial Instruments - Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - Fair Value, Input, Level 3 [Member] - USD ($)	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance, beginning	$ 526,432	$ 603,411
Change in fair value	(343,768)	68,253
Payments	(182,664)	(111,495)
Balance, ending		$ 560,169

Segment Reporting (Details Narr

Segment Reporting (Details Narrative)	9 Months Ended
	Sep. 30, 2019Segment
Segment Reporting [Abstract]
Number of operating segment	2

Segment Reporting - Schedule of

Segment Reporting - Schedule of Revenues, Operating Expenses and Operating Income (Loss) by Reportable Segment (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Net revenue	$ 16,851,328	$ 17,044,526	$ 48,681,038	$ 34,034,788
Direct operating costs	10,535,629	12,123,907	31,779,564	20,941,535
Selling and marketing	347,568	461,512	1,091,524	1,169,583
General and administrative	4,451,975	5,131,295	13,757,805	10,786,234
Research and development	175,758	263,717	648,822	768,517
Change in contingent consideration	(279,565)	25,473	(343,768)	68,253
Depreciation and amortization	814,210	822,098	2,407,111	1,972,565
Restructuring and impairment charges	136,332		136,332
Total operating expenses	16,181,907	18,828,002	49,477,390	35,706,687
Operating income (loss)	669,421	(1,783,476)	(796,352)	(1,671,899)
Healthcare IT [Member]
Net revenue	12,938,042	13,730,105	38,518,361	30,720,367
Direct operating costs	7,508,208	9,485,642	23,912,120	18,303,270
Selling and marketing	339,603	451,872	1,065,750	1,159,943
General and administrative	2,791,573	2,730,595	8,549,122	6,591,165
Research and development	175,758	263,717	648,822	768,517
Change in contingent consideration	(279,565)	25,473	(343,768)	68,253
Depreciation and amortization	735,133	740,342	2,170,204	1,890,809
Restructuring and impairment charges	136,332		136,332
Total operating expenses	11,407,042	13,697,641	36,138,582	28,781,957
Operating income (loss)	1,531,000	32,464	2,379,779	1,938,410
Practice Management [Member]
Net revenue	3,913,286	3,314,421	10,162,677	3,314,421
Direct operating costs	3,027,421	2,638,265	7,867,444	2,638,265
Selling and marketing	7,965	9,640	25,774	9,640
General and administrative	548,746	552,514	1,504,506	552,514
Research and development
Change in contingent consideration
Depreciation and amortization	79,077	81,756	236,907	81,756
Restructuring and impairment charges
Total operating expenses	3,663,209	3,282,175	9,634,631	3,282,175
Operating income (loss)	250,077	32,246	528,046	32,246
Unallocated Corporate Expenses [Member]
Net revenue
Direct operating costs
Selling and marketing
General and administrative	1,111,656	1,848,186	3,704,177	3,642,555
Research and development
Change in contingent consideration
Depreciation and amortization
Restructuring and impairment charges
Total operating expenses	1,111,656	1,848,186	3,704,177	3,642,555
Operating income (loss)	$ (1,111,656)	$ (1,848,186)	$ (3,704,177)	$ (3,642,555)