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Healthcare Practices: Managed Payroll for Mid-Size Businesses (25-100 Employees) (2026)
Managed payroll for a mid-size healthcare practice, 50 to 100 employees, is where FMLA and the ACA employer mandate have attached and the question becomes whether to hire the payroll clerk BLS prices at $58,260 or pay $3,375 a month at 75 employees. BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
What attached at 50 for a healthcare practice
An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024.
FMLA covers a healthcare practice with 50 or more employees in 20 or more workweeks, with job-protected unpaid leave and benefits continued, so leave balances, intermittent hours and benefit deductions during leave all live in payroll. The ACA applicable large employer test counts full-time equivalents from payroll hours, and once it applies the 1094-C and 1095-C filings are built from the same data every year. For healthcare practices with part-time physicians the FTE count is the number to watch, not the headcount.
Hire or outsource at 75 employees
BLS OEWS May 2025 puts the national median for payroll and timekeeping clerks at $58,260, roughly $75,738 loaded, for one person who also has to know shift differentials, on-call pay and credentialing-based pay tiers and who is a single point of failure on every pay date. Managed payroll at 75 employees is $3,375 a month, $40,500 a year, with the ACA and FMLA mechanics inside the price. The next federal lines, WARN notice and the EEO-1 report, wait at 100.
HIPAA covered entities must train every workforce member on their privacy policies, train each new hire within a reasonable period after joining, document that the training was provided, and retain that documentation for 6 years from creation or the date it was last in effect.
The rules behind this page, with sources
General information, not legal advice. Every rule below was read on the agency page linked next to it.
- An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024. [IRS Employer Shared Responsibility Provisions]
- HIPAA covered entities must train every workforce member on their privacy policies, train each new hire within a reasonable period after joining, document that the training was provided, and retain that documentation for 6 years from creation or the date it was last in effect. [45 CFR 164.530(b) and (j)]
Read the full guide to managed payroll by company size, and the rest of the healthcare practice payroll library.
Managed Payroll, Handled.
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Frequently Asked Questions
What does managed payroll cost a healthcare practice with 75 employees?
$3,375 a month at $45 per employee, all-inclusive, including the 1094-C and 1095-C build.
Is a mid-size healthcare practice an applicable large employer?
An employer that averaged at least 50 full-time employees, counting full-time equivalents, in the prior calendar year is an applicable large employer and must offer affordable minimum essential coverage to full-time employees and their dependents or face an employer shared responsibility payment. A full-time employee is one with at least 30 hours of service a week or 130 hours a month; the base payments are $2,000 and $3,000 per employee per year, indexed, and were $2,970 and $4,460 for 2024.
What does the in-house alternative cost at this size?
$58,260 a year at the BLS OEWS May 2025 national median for a payroll and timekeeping clerk, before benefits, employer taxes and software.
What does managed payroll cost for a healthcare practice?
$45 per employee per month, all-inclusive, inside the payroll software you already use, with no monthly minimum. Shift differentials, on-call pay and credentialing-based pay tiers are configured at setup, not billed as add-ons.
Related Resources
Anthony leads payroll solutions at Business Executive Group, a national managed payroll firm serving businesses across industries including Healthcare Practices. BEG manages payroll at $45 PEPM, all-inclusive, with deep expertise in compliance, multi-state filing, and industry-specific payroll requirements. Get instant pricing at beghr.com.
Authoritative source: U.S. Department of Labor: Wage and Hour Division
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