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Run the Payroll Fee Auditor →Blog · Payroll Management · Healthcare
Healthcare Practices: Managed Payroll for Small Businesses (Under 25 Employees) (2026)
Managed payroll for a small healthcare practice is a complexity decision, not a headcount one: at $45 per employee with no monthly minimum a 10-person healthcare practice pays $450 a month, and the case for it is strongest once shift differentials or a second state is in the picture. BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
What managed payroll costs a small healthcare practice
At $45 per employee per month with no monthly minimum and no setup fee, a 5-person healthcare practice pays $225 a month, a 10-person one $450 and a 20-person one $900, all-inclusive. The cost grows one employee at a time, so there is no headcount to wait for. Payroll software at roughly $40 to $150 a month plus $5 to $12 per employee is cheaper in raw dollars for a single-state, all-W-2, hourly-and-salary payroll. The question is whether this healthcare practice is that payroll.
The complications that decide it for healthcare practices
Hospitals and residential care establishments may compute overtime over a fixed 14 consecutive day work period instead of the 40 hour workweek, paying time and one half for hours over 8 in a day and over 80 in the period. The employer must have a prior agreement or understanding with the affected employees before the work is performed, and cannot use both systems for the same employee.
Shift differentials, on-call pay, credentialing-based pay tiers and multi-location clinic payroll: each is a pay code that self-service software ships blank, and each is a place a small healthcare practice with no payroll specialist gets it wrong for years before an audit or a wage claim finds it. One of these, or an employee in a second state, or a first garnishment order, is the point where the managed price stops being a premium.
What a small healthcare practice is already subject to
Below 50 employees the federal lines already crossed are e-filing at 10 information returns, OSHA logs at 11 unless the industry is on the exempt list, Title VII and the ADA at 15, and the ADEA and COBRA at 20. None of them wait for a payroll department to exist.
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.
- Hospitals and residential care establishments may compute overtime over a fixed 14 consecutive day work period instead of the 40 hour workweek, paying time and one half for hours over 8 in a day and over 80 in the period. The employer must have a prior agreement or understanding with the affected employees before the work is performed, and cannot use both systems for the same employee. [DOL Fact Sheet #54]
Read the full guide to managed payroll by company size, and the rest of the healthcare practice payroll library.
Managed Payroll, Handled.
BEG manages payroll at $45 per employee per month, all-inclusive. Get an instant cost comparison for your business.
Frequently Asked Questions
Is managed payroll worth it for a healthcare practice under 20 employees?
When there is a complication: shift differentials, a second state, a garnishment, or a classification question about physicians and nurses. Without one, software is the cheaper price for a simple payroll and this page says so.
What does a 10-person healthcare practice pay?
$450 a month: 10 employees at $45 per employee, all-inclusive, with no monthly minimum and no setup fee.
Which healthcare practice rule most often breaks a self-service setup?
Hospitals and residential care establishments may compute overtime over a fixed 14 consecutive day work period instead of the 40 hour workweek, paying time and one half for hours over 8 in a day and over 80 in the period. The employer must have a prior agreement or understanding with the affected employees before the work is performed, and cannot use both systems for the same employee.
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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