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Healthcare Practices: Payroll Outsourcing Cost vs. In-House Hire (2026)
Payroll outsourcing for a healthcare practice costs $45 per employee per month, all-inclusive, against an in-house payroll clerk at the $58,260 BLS national median before benefits and taxes. Live in 3 to 5 business days, with shift differentials and on-call pay configured at setup.
What the outsourced price includes for a healthcare practice
Processing on your schedule, federal and state deposits and filings in every state with an employee, new hire reporting, direct deposit, garnishment processing, W-2s and 1099s, year-end close, and the healthcare practice configuration for shift differentials, on-call pay, credentialing-based pay tiers and multi-location clinic payroll. Corrections caused by the provider are the provider's cost, including amended returns. There is no per-run fee, no per-state fee and no year-end fee.
What the in-house price includes, honestly
A payroll and timekeeping clerk at the BLS OEWS May 2025 national median of $58,260, about $75,738 loaded, plus software, plus the cost of the errors one person makes alone. Shift differentials and non-discretionary bonuses such as attendance, retention and supplementary shift bonuses must be added into the regular rate before the overtime premium is computed. Paying time and one half of the base hourly rate alone is a violation when differentials are paid.
Break-even for healthcare practices
At 50 employees outsourcing is $27,000 a year; at 100 it is $54,000. Both sit under the loaded clerk at about $75,738. Below about 20 employees the realistic comparison is with software rather than a hire, where the case rests on shift differentials rather than price.
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.
- Shift differentials and non-discretionary bonuses such as attendance, retention and supplementary shift bonuses must be added into the regular rate before the overtime premium is computed. Paying time and one half of the base hourly rate alone is a violation when differentials are paid. [DOL Fact Sheet #54]
Read the full guide to how much payroll outsourcing costs, and the rest of the healthcare practice payroll library.
Managed Payroll, Handled.
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Frequently Asked Questions
What is included in the outsourced payroll price for a healthcare practice?
Processing, all federal and state filings, new hire reporting, direct deposit, garnishments, W-2s and 1099s, year-end close and the healthcare practice pay code setup. No per-run, per-state or year-end fees.
What does a payroll clerk cost a healthcare practice in-house?
$58,260 a year at the BLS OEWS May 2025 national median, about $75,738 with benefits and employer taxes, before software.
What does a payroll error cost a healthcare practice?
Shift differentials and non-discretionary bonuses such as attendance, retention and supplementary shift bonuses must be added into the regular rate before the overtime premium is computed. Paying time and one half of the base hourly rate alone is a violation when differentials are paid.
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. Bureau of Labor Statistics: Occupational Employment and Wage Statistics
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