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Run the Payroll Fee Auditor →Blog · Payroll Management · Healthcare
Healthcare Practices: Payroll Software vs. Managed Payroll Service (2026)
Payroll software gives a healthcare practice the fields; managed payroll gives it someone accountable for filling them correctly, which for healthcare practices means shift differentials, on-call pay and credentialing-based pay tiers configured against the rules cited here rather than left at defaults. BEG: $45 per employee per month inside the payroll software you already use, live in 3 to 5 days.
What software leaves to a healthcare practice to get right
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.
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.
The honest comparison
Software at roughly $40 to $150 a month plus $5 to $12 per employee handles a single-state, all-W-2, hourly-and-salary payroll well, and the customer owns every configuration decision, every deposit and every notice. Managed payroll at $45 per employee per month, with no monthly minimum, owns the configuration, the deposits, the filings and the corrections. For healthcare practices the deciding question is who documents the exemption status of physicians and nurses and who rebuilds the pay codes when the rule changes.
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]
- 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 fully managed versus self-service payroll, 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
What does payroll software get wrong for healthcare practices?
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.
When is software the right answer for a healthcare practice?
A single state, all W-2, hourly and salary pay, no shift differentials, and under about 20 employees, where software's lower per-employee cost outweighs what a managed service adds.
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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