What changed in this filing

/stocks — the workspaceLOADING

Item 1. Business

2023-03-02 compared with 2022-03-14 · 176 added, 172 removed, 192 unchanged (64% of the section changed)

Inc., formerly MTBC, Inc.

(“CareCloud,” and together with its consolidated subsidiaries, the “Company,” “we,”

“us” and/or “our”) is a leading healthcare information technology company that provides a full suite of proprietary

cloud-based solutions and related business services, to healthcare providers, from small practices to enterprise medical groups, hospitals,

and health systems throughout the United States.

Healthcare organizations today operate in highly complex and regulated environments,

and our suite of technology-enabled solutions helps our clients increase financial and operational performance, streamline clinical workflows,

and improve the patient experience.

Our Software-as-a-Service (“SaaS”) platforms include practice management (“PM”),

electronic health record (“EHR”), business intelligence, telehealth, patient experience management (“PXM”) solutions,

and robotic processing automation (“RPA”) bots, along with complementary software tools and business services such as revenue

cycle management (“RCM”), premiere healthcare consulting and implementation services, and on-demand workforce staffing capabilities

for high-performance medical groups and health systems nationwide.

a high level, these solutions can be categorized as follows:

Inc., (together with its consolidated subsidiaries, “CareCloud”, the “Company,” “we,” “us”

and/or “our”) is a leading provider of technology-enabled services and solutions that redefine the healthcare revenue cycle.

We provide technology-enabled revenue cycle management and a full suite of proprietary cloud-based solutions to healthcare providers,

from small practices to enterprise medical groups, hospitals, and health systems throughout the United States.

Healthcare organizations

today operate in highly complex and regulated environments.

Our suite of technology-enabled solutions helps our clients increase financial

and operational performance, streamline clinical workflows, and improve the patient experience.

portfolio of proprietary software and business services includes:

technology-enabled business solutions that maximize revenue cycle management

and create efficiencies through platform agnostic AI-driven applications;

cloud-based software that helps providers manage their practice

and patient engagement while leveraging analytics to improve provider performance;

digital health services to address value-based care

and enable the delivery of remote patient care;

healthcare IT professional services & staffing to address physician burnout, staffing

shortages and leverage consulting expertise to transition into the next generation of healthcare;

and, medical practice management services

to assist medical providers with operating models and the tools needed to run their practice.

high-value business services, such as revenue cycle management, are often paired with our cloud-based software, premiere healthcare consulting

and implementation services, and on-demand workforce staffing capabilities for high-performance medical groups and health systems nationwide.

technology-enabled business solutions can be categorized as follows:

● Technology-enabled

business solutions, which are sometimes provided as individual SaaS offerings and often provided

in combination with each other, including:

which are easy to use and sometimes integrated with our business services, and enable our

healthcare provider clients to deliver better patient care, streamline their clinical workflows,

decrease documentation errors and potentially qualify for government incentives;

software and related capabilities, which support our clients’ day-to-day business operations

and financial workflows, including automated insurance eligibility software, a robust billing

and claims rules engine and other automated tools designed to maximize reimbursement;

solutions designed to transform interactions between patients and their clinicians, including

smartphone applications that assist patients and healthcare providers in the provision of

healthcare services, including contactless digital check-in solutions, messaging and online

appointment scheduling tools;

RPA solution that leverages the power of our own proprietary healthcare-specific microbots,

designed to automate routine financial and clinical workflows across the healthcare industry.

Our solution allows clients to automate costly, labor-intensive tasks, alleviate the surge

in demand for additional labor while driving efficiencies across a large array of healthcare

settings nationwide;

solutions which allow healthcare providers to conduct remote patient visits;

revenue cycle management:

Cycle Management (“RCM”) services including end-to-end medical billing, eligibility,

analytics, and related services, all of which can be provided utilizing our technology platform

and robotic process automation tools or leveraging a third-party system;

coding and credentialing services to improve provider collections, back-end cost containment,

and drive total revenue realization for our healthcare clients;

claims clearinghouse which enables our clients to electronically scrub and submit claims

and process payments from insurance companies.

intelligence and healthcare analytics platforms that allow our clients to derive actionable

insights from their vast amount of data;

○ Interoperability

and data transformation software to support the complex realities of data exchange with healthcare

trading partners, including labs, insurance companies, and other healthcare IT vendors;

services including end-to-end medical billing, eligibility, analytics, and related services,

all of which can be provided utilizing our technology platform or through a third-party system;

● Cloud-based

Health Records (“EHR”), which are easy to use and sometimes integrated with our

business services, and enable our healthcare provider clients to deliver better patient care,

streamline their clinical workflows, decrease documentation errors, and potentially qualify

for government incentives;

Management (“PM”) software and related capabilities, which support our clients’

day-to-day business operations and financial workflows, including automated insurance eligibility

software, a robust billing and claims rules engine, and other automated tools designed to

maximize reimbursement;

Experience Management (“PXM”) solutions designed to transform interactions between

patients and their clinicians, including smartphone applications that assist patients and

healthcare providers in the provision of healthcare services, contactless digital check-in

solutions, messaging, and online appointment scheduling tools;

Intelligence (“BI”) and healthcare analytics platforms that allow our clients

to derive actionable insights from their vast amount of data;

applications, interfaces, and a variety of other technology solutions that support our healthcare

care management is a program that supports care for patients with chronic conditions by certified

care managers that operate under the supervision of the patient’s regular physician;

patient monitoring enables patient data collected outside the clinical setting through remote

devices to be fed into their provider’s EHR to enable proactive patient care;

○ Telemedicine

solutions which allow healthcare providers to conduct remote patient visits and extend the

timely delivery of care to patients unable to travel to a provider’s office.

IT professional services & staffing:

○ Professional

services consisting of application and advisory services, revenue cycle services, data analytic

services and educational training services;

augmentation and on-demand staffing to support our clients as they expand their businesses,

seek highly trained personnel, or struggle with staffing shortages.

practice management services are provided to medical practices.

In this service model, we

provide the medical practice with appropriate facilities, equipment, supplies, support services,

nurses, and administrative support staff.

We also provide management, bill-paying and financial

advisory services.

services consisting of a broad range of consulting services including full software implementations

and activation, revenue cycle optimization, data analytic services, and educational training

○ Strategic advisory services to manage system evaluations and selection, provide interim management, and operational assessments;

○ Workforce augmentation and on-demand staffing to support our clients as they expand their businesses, seek highly trained personnel, or

struggle to address staffing shortages.

medical practice management solutions include:

practice management:

practice management services for medical providers, including facilities, equipment, supplies,

support services, nurses, and administrative support staff.

modernization of the healthcare industry, along with the increased adoption of value-based care models, is transforming nearly every

aspect of a healthcare organization from policy to providers;

clinical care to member services, devices to data, and ultimately the quality

of the patient’s experience as a healthcare consumer.

solutions enable clients to increase financial and operational performance, streamline clinical workflows, get better insight through

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burdens and operating costs.

modernization of the healthcare industry is transforming nearly every aspect of a healthcare organization from policy to providers;

care to member services, devices to data, and ultimately the quality of the patient’s experience as a healthcare consumer.

create elegant, user-friendly applications that solve many of the challenges facing healthcare organizations.

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organizational requirements and market demands.

December 2020, Centers for Medicare & Medicaid Services (“CMS”) reported that national healthcare expenditure in the

grew 9.7% to $4.1 trillion in 2020.

U.S healthcare spending will grow 5.4% annually on average during the years 2021 through 2028,

reaching $6.2 trillion by 2028.

CMS also projected that health spending will grow 1.1% faster than gross domestic product (“GDP”)

annually during the years 2021 through 2028;

and as a result, the healthcare share of GDP is expected to rise from 17.7% in 2018 to 19.7%

March 2022, Centers for Medicare & Medicaid Services (“CMS”) 1 reported that national healthcare expenditure

grew by 4.2% in 2021.

healthcare spending will grow 5.1% annually on average during the years 2021 through 2030, reaching

$6.8 trillion by 2030.

CMS also projected that the health share of GDP is expected to be 19.6% in 2030, nearly the same as the 2020 share

Additionally,

analysts from Markets & Markets have estimated the US Healthcare IT industry market to be approximately $177 billion with its largest

sub-segment RCM at approximately $87 billion in 2019, growing at a 12% compound annual growth rate (“CAGR”).

The North American

EHR market has been estimated to be approximately $40 billion, growing at a CAGR of 6% per year.

The Analytics and AI sub-segment was

estimated to be approximately $30 billion, growing at a 27% CAGR and the Telehealth market is estimated to be approximately $20 billion

with a CAGR of 17%.

Standalone billing and practice management solutions are reported to be declining in the market today as medical

practices move towards integrated, end-to-end systems that incorporate front and back-office data flows, provide seamless access to clinical

data from EHRs, and streamline the entire revenue cycle management process.

analysts from Allied Market Research have estimated the U.S.

Healthcare IT industry market to be approximately $97 billion in 2020 and

is projected to reach $344 billion by 2030, growing at a 13% compound annual growth rate (“CAGR”).

2 Its largest

sub-segment, RCM, is reported to be nearly $140 billion in 2022 and is estimated to grow at a 10% CAGR through 2030 according to Grand

View Research.

3 The North American EHR market is expected to be valued at more than $50 billion by 2028.

The Telehealth market

is estimated to be approximately $23 billion with a CAGR of 23%.

CMS Office of the Actuary Releases 2021-2030 Projections of National Health Expenditures | CMS

Healthcare IT Market in US Size, Share, Trends | Report 2030 (alliedmarketresearch.com)

Revenue Cycle Management Market Size, Share, Trends | Report 2023-2030 (Grand View Research)

Market Opportunity

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to help meet their needs.

clients also have to factor in the rising cost of health insurance, changes in health benefit plan design, and the impact that these

clients also have to account for the rising cost of health insurance, changes in health benefit plan design, and the impact that these

factors have had on the increase in patient consumerism.

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care delivery settings.

Much of this change is driving executives and leaders to assess their IT and data strategy and reevaluate what

it means for the future of their organizations.

healthcare industry has seen tremendous change over the past decade.

Our study of the evolving needs of our clients leads us to believe

that there will be a continuing need for our services and products and emerging needs for the products and services that we are already

Much of this change is driving executives and leaders to assess their IT and data strategy and reevaluate their

adoption of next generation healthcare solutions.

healthcare industry has seen tremendous change over the last three years, with COVID-19 ushering in a new era of digital health.

study of the evolving needs of our clients leads us to believe that there will be an increasing need for our services and products and

emerging needs for the products and services that we are already developing.

These trends will fuel growth over the next several years.

In order for healthcare organizations to continue to succeed,

these new realities require robust solutions and careful execution.

Legacy tools that once powered these healthcare organizations are

insufficient to support their growth and long-term strategies.

Our solutions facilitate the transition needed by these organizations

to drive their future growth.

Our expansive product and services portfolio enables us to displace competitors and gain market share across

a vast array of specialties, care settings and customer segments across the country.

In order for healthcare organizations to continue to succeed, these new realities require robust solutions and careful execution.

tools that once powered these healthcare organizations are insufficient to support their growth and long-term strategies.

Our solutions

facilitate the transition needed by these organizations to adopt the next generation of healthcare solutions to drive their future growth.

Our expansive product and services portfolio enables us to displace competitors and gain market share across a vast array of specialties,

care settings and customer segments across the country.

Business Strategy

objective is to be a market leading provider of integrated, end-to-end SaaS and business services solutions to healthcare organizations.

Our mission is to create flexible and comprehensive products and services to help our clients with the business of medicine.

end, we invest significant resources toward improving our current offerings and building new solutions that help transform our clients’

organizations.

We expect to have increased software capabilities and offer additional complementary business services that will address

the needs of the ever-changing, dynamic market conditions of the U.S.

is a market leading provider of integrated, end-to-end SaaS and technology-enabled solutions that help our clients with the business

Our mission is to redefine the next generation of technology-enabled revenue cycle solutions.

To that end, we invest significant

resources toward improving our current offerings and building new solutions that help transform our clients’ organizations with

next generation technology.

We expect to have increased software capabilities and offer additional complementary business services that

will address the needs of the ever-changing, dynamic market conditions of the U.S.

healthcare space.

achieve our objective and mission, we employ the following strategies:

comprehensive product and services suite to medical practices and hospitals.

comprehensive next generation RCM solutions to medical practices and hospitals.

We believe that healthcare providers are

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adjacent markets that we may not serve today.

our client base.

We believe the market for our expansive value proposition is underserved, and we will continue to make investments

to capture market share.

We will invest in our sales and marketing activities, partners, and products to expand our client footprint.

driving organic growth to expand our client base.

We believe the market for our expansive value proposition is underserved, and

we will continue to make investments to create awareness of our brand, optimize our sales and implementation lifecycles, and capture

greater market share.

We are investing more in our sales and marketing activities, partners, and products to expand our client footprint.

our relationships with existing clients.

We intend to increase the number of SaaS subscription licenses and services purchased

by our current clients as they use our solutions.

We are also focused on converting SaaS clients into higher revenue per client offerings

such as revenue cycle management and other business services.

This expansion of services typically represents a 3-4x increase in overall

revenue per client.

Strengthening

our client community.

We realize that our success is tied directly to our clients’ success.

Accordingly, a substantial

portion of our highly trained and educated workforce is devoted to client service.

Our CareCloud Wellness offerings have been well-received allowing us to generate additional

recurring revenue from existing clients.

We intend to increase the number of SaaS subscription licenses and services purchased by our

current clients as they use our solutions.

We are also focused on converting SaaS clients into higher revenue per client offerings such

as revenue cycle management and other business services.

This expansion of services typically represents a 3-4x increase in overall revenue

significant cost advantages provided by our technology and global workforce.

Our unique business model includes our web-based

Our unique business model includes our cloud-based

software and a cost-effective offshore workforce located in Pakistan, Azad Jammu and Kashmir, and Sri Lanka (together, the “Offshore

We believe that this operating model provides us with significant cost advantages compared to other revenue cycle management

We believe this operating model provides us with significant cost advantages compared to other revenue cycle management

companies and it allows us to significantly reduce the operational costs of the companies we acquire.

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monetize this data in an identified manner to help improve clinical outcomes and other financial metrics.

solutions are designed to systematically drive clinical quality and patient outcomes, while streamlining staff and provider workflows

and reimbursements and to support different settings of care and healthcare models.

solutions are designed to systematically drive clinical quality and patient outcomes, streamline staff and provider workflows and reimbursements,

as well as support different settings of care and healthcare models.

Our product and service strategy is simple:

products and deliver solutions that meet clients’ needs.

product and services portfolio is organized across six strategic areas:

Software - the core systems that power medical practices across clinical, financial, and patient workflows, including

our PM systems, EHR solutions and our PXM applications or customized purpose-built applications.

Technology-enabled

Services - software-enabled RCM offerings and other business services, such as medical coding, credentialing, authorization

management and the like are geared towards driving patient and insurance collections across the reimbursement life cycle.

Apps and App Ecosystem Partners - additional proprietary software products, including our business intelligence platform,

robotic process automation bots, CareCloud Conductor, our interoperability and data transformation suite, telemedicine applications,

mobile apps and more of those applications that consume our APIs or other interfaces built by the market at large.

Healthcare IT Consulting & Staffing (medSR) - an extensive set of services including EHR vendor-agnostic optimization

and activation, project management, IT transformation consulting, process improvement, training, education, and staffing for large healthcare

organizations including health systems and hospitals.

Workforce (CareCloud Force) - leveraging our unique resources, and in turn selling this capacity at scale directly to

partners and clients at a reduced rate as compared to other competitors in the same space.

These on-demand workforce capabilities include

offshore engineering capacity for development and offshore RCM operations personnel.

Business Services - additional services in support of our wide-ranging client base.

These include medical

practice management services to a select group of medical practices, a group purchasing organization with negotiated discounts with pharmaceutical

manufactures containing more than 4,000 physician and mid-level provider members and other ancillary services.

categorization approach allows us to be both methodical and nimble across the healthcare organizations and market segments we serve while

providing us a framework to create solution sets for the market today and more importantly, for what our clients will need tomorrow.

we build products and

deliver solutions that meet our clients’ needs.

the combination of our strategic acquisition strategy and continued development of next generation solutions, we provide comprehensive

products and services tailored for small medical practices, large physician groups and health systems, as well as industry partners.

We continue to optimize our technology offering by integrating them into our application ecosystem and with other industry solutions.

The interconnectivity of our solutions will continue driving a consolidation of brands within our product architecture, aimed at improving

the awareness and alignment of our products to targeted industry segments.

robust product and service portfolio allows us to be both methodical and nimble across the healthcare organizations and market segments

we serve while providing a framework to create solution sets for the market today and more importantly, for what our clients will need

believe that our fully integrated solutions uniquely address the challenges in the industry.

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approximately 2,600 independent medical practices and hospitals, representing 80 specialties and

subspecialties in 50 states allowing for significantly low revenue concentration risk.

subspecialties in 50 states allowing for low revenue concentration risk.

addition, we served approximately 150 clients that are not medical practices, but are primarily service organizations who serve the healthcare

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Our clients span from the single doctor independent

medical practices to large medical groups, including an enterprise specialty-specific healthcare organization with more

than 2,300 providers located across multiple states.

We also service large major academic medical

institutions, small and large hospitals and health systems with service areas covering millions of patients.

medical practices to large medical groups, including an enterprise specialty-specific healthcare organization with more than 3,000

providers located across multiple states.

We also service large major academic medical institutions, small and large hospitals

and health systems with service areas covering millions of patients.

and Marketing

have developed sales and marketing capabilities aimed at driving growth of our client base, including small medical practices, large

groups, and health systems.

We expect to expand by selling our complete suite of software and services to new clients and up-selling

additional solutions into our existing client base.

We have a direct sales force including team members focused on areas such as

our CareCloud Force and medSR deals.

In addition, our direct sales are augmented through our partner initiatives and

marketing campaigns.

the past several years, organic growth has been a company-wide focus.

We have developed sales and marketing capabilities aimed at driving

growth of our client base, including small medical practices, large groups, and health systems.

We expect to expand by selling our complete

suite of software and services to new clients and up-selling additional solutions into our existing client base.

We have a direct sales

force including team members focused on specific functional or divisional areas, such as CareCloud Force (workforce augmentation) and

medSR (healthcare IT consulting).

In addition, our direct sales are augmented through our partner initiatives and marketing campaigns.

We continue to leverage and optimize various digital channels to present our solutions, identify national events to demonstrate our integrated

capabilities and expand our participation in thought leadership and social communications to connect with the healthcare community.

Growth Levers

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Growth and Direct Sales

have organized our sales force into different segments for sales of all of our products and services in order to best address our clients’

needs and our markets.

With this design, our sales team can address a client’s specific needs, whether a new client is seeking

our products or services for the first time, or a current client is in need of additional solutions.

marketing team operates in support of our salesforce and provides specialized demand generation capabilities for sales efforts

and product marketing for sales efforts.

Our sales approach is consultative in nature for most of our offerings, which generally includes

an analysis based on a prospective client’s needs, crafting service proposals, and negotiating contracts that culminate in the

commencement of services.

sales and marketing team has expanded 11 times since 2019.

The core philosophy behind this expansion is for every team member to perform

at the top of their skills and ability.

We have organized our sales force into different segments to promote the respective products

and services for that segment and best address our clients’ needs and our markets.

With this design, our sales team can address

a client’s specific needs, whether a new client is seeking our products or services for the first time, or a current client is

in need of additional solutions.

marketing team operates in support of our sales force and provides specialized demand generation capabilities for sales efforts, product

marketing to align solutions and segments, customer communication and upselling initiatives, and drives a national tradeshow strategy

to showcase our brand.

Our sales approach is consultative in nature for most of our offerings, which generally includes an analysis based

on a prospective client’s needs, crafting service proposals, and negotiating contracts that culminate in the commencement of services.

go-to-market strategy is designed to meet our customers’ needs.

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that can meet our customers’ unique needs within a specific product category, client segment, or both.

Our latest go-to-market

strategy takes this dynamic into account:

through Partnerships

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We have entered into such engagements

with industry participants, and from which we began to derive revenue starting in mid-2014.

We have developed application interfaces

with numerous EHR systems, together with device and lab integration to support these relationships.

with industry participants, and developed application interfaces with numerous EHR systems, together with device and lab integration

to support these relationships.

through Acquisitions

Healthcare IT service industry is highly fragmented, with many local and regional RCM companies serving small medical practices and hospitals.

Healthcare IT industry is highly fragmented, with many local and regional RCM companies serving small medical practices and hospitals.

We believe that the industry is ripe for consolidation and that we can achieve significant growth through acquisitions.

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this early investment is designed to increase customer satisfaction and retention, while laying the foundation for long-term accretion.

market for practice management, EHR and RCM solutions and related services is highly competitive, and we expect competition to increase

market for RCM, practice management, EHR solutions, and related services is highly competitive, and we expect competition to increase

in the future.

We face competition from other providers of both integrated and stand-alone practice management, EHR and RCM solutions,

including competitors who utilize a web-based platform and providers of locally installed software systems.

We face competition from other providers of both integrated and stand-alone RCM providers, practice management, and EHR

solutions, including competitors who utilize a web-based platform and providers of locally installed software systems.

of our competitors have longer operating histories, greater brand recognition and greater financial marketing.

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more than 400 experienced health industry experts onshore.

These experts are supported by our highly educated and specialized

offshore workforce of approximately 3,400 team members at labor costs that we believe are approximately one-tenth the cost of comparable

These experts are supported by our highly educated and specialized offshore

workforce of approximately 3,600 team members at labor costs that we believe are approximately one-tenth the cost of comparable U.S.

unique business model has allowed us to become a leading consolidator in our industry sector, gaining us a reputation for acquiring and

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the employees of our subsidiaries, as of December 2022, the Company employed approximately 4,150 people worldwide on a full-time basis.

Approximately 72% of our employees are focused on service and client delivery functions, approximately 12% are assigned to research and

development, and approximately 1.4% are engaged in sales and marketing.

The balance of the employees are classified as general and administrative,

which includes support staff to maintain our offshore offices, a function that many businesses in other geographies might choose to outsource.

We also utilize the services of a small number of part-time employees.

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10-K, and you should not consider information on our website to be part of this document.

CareCloud.com, A Unique Healthcare IT Company, CareCloud and other trademarks and service marks of CareCloud appearing in this Annual

Report on Form 10-K are the property of CareCloud.

Trade names, trademarks and service marks of other companies appearing in this Annual

Report on Form 10-K are the property of their respective holders.

CareCloud.com,

CareCloud, MTBC, A Unique Healthcare IT Company, and other trademarks and service marks of CareCloud appearing in this Annual Report

on Form 10-K are the property of CareCloud.

Trade names, trademarks and service marks of other companies appearing in this Annual Report

on Form 10-K are the property of their respective holders.

are a smaller reporting company.

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This year the Company is

required to comply with the auditor attestation requirements of Section 404 of the Sarbanes-Oxley Act of 2002, as amended.

with this Form 10-K, the Company is now an accelerated filer.

not required to comply with the auditor attestation requirements of Section 404 of the Sarbanes-Oxley Act of 2002, as amended.

with this Form 10-K, the Company is now a non-accelerated filer.

You Can Find More Information

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by calling the SEC at 1-800-SEC-0330.

Also, the SEC’s website (www.sec.gov) contains reports, proxy and information

statements, and other information that we file electronically with the SEC.

Also, the SEC’s website (www.sec.gov) contains reports, proxy and information statements,

and other information that we file electronically with the SEC.

Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.

What changed 10-K

Item 1. Business