Free Payroll Tool
See what your payroll provider really charges
Most providers hide per-run and add-on fees. Audit your real cost per employee in about 30 seconds, free.
Run the Payroll Fee Auditor →Blog · Payroll Management · Healthcare
Healthcare Practices: Multi-Location Payroll Guide (2026)
Multi-location payroll for healthcare practices means one payroll with per-location cost centers, a state account wherever a location or a remote employee sits, headcount thresholds counted across the whole company, and the healthcare practice rules cited here applied at every site. BEG: $25 per employee per month in your existing platform or $45 on isolved, live in 3 to 5 days.
Rules that change with a second healthcare practice location
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.
On-call time counts as hours worked only when the employee must remain on or so near the premises that the time cannot be used for their own purposes; carrying a cell phone and staying within 45 minutes of the facility is generally not hours worked. Automatic 30 minute meal deductions are allowed only if the employee is completely relieved of duty.
What is counted company-wide
OSHA recordkeeping, the ADA and Title VII, COBRA, FMLA and the ACA employer mandate all count employees across every location, so a second site can trip a threshold no single site reaches. FMLA eligibility is the exception: the 50-employee test is measured within 75 miles of the employee's own worksite. A location in a new state adds a withholding account (unless the state has no wage tax), an unemployment account, that state's minimum wage and overtime rule for physicians and nurses, and its new hire and final pay deadlines.
How the payroll is structured
One EIN, one payroll, one set of pay codes for shift differentials, on-call pay and credentialing-based pay tiers, with location as a cost center on every employee record so labor cost, tax registrations and required postings resolve by site. Separate EINs per location are a legal-entity decision, not a payroll one, and each EIN files its own 941s and W-2s.
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]
- On-call time counts as hours worked only when the employee must remain on or so near the premises that the time cannot be used for their own purposes; carrying a cell phone and staying within 45 minutes of the facility is generally not hours worked. Automatic 30 minute meal deductions are allowed only if the employee is completely relieved of duty. [DOL Fact Sheet #53]
Read the full guide to how to manage payroll in multiple states, and the rest of the healthcare practice payroll library.
Managed Payroll, Handled.
BEG manages payroll at $25-$45 per employee per month, all-inclusive. Get an instant cost comparison for your business.
Frequently Asked Questions
Does a second healthcare practice location need its own payroll?
No. One payroll with location cost centers is the norm under a single EIN. A second EIN, if the entity structure requires one, files its own returns and W-2s.
Which thresholds count employees across all healthcare practice locations?
OSHA logs, Title VII and the ADA, COBRA, FMLA coverage and the ACA employer mandate. FMLA eligibility for an individual is measured within 75 miles of that employee's worksite.
Healthcare practice multi-site rule: 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.
What does managed payroll cost for a healthcare practice?
$25 per employee per month inside your existing platform or $45 on BEG's isolved HCM, all-inclusive, with a $500 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 $25-$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
From the blog