Most mornings, Mahmud Haq, the company's founder and chairman, convenes a meeting of his top managers. They sit in a crowded conference room in front of a wall-mounted, flat-screen television and talk to another group of managers gathered in another conference room -- 7,000 miles away in Pakistan.

"So, how are things going with the call center?" Haq asked into a speaker-phone on a recent morning. On the other end was his Pakistani team, who supervise nearly 600 employees at the company's 24-hour telephone and processing center on the outskirts of Islamabad.

MTBC fashions itself as the Foxton's of medical billing, a discount operation whose low labor costs allow it to charge doctors' offices a slim 4 percent commission to collect payments from public and private insurance payers. Its rate undercuts the competition by more than half.

The company also offers speed. While claims filed on paper by doctors' offices and clinics take, on average, 90 days to process, MTBC argues its electronic claims filing service generates insurance reimbursements for doctors and clinics within seven to 10 days.