Sustainable Medical Billing adds nearshore teams and rural hospital RCM in one week

Sustainable Medical Billing (SMB) announced two acquisitions in the space of two days. On 21 October it said it was buying SMRTDO Medical Billing, and on 22 October it announced the purchase of Impact Healthcare Solutions, as RevCycleAI reported. Financial terms were not disclosed for either deal.

What each deal adds

SMRTDO brings more than 300 team members and gives SMB its first nearshore operations, based in Nicaragua and Colombia. That is a team of similar size to the 300-plus employees SMB itself reported in August, so on headcount alone the deal is a big step. SMRTDO is headquartered in Managua, and its leadership is staying in their current roles.

Impact Healthcare Solutions provides revenue cycle services to rural and community hospitals, health systems and physician practices. According to RevCycleAI, the transaction was completed in September 2026 and made public on 22 October. David Caston will lead SMB's hospital billing and consulting team, and Landon Tooke becomes chief compliance officer and general counsel.

A run of deals

These are not SMB's first acquisitions. In September 2025, MedEvolve sold its RCM services business to SMB, which Techleap's news feed describes as a national RCM services provider. MedEvolve said it would concentrate on its AI-driven revenue cycle automation and analytics technology.

In August 2026, SMB bought RevCycle Partners, an Illinois-based specialist serving more than 400 optometry practices, after RevCycle's software arm OneSpot was spun out as a separate company, as Levin Associates reported. At that point SMB had more than 300 employees, according to the same report.

Taken together, the deals show SMB building out by specialty (eyecare, rural hospitals) and by delivery capacity (the nearshore teams).

The bigger picture

Much of the funding attention in revenue cycle goes to AI software, but the services side is moving too. The MedEvolve and RevCycle Partners deals both separated software from services, with SMB taking the services business, and the SMRTDO deal adds people rather than technology. A week after Sunbound bought a services firm to sit alongside its software, SMB is building scale the other way round: services first, assembled through acquisition. For buyers of outsourced billing, the number of large, multi-specialty providers to choose from is shifting as these roll-ups continue.