Last updated: 2026-08-21
Honest Taskers, Ditto Transcripts, and Transcure lead this year's shortlist of medical transcription outsourcing companies in the USA, seven firms ranked on whether the work is performed in the United States, published pricing, turnaround, HIPAA posture including whether a BAA is signed, and specialty coverage. Only one firm here states that its transcriptionists are all US-based, and that single fact is what this comparison exists to surface. Below we set out whether HIPAA requires the work to happen in the USA, what happens when an address is mistaken for delivery, how much more a US note costs, where the transcriptionist physically sits, and which three dictations to send every vendor.
Disclosure: Honest Taskers publishes this list and appears at position 1. We're judged on the same five published criteria as every other company here.
At a glance
- 1Honest Taskers
- 2Ditto Transcripts
- 3Transcure
- 4Athreon
- 5iScribe Health
- 6Staffingly
- 7Task Virtual
On this page
- How we chose these companies
- Companies compared
- The 7 companies
- Does HIPAA require transcription to happen in the USA?
- What happens when a US address is mistaken for US transcription delivery?
- How much more does US transcription cost per note?
- Where does the transcriptionist physically sit?
- Which three dictations should you send every transcription vendor?
- Methodology and sources
How we chose these companies
A US address is not US delivery, and in this category the two are routinely conflated. A firm can be incorporated in Denver, list an office in Princeton, and have every transcript typed in Chennai, all without saying anything untrue. So the first criterion here is narrow and deliberate: does the company state where the people producing your transcripts sit? One firm here says all its transcriptionists are US-based. One says its staff span the US and abroad. The rest either name offshore delivery openly or say nothing.
It's worth being clear that offshore delivery is lawful. HIPAA sets no geographic restriction on processing protected health information, and Indian and Filipino transcription operations have served US clinicians competently for decades. The reasons to want US delivery are real but specific: some hospital vendor policies require it, some state contracts require it, and some practices simply want a straightforward answer when a patient asks where their record was typed.
Beyond location we compared published pricing, turnaround, HIPAA posture including whether a business associate agreement is signed, and specialty coverage. Specialty matters more than buyers expect, because transcription accuracy collapses on unfamiliar vocabulary regardless of where the transcriptionist sits, and a firm naming your specialty has met your terminology before.
Compliance is the gate. Transcription handles clinical content continuously, so the business associate agreement the U.S. Department of Health and Human Services requires applies from the first file, and a confidentiality agreement is not the same instrument. Wage context for the in-house comparison is the U.S. Bureau of Labor Statistics May 2025 Occupational Employment and Wage Statistics, which puts the national median for medical transcriptionists at $19.43 an hour, about $40,410 a year.
Companies compared
| Company | Where the work is performed (as stated) | Published pricing | Turnaround | HIPAA and BAA (as stated) | Specialty coverage |
|---|---|---|---|---|---|
| Honest Taskers | Recruits in the Philippines, Latin America, India and Pakistan; professionals work the client's US time zone | $10.00 to $12.65/hr | Works your clinic hours; same-day as you direct | Verified by Accountable; BAA signed when PHI is accessed; SOC 2 audit ready | Staffed by specialty at hire; practice interviews candidates |
| Ditto Transcripts | All US-based transcriptionists on the fully human tier; US citizens, background-checked | $0.10 and $0.16/line AI-assisted; $0.14 and $0.16/line fully human | 4-hour STAT; 24-hour standard; 2 to 48 hours stated in FAQ | States HIPAA-compliant transcription and signed confidentiality agreements; no BAA language quoted | 20+ specialties including radiology, cardiology, orthopedics, emergency medicine, behavioral health, pathology |
| Transcure | Offices in Texas, New Jersey and Florida; 1,100+ certified billers and coders | 3% to 5% of monthly collections for full RCM | Not publicly listed | ISO 27001; AAPC-certified staff | 40+ specialties |
| Athreon | Transcription staff in the US and abroad, in places including the Philippines and India | Not publicly listed | From 4 hours; faster STAT options | States it signs BAAs, background-checks staff, runs annual risk assessments, carries professional liability insurance | Hospitals, solo practices, surgery centers, multispecialty groups; also legal and government |
| iScribe Health | Not publicly listed | Not publicly listed | Not publicly listed | Displays a SOC 2 Type II Certified badge; HIPAA and BAA specifics not detailed | E&M coding product limited to orthopedic and urology on certain EHRs |
| Staffingly | India, Pakistan, Bangladesh | $399/wk at 45 hrs; $349 at 5+; $299 at 10+ | Not publicly listed | SOC 2 Type II; ISO/IEC 27001:2022; HIPAA; GDPR; signed BAA; $5M E&O and cyber policy | Not itemized by specialty |
| Task Virtual | Office in Kolkata, West Bengal | $6.24/hr | Not publicly listed | HIPAA-trained; states assistants are required to sign BAAs | Not itemized by specialty |
1. Honest Taskers
Best for: US practices that want documentation handled on US hours by a named person.
Delivery: Offshore, on US hoursPricing: $10.00 to $12.65/hrCoverage: Clinic hoursFirst hire: Two-week working trial
Honest Taskers serves US practices with professionals working the client's US time zone, which addresses the practical half of what buyers usually mean by wanting US transcription: work that happens during your day, by someone you can reach, who knows your practice. A staffed documentation assistant prepares notes, chases missing results, and handles the follow-up a visit generates, rather than returning a file and stopping there.
Compliance runs on quarterly HIPAA and data privacy training led by a dedicated compliance officer, a Business Associate Agreement signed where the professional will access PHI, remote work screening covering a dedicated password-protected computer with VPN and antivirus requirements, and a security environment described as SOC 2 audit ready, with HIPAA compliance verified by Accountable. Rates run $10.00 to $12.65 an hour, reported retention is 99.6% average monthly, and the practice interviews candidates before hiring. See the virtual medical scribe page for scope.
Limitation: our professionals are recruited in the Philippines, Latin America, India, and Pakistan, not the United States. If a vendor policy or contract requires the work to be performed on US soil, we do not meet that requirement and Ditto Transcripts at position two is the entry that does.
2. Ditto Transcripts
Best for: practices and hospitals that require transcription performed in the United States.
Delivery: All US-based transcriptionistsPricing: $0.10 to $0.16 per lineTurnaround: 4-hour STAT, 24-hour standardStaff: US citizens, background-checked
Ditto Transcripts is the only firm in this article stating that all transcriptionists on its fully human tier are US-based, and it goes further than most by adding that they are US citizens who pass background checks and sign confidentiality agreements. For an organization whose vendor policy or state contract requires domestic processing, that combination is the requirement met on the page rather than in a sales call.
It also publishes its pricing openly and separates its two products, which nobody else here does: $0.10 a line for AI-assisted with human editing at 24-hour turnaround and $0.16 STAT at four hours, against $0.14 standard and $0.16 STAT for the fully human tier. It states a 99% accuracy guarantee and covers more than 20 specialties including radiology, cardiology, orthopedics, emergency medicine, behavioral health, and pathology, serving hospitals, clinics, private practices, and health systems.
Limitation: it describes HIPAA-compliant transcription and signed confidentiality agreements but no business associate agreement, which is a different instrument, so confirm what gets signed before sending dictation.
3. Transcure
Best for: practices wanting US offices and documentation bundled with revenue cycle.
Offices: Texas, New Jersey, FloridaPricing: 3% to 5% of collectionsStaff: 1,100+ certifiedCert: ISO 27001
Transcure names US offices in Texas, New Jersey, and Florida alongside a stated team of over 1,100 certified billers and coders, and prices the full revenue cycle at a published 3% to 5% of monthly collections across more than 40 specialties. For a practice whose documentation problem sits inside a broader revenue cycle problem, buying both from one firm with named US offices means one contract and one accountability line rather than two.
Limitation: it names US offices without stating that all delivery happens there, transcription isn't priced separately from the revenue cycle percentage, and no turnaround is published, so ask about all three.
4. Athreon
Best for: organizations that want honest disclosure about mixed delivery and strong compliance.
Delivery: US and abroad, PH and India namedPricing: Not publicly listedTurnaround: From 4 hoursCompliance: Signs BAAs, liability insurance
Athreon states plainly that its transcription staff sit in the US and abroad, in places including the Philippines and India, which is more candour than most of this category offers and lets you ask the right follow-up question rather than discovering the answer later. Its compliance description is the strongest here, covering staff background checks, annual risk assessments, signed business associate agreements, professional liability insurance, and submission to client security reviews. Turnaround options start at four hours with faster STAT available.
Limitation: because staffing is mixed, US-only delivery isn't guaranteed, so if that's a hard requirement you'll need it written into the contract rather than assumed.
5. iScribe Health
Best for: practices that want the transcription performed by software rather than by anyone abroad.
Delivery: SoftwarePricing: Not publicly listedProduct: Ambient AI scribeCertification: SOC 2 Type II badge
iScribe Health sidesteps the location question by removing the transcriptionist: it's an AI medical scribe using ambient notetaking and speech-to-text with deep EHR integration, so no person abroad handles your dictation because no person handles it at all. For organizations whose concern about offshore transcription is specifically about who reads the clinical content, that's a genuine answer rather than a workaround. It displays a SOC 2 Type II certified badge and states a 95% audited accuracy rate for its evaluation and management coding product on orthopedic and urology practices using certain EHR platforms.
Limitation: no pricing, turnaround, or HIPAA and BAA specifics are published, the accuracy figure applies to a narrow product, and AI errors read fluently, so the review burden moves to the clinician.
6. Staffingly
Best for: practices with no US-delivery requirement wanting the lowest full-time cost.
Delivery: India, Pakistan, BangladeshPricing: $399/wk at 45 hrsVolume: $349 at 5+, $299 at 10+Cover: $5M E&O and cyber
Staffingly names its three delivery countries openly and prices at $399 a week per full-time equivalent covering 45 hours, dropping to $299 at ten or more people, roughly $6.64 an hour at volume. Its compliance disclosure is the most complete in this article, covering SOC 2 Type II, ISO/IEC 27001:2022, HIPAA, GDPR, a signed business associate agreement, and a $5 million errors and omissions and cyber policy, which is a stronger documented position than the US-based firms here publish.
Limitation: delivery is entirely offshore, so it fails a US-delivery requirement outright, and its workflow is AI-assisted with a person verifying output rather than fully human.
7. Task Virtual
Best for: practices with no US-delivery requirement wanting the lowest hourly rate.
Delivery: Kolkata, West BengalPricing: $6.24/hrModel: Hourly or monthlyCompliance: HIPAA-trained, BAAs signed
Task Virtual names medical transcription explicitly and publishes $6.24 an hour from a stated Kolkata office, the lowest verified rate here. India's time difference is an advantage for transcription specifically: dictate through your clinic day and the transcripts are ready before you open the next morning, which is the one documentation workflow where being twelve hours away helps rather than hurts. It states assistants are HIPAA-trained and required to sign business associate agreements.
Limitation: delivery is entirely offshore, so it fails a US-delivery requirement, and it publishes a corporate office rather than where assistants work, with no turnaround or accuracy commitment.
Does HIPAA require transcription to happen in the USA?
No. HIPAA sets no geographic restriction on processing, so the compliance question is whether a business associate agreement is in place and what security surrounds the work, not which country it happens in. US delivery costs more per line and buys you three other things: a simple answer to vendor policies and state contracts requiring domestic processing, transcriptionists whose first language matches your dictation, and a straightforward reply when a patient asks where their record was typed. Published rates for fully human US transcription sit at $0.14 to $0.16 a line, against $0.10 for AI-assisted work.
Offshore delivery is lawful, long-established, and cheaper, with staffed rates from $6.24 an hour. HIPAA sets no geographic restriction on processing, so the compliance question is whether a business associate agreement is in place and what security surrounds the work, not which country it happens in. The offshore firms in this article publish stronger documented compliance than the US-based ones do, which is worth sitting with if your instinct says otherwise.
Software removes the question by removing the human, and ambient AI scribing has become genuinely capable on clear audio and common vocabulary. Its cost is a different risk: AI fails silently, producing fluent text that is wrong, where a transcriptionist would flag what they couldn't make out. That shifts the review burden onto the clinician, and a note signed without being read is the clinician's exposure regardless of what produced it.
What happens when a US address is mistaken for US transcription delivery?
You buy a domestic guarantee you do not have, which is the central confusion in this category and the first of the things that go wrong.
- A US business address mistaken for US delivery, which is the central confusion here.
- Mixed staffing where US delivery isn't guaranteed unless written into the contract.
- Confidentiality agreements described as equivalent to a business associate agreement.
- Accuracy guarantees that don't distinguish a wrong preposition from a wrong dosage.
- Line definitions varying between vendors, making per-line quotes incomparable.
- Specialty vocabulary defeating both software and unfamiliar transcriptionists.
- AI errors that read fluently, so nothing signals a review is needed.
- Turnaround measured from receipt rather than from dictation.
- Notes signed without being read, which is the clinician's exposure.
How much more does US transcription cost per note?
About a dollar to two dollars a note, which is less than most buyers expect. Ditto Transcripts publishes the only per-line schedule, $0.14 a line for fully human US-based transcription at standard turnaround, $0.16 STAT at four hours, and $0.10 for its AI-assisted tier. Honest Taskers publishes $10.00 to $12.65 an hour, Task Virtual $6.24, and Staffingly $399 a week. Transcure prices the full revenue cycle at 3% to 5% of collections. Athreon and iScribe Health quote on request.
The US premium is smaller than most buyers expect. At a typical 30 to 50 lines a note, fully human US transcription runs about $4.20 to $7 a note against $3 to $5 for the AI-assisted tier, so the difference on 20 notes a day is roughly $25 to $40. Set against the cost of one dosage transcribed wrongly and reviewed carelessly, that gap is not where a practice should be economising. The larger decision is between transcription and a staffed assistant: at 20 notes a day, transcription costs $1,800 to $3,000 a month, which exceeds a part-time staffed person who also does everything else around the note. Rates move, so confirm before you sign.
Where does the transcriptionist physically sit?
Stated plainly, rather than implied by an office address, and that heads a longer list of what to establish before signing.
- Where the transcriptionists physically sit, stated rather than implied by an office address.
- Whether US delivery is guaranteed in the contract if it's a requirement.
- A signed BAA, not a confidentiality agreement described as equivalent.
- Whether a human or software produces the transcript.
- How a line is defined, if pricing is per line.
- Turnaround measured from dictation, not from receipt.
- Your specialty named on their site.
- What an accuracy guarantee covers and how it's measured.
- How unclear audio is flagged rather than guessed at.
Which three dictations should you send every transcription vendor?
The same three real ones to each firm, including your worst audio, so the comparison is of the same work rather than of three different samples.
- Check whether any vendor policy or contract requires US delivery, since many assume it without a requirement.
- Count your notes per day and their typical length in lines.
- Convert every quote to cost per note and cost per month.
- Send the same three real dictations to each shortlisted firm, including your worst audio.
- Ask where each returned transcript was produced, and by whom or what.
- Ask whether a BAA is signed as standard.
- Get US delivery written into the contract if it's a requirement.
- Start with one clinician and one visit type.
- Review at 30 days on turnaround, edits required, and errors that reached a signed note.
Methodology and sources
We verified each company at its own website on August 21, 2026, recording where the work is stated to be performed, published pricing, turnaround, HIPAA posture including whether a BAA is described, and specialty coverage. A US business address is recorded as an address, not as a delivery location, unless the company states where its people work. Business associate requirements come from the U.S. Department of Health and Human Services, which sets no geographic restriction on processing protected health information. Rates were captured as dated points rather than quotes, and anything unpublished is marked "not publicly listed" rather than inferred. Accuracy figures are reported as company-stated with the scope each firm attaches to them. TranscriptionOutsourcing.net blocks automated retrieval and could not be read from source. This list is organized by delivery location, which produces a different order and partly different roster from our general medical transcription guide, where the lead criterion is whether a human or software produces the transcript.
Related documentation guides
For the staffed alternative, our virtual medical scribe page covers what a scribe owns during and after a visit.
If offshore access to patient data is the concern, our guide on whether offshore virtual assistants can access PHI covers the rules.
Speak with Honest Taskers about your documentation workload.