My understanding is that it is MedFx software which is licensed by AC to be integrated into AC for those that want it. I admit that I currently pay about 125-150 per month for use of Medisoft but I have to buy expensive upgrades almost every year so it is probably a wash. People think it is very expensive but unfortunately most clearing houses charge a high monthly fee and it is difficult to compare a PM program to free services such as Office Ally as they are different business models. If you like what you use then don't change but 249 per month is unfortunately not a bad price.