Payment Processing in private practice

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sighchiatry

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I'm curious to learn what those of you in private practice are using for your payment processing, what the rates are, how your experience has been, etc.

I've been using the processor integrated into luminello called blue fin. I've had a few speed bumps with them. Overall it's relatively smooth, but it's not a competitive rate.
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The rates for blue fin aren’t great so I never completed set up despite the convenience. I’m only taking cash&check right now. No bounced checks but that can be a concern. I have friends who opened business bank accounts that allow cc processing with just a 3% fee. I think chase does this
 
Out of my 58K income for 2019 so far, 10.8K has been thru credit card payments, and the Luminello/Blue Fin has charged me $522 so far. The convenience and integration with the charting system thus far, I'm willing to stick with it, considering the bulk of payments are coming from insurance deposits for my practice.
 
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I have a merchant account with WorldPay which is integrated into my EMR (Office Ally 24/7). I pay 150-200 per month in processing fees. I've also signed up to use quickbooks payments, to send invoices by email to those people who do not respond via my patient portal or had never signed up in the first place. I take venmo payments too. I compared Worldpay to Intuit (Quickbooks), Luminello (Bluefin), and Square during the summer. Here's how they compared for me:

WorldpayIntuitLuminelloSquare
July5,820.1388$209.00$196.02$200.17$173.25
June4,190.8282$151.00$145.81$150.56$127.55
May5,352.6687$192.00$181.79$186.04$160.25
 
RomanticScience said:
I have a merchant account with WorldPay which is integrated into my EMR (Office Ally 24/7). I pay 150-200 per month in processing fees. I've also signed up to use quickbooks payments, to send invoices by email to those people who do not respond via my patient portal or had never signed up in the first place. I take venmo payments too. I compared Worldpay to Intuit (Quickbooks), Luminello (Bluefin), and Square during the summer. Here's how they compared for me:

WorldpayIntuitLuminelloSquare
July5,820.1388$209.00$196.02$200.17$173.25
June4,190.8282$151.00$145.81$150.56$127.55
May5,352.6687$192.00$181.79$186.04$160.25
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So are you going with the integration of worldpay being worth the extra 25-30 dollars savings vs square due to it posting directly into patient's accounts in your EMR vs having someone manually enter the square numbers?
 
For now, yes; my patient portal has a Billpay feature which is integrated into the practice management/accounting module of my EMR. I've tolerated this cost because my EMR is supercheap, $29.99/mo.

If it's helpful, these are the numbers used in the calculations:

Worldpay: Variable % (~1.89%) + Misc Fees
Intuit: Flat 2.99% + $0.25 per transaction
Luminello: Flat 2.99% + $0.15 per transaction + $12.95 PCI compliance fee.
Square: Flat 2.75% + $0.15 per transaction
 
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FYI Square is now 2.6% + 10 cents per transaction
 
Sushirolls said:
Out of my 58K income for 2019 so far, 10.8K has been thru credit card payments, and the Luminello/Blue Fin has charged me $522 so far. The convenience and integration with the charting system thus far, I'm willing to stick with it, considering the bulk of payments are coming from insurance deposits for my practice.
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Makes complete sense for a practice set up like this.

For a self pay practice it's hard to swallow paying those fees every month or so.
 
RomanticScience said:
I have a merchant account with WorldPay which is integrated into my EMR (Office Ally 24/7). I pay 150-200 per month in processing fees. I've also signed up to use quickbooks payments, to send invoices by email to those people who do not respond via my patient portal or had never signed up in the first place. I take venmo payments too. I compared Worldpay to Intuit (Quickbooks), Luminello (Bluefin), and Square during the summer. Here's how they compared for me:

WorldpayIntuitLuminelloSquare
July5,820.1388$209.00$196.02$200.17$173.25
June4,190.8282$151.00$145.81$150.56$127.55
May5,352.6687$192.00$181.79$186.04$160.25
Click to expand...


Thank you for sharing this.

How have you adjusted your Venmo practice to make it more secure/HIPAA compliant than it is at default?

I've set my account to fully private (only the person and me can see transactions), I never submit requests for payment, and I've connected it to my secure email with a BAA.
 
I went with CMS largely because it was integrated with my EMR. Setting up the account took longer than necessary and was frustrating due to the rep being "in school" with some limited availability. The time difference MST made early morning contact impossible. Since implementing it I have been happy with the service and feel the rates are reasonable.

Look into Pro Merchant. I had planned to go with them but without a land line it is my understanding they were going to require additional more expensive swipe equipment. With all the companies I looked into the buy vs rent vs the company furnishes the equipment options were confusing so after weighing the pros and cons I went with CMS largely due to EMR integration and a $60 swipe piece that I purchased from Amazon.
 
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WisNeuro said:
No big differences for executive vs non?
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Executive eliminates the monthly fee. Executive doesn’t avoid the “qualified rate on only certain transactions” problem. 1.5% sounds great, but if it’s only 1/3rd of your transactions, 1.5% doesn’t mean much. Interchange on many credit cards is 2+% and they don’t qualify.

I use paymentdepot. There is a flat monthly fee and I negotiated a nickel for every transaction on top of interchange. Debit cards have low interchange rates, so I get under 1% on those.
 
For a practice that only generates 25k in credit card payments my guess is it really doesn't matter which route you go. That's like 750 in fees if you had a flat 3% rate which would be ridiculously high vs 500 if you had somehow a flat 2% rate on everything which is ridiculously low.

There are some offices which charge you the convenience fee as the patient. I believe all the fees are tax deductible as well so moot point unless your in a large cash practice which when 1% of 300-400k is a few thousand in differences then it matters a lot more.
 
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Shufflin said:
my payment processing consists of the patient handing me cash or a check. you can't beat 0.0% per transaction
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I have only had 1 person ever bounce a check in 3 years and they gladly paid for the fees so i see this as another way to cut overhead unless you have patients with HSA cards then i think you need a card machine for those cases.
 
Shufflin said:
my payment processing consists of the patient handing me cash or a check. you can't beat 0.0% per transaction
Click to expand...

If you charge $5 per $150 as a processing fee, which the patient is happy to do because it's easy and they get almost all of it back in cc rewards, and you deduct the 3% that the processing company charges you, then you come out ever so slightly ahead.

Playing with a 40% tax rate and $150k in cc sales, just over $200 extra for you.
 
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downwithDTB said:
If you charge $5 per $150 as a processing fee, which the patient is happy to do because it's easy and they get almost all of it back in cc rewards, and you deduct the 3% that the processing company charges you, then you come out ever so slightly ahead.

Playing with a 40% tax rate and $150k in cc sales, just over $300 extra for you.
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The majority of non cash based practices will have copays in the 20-40 range. Should you charge a dollar in processing fees for such a practice?

That looks sorta cheap in a way but maybe I am out of line in that thinking.
 
finalpsychyear said:
The majority of non cash based practices will have copays in the 20-40 range. Should you charge a dollar in processing fees for such a practice?

That looks sorta cheap in a way but maybe I am out of line in that thinking.
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I share your thinking, charging the fee makes me feel like a bake sale stand.
 
sighchiatry said:
A flat 2.2% with no extra fees would beat everything I've seen. Mind sharing where this is / how to get it?
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That’s my average. It isn’t flat. I prefer interchange + pricing like with paymentdepot. I pay a flat monthly fee + $.05/transaction to the merchant company in exchange for interchange pricing. You don’t want a flat fee company.
 
Can't you just write it off as a business expense and get it back in taxes?
 
TexasPhysician said:
Tax deductions are not tax credits.
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What's the difference? My accountant just says spend spend spend you can write it off. I stayed at a crazy expensive hotel for a conference. He says anything business related is a write off and I get it back
 
futuredo32 said:
What's the difference? My accountant just says spend spend spend you can write it off. I stayed at a crazy expensive hotel for a conference. He says anything business related is a write off and I get it back
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Hmm are you sure that is what your accountant is saying? Let me giving you the simplest example using 100 dollars and a 50% tax rate.

So in this example we are using 100 dollars to simplify calculations and a medical conference that is tax deductible that you may go to if you choose which you can write off.

Scenario A : You decide Im going to skip the conference so that 100 dollars will get taxed at 50% and you go home with 50 dollars. This is the only scenerio where you actually end up with the most money. All other scenerios given that what your expensing qualifies for a deduction you won't magically take home more but you might pay less if you HAVE to do it.

Scenario B: I have 100 dollars left and MUST go to a conference that is 50 dollars so i pay 100-50 = 50 x 50% tax gives me 25 dollars in my pocket. So this is better if you must do it because if you don't expense it you would pay the full 50 out of your pocket.

The exception to where deductions can put you ahead are things like 401k, hsa.
 
finalpsychyear said:
Hmm are you sure that is what your accountant is saying? Let me giving you the simplest example using 100 dollars and a 50% tax rate.

So in this example we are using 100 dollars to simplify calculations and a medical conference that is tax deductible that you may go to if you choose which you can write off.

Scenario A : You decide Im going to skip the conference so that 100 dollars will get taxed at 50% and you go home with 50 dollars. This is the only scenerio where you actually end up with the most money. All other scenerios given that what your expensing qualifies for a deduction you won't magically take home more but you might pay less if you HAVE to do it.

Scenario B: I have 100 dollars left and MUST go to a conference that is 50 dollars so i pay 100-50 = 50 x 50% tax gives me 25 dollars in my pocket. So this is better if you must do it because if you don't expense it you would pay the full 50 out of your pocket.

The exception to where deductions can put you ahead are things like 401k, hsa.
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Where did the 50% tax rate come from? He made t sound like it was all coming back to me.
 
futuredo32 said:
What's the difference? My accountant just says spend spend spend you can write it off. I stayed at a crazy expensive hotel for a conference. He says anything business related is a write off and I get it back
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If your accountant said that, fire your accountant yesterday.

Say you earn $300k. If you spend spend spend and have $100k in tax deductions, you are taxed on $200k. You lose the $100k you spend. You pay taxes on only $200k.

If you spend minimally and have $25k in deductions, you are taxed on $275k and only lost $25k.

I’d rather pay taxes on the saved $75k than a guaranteed loss by spending it.
 
TexasPhysician said:
If your accountant said that, fire your accountant yesterday.

Say you earn $300k. If you spend spend spend and have $100k in tax deductions, you are taxed on $200k. You lose the $100k you spend. You pay taxes on only $200k.

If you spend minimally and have $25k in deductions, you are taxed on $275k and only lost $25k.

I’d rather pay taxes on the saved $75k than a guaranteed loss by spending it.
Click to expand...

Came here just to echo the sentiment re:accountant. If he believes that tax deductions all just come back to you, there is no way he is doing your taxes correctly.
 
TexasPhysician said:
If your accountant said that, fire your accountant yesterday.

Say you earn $300k. If you spend spend spend and have $100k in tax deductions, you are taxed on $200k. You lose the $100k you spend. You pay taxes on only $200k.

If you spend minimally and have $25k in deductions, you are taxed on $275k and only lost $25k.

I’d rather pay taxes on the saved $75k than a guaranteed loss by spending it.
Click to expand...
I guess I need a new cpa. Thank you
 
I use payment depot for my CC processing. You have to pay a monthly fee but they are an interchange + 0.15cent processor. For the high ticket charges, doing interchange is better than a flat rate. I’m averaging about 1.9% of CC processing fees a month. My patient population are mid 20 to 30 year olds and they all want to use CC. No one is coming in with a check anymore. You’re considered a dinosaur who isn’t up with current times if you can’t accept cc or do Venmo.
 
futuredo32 said:
I guess I need a new cpa. Thank you
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Hopefully you misunderstood your accountant but also consider doing some research on the business end of business. Contract negotiations, taxes, insurance, retirement etc. Given the income physicians make the potential losses and/or gains are significant.

This would be a good start.
www.whitecoatinvestor.com

Home | White Coat Investor

Sick of feeling like you're being taken advantage of by the financial services industry just because you have a high income? Wondering what to do with your student loans or how to get a mortgage? Not sure how to buy disability insurance or how to invest your money? Here's a site written for...
www.whitecoatinvestor.com www.whitecoatinvestor.com
 
Jules A said:
Hopefully you misunderstood your accountant but also consider doing some research on the business end of business. Contract negotiations, taxes, insurance, retirement etc. Given the income physicians make the potential losses and/or gains are significant.

This would be a good start.
www.whitecoatinvestor.com

Home | White Coat Investor

Sick of feeling like you're being taken advantage of by the financial services industry just because you have a high income? Wondering what to do with your student loans or how to get a mortgage? Not sure how to buy disability insurance or how to invest your money? Here's a site written for...
www.whitecoatinvestor.com www.whitecoatinvestor.com
Click to expand...
No. He said "everything you spend for business you get back, live it up when you go to conferences." Was becoming a PLLC also a bad idea? I have to pay 7% unemployment tax. I have no employees.
 
futuredo32 said:
No. He said "everything you spend for business you get back, live it up when you go to conferences." Was becoming a PLLC also a bad idea? I have to pay 7% unemployment tax. I have no employees.
Click to expand...

I will again echo others' sentiments. As someone who has dealt with business related taxes, mostly in real estate, this is dead wrong. Even if he understands the difference between deductions and credits, this is still terrible advice. Wow, just wow. As others have said, read WCI, and if you're still interested, Jack Bogle has some very good books that explain taxes, investing, etc in a way that is very easily understood by people with no finance background.


PLLC/LLC is a different story with different caveats. Really depends on your situation.
 
futuredo32 said:
No. He said "everything you spend for business you get back, live it up when you go to conferences." Was becoming a PLLC also a bad idea? I have to pay 7% unemployment tax. I have no employees.
Click to expand...

Plenty of discussions on which entity to use if 1099 or opening private practice. Unfortunately the message board is undergoing an update and isn't functioning optimally however their search engine is good and you will likely get much if not all the information you need.
 
I stayed at a $250 a night hotel because I thought it was coming back to me when I went to a conference!!!!!!!! And it was a week. I would have stayed at a Motel 6 or something. Thank you.
 
futuredo32 said:
I stayed at a $250 a night hotel because I thought it was coming back to me when I went to a conference!!!!!!!! And it was a week. I would have stayed at a Motel 6 or something. Thank you.
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For my personal situation I'd loosely estimate that as the hotel actually costing me ~ $150 a night.
 
futuredo32 said:
Except for the coming year I don't work much , so I am doing IBR or IDR, I don't know which. The year following this my loan payments will be huge, but I just pay 300 a month. I know a lot will disagree (no comments needed about this) but I owe over 400k. So, my loans will never be repaid. And I am fine with that. I will pay big after working a ton in 2020 but after that, back to my tiny payments for 15 or 16 years and done. And I have been doing it since 2015. And seriously, no advice needed about my student loans. Ty for the other advice though.
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If you don't want people to comment on your loans, why bring them up in extensive detail? You've visited this forum before, yeah? We're all kinds of nebby up in here.
 
clausewitz2 said:
If you don't want people to comment on your loans, why bring them up in extensive detail? You've visited this forum before, yeah? We're all kinds of nebby up in here.
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Lol haven't used, seen or heard the word nebby in a while but love it!
 
clausewitz2 said:
If you don't want people to comment on your loans, why bring them up in extensive detail? You've visited this forum before, yeah? We're all kinds of nebby up in here.
Click to expand...

Reminds me of my patient who went on and on about his cocaine use but then said not to talk about it or make any comments. I think futuredo32 is just tip toeing into the contemplative stage of change 🤣
 
Please go purchase the WCI book and course. The more you post the more i feel like you are in dire need of something like that ASAP before it is too late.
 
futuredo32 said:
I stayed at a $250 a night hotel because I thought it was coming back to me when I went to a conference!!!!!!!! And it was a week. I would have stayed at a Motel 6 or something. Thank you.
Click to expand...

Is your accountant a high schooler? Every undergrad accounting major can tell you the difference between a tax credit and deduction....
 
An update for my colleagues using luminello.

You can negotiate the processing fee with them.

It helps if you present them with the rates from other, more competitive services.

Here are a few:
www.talktoivy.com

Ivy Pay - Therapist App

Ivy Pay helps you charge a client's card on file for seamless payments that are easy and confidential. It's the instant pay option exclusively designed for therapists. Get started free.
www.talktoivy.com www.talktoivy.com

www.therapynotes.com

Integrated Payment Processing | TherapyNotes® Features

TherapyNotes® is practice management software for behavioral health, helping you securely manage records, book appointments, write notes, bill, and more.
www.therapynotes.com www.therapynotes.com
 
sighchiatry said:
An update for my colleagues using luminello.

You can negotiate the processing fee with them.

It helps if you present them with the rates from other, more competitive services.

Here are a few:
www.talktoivy.com

Ivy Pay - Therapist App

Ivy Pay helps you charge a client's card on file for seamless payments that are easy and confidential. It's the instant pay option exclusively designed for therapists. Get started free.
www.talktoivy.com www.talktoivy.com

www.therapynotes.com

Integrated Payment Processing | TherapyNotes® Features

TherapyNotes® is practice management software for behavioral health, helping you securely manage records, book appointments, write notes, bill, and more.
www.therapynotes.com www.therapynotes.com
Click to expand...



what were you able to negotiate luminello down to if you dont mind me asking?
 
sighchiatry said:
2.6% + 5 cents per transaction (was 2.99 + 15 cents)
$5 a month PCI fee (was 12.95)
$10 monthly minimum (was 20)

If anyone is able to negotiate better terms with them, please let me know.
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I didn't even think to do this, but I might try soon. Thanks! Although it's all a business deduction for me so doesn't matter much in the end.
 
PistolPete said:
I didn't even think to do this, but I might try soon. Thanks! Although it's all a business deduction for me so doesn't matter much in the end.
Click to expand...

Why doesn't it matter, isn't it better to reduce your cost even if it is a deduction?
 
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