The true cost of collecting patient payments

Your rate isn't your total cost

A 2.6% processing rate is only part of the picture. Gateway and terminal fees, statement and A/R software, membership billing, refunds, compliance costs, deposit reconciliation and front-desk time all add up. The real question: how much time and money does the whole patient-payment workflow consume, and where do errors happen?

Two calculations, kept separate

Hypothetical: $250,000 of monthly card volume and $6,500 of processing fees = a 2.60% effective card rate.

Add $250 for statement/A/R software, $600 for payment integrations and about $1,000 of staff time, and the broader collections cost is $8,350 a month. Dividing that by card volume gives a directional 3.34%, but it isn't a card rate — label what's in the numerator and denominator.

Reconciliation is a money control

A payment can be marked paid at the front desk before funds settle, batches can land in a different period and one deposit can hold many transactions. Match three records consistently: the practice-management system, the processor's settlement report and the bank/ledger. Then you can separate true A/R from cash in transit or posting errors.

What about surcharging?

Surcharging is a separate operational and compliance decision, with card-network rules, state laws, debit-card restrictions and disclosure requirements. Lower fees can be offset by patient friction. Get qualified advice for your state before changing anything.