Member Contributor — Lynne Azpeitia, LMFT

Getting Paid:
Fast, Easy, Convenient, and Cost-Effective Ways to Get Paid
and Increase the Cash Flow in Your Practice

When clients pay for therapy services in your practice, what type of payment do you accept?

Credit Card? Debit Card? HSA or FSA Card? Bank Bill Pay Issued Check? Personal Check? Cash? Money Order? Yes, they still issue money orders.

Today there are so many options to choose from for client payment. How do we decide which one is best for us and our practice? What are legal and ethical options available to therapists to get paid fast and not have to pay too much in bank or credit card charges?

Not too long ago clients handed their therapist cash or a check before or after the session—or were sent an invoice/billed at the end of the month; and then mailed or brought in their check or gave the therapist cash at the next therapy session.

Should you consider adding to or changing the type of payment you accept for therapy charges?
How can a therapist decide which forms of payment are best for their therapy practice?

With whatever types of payment you decide to accept in your therapy practice, it’s important to look at how much it costs you or saves you — in time, energy, wait time for funds, as well as the charges/money paid—to process those funds and get them into your practice bank account.

Therapists, like most small business owners, are always wanting to know what the best way is to get paid and increase their available cash. They want to know how to get their funds into the bank as quickly and easily as possible and how to pay the lowest possible amount to do that. Having earned this money, therapists want to take home as much of it as possible, save time, and have more clients.

In fact, the most common reason therapists give for accepting only Zelle, Venmo, check or cash is that it costs money (just under 3% of each transaction) to take credit cards. And, as you have probably heard, most therapists do not like to — or want to — pay any credit or debit card, or other type, of processing charges since this amount is subtracted from the amount of money the therapist receives from what the client pays.

However, contrary to popular lore, whatever type of payment a therapist accepts for therapy sessions, it costs the therapist something.

At the very least it costs time, energy, effort, and time before the funds can be accessed, and it can also cost money per transaction. How is it worth it for a therapist to take card and electronic payments and pay those transaction fees?

Giving your clients more ways to pay can increase the number of clients in your practice and improve your cash flow.

It's a fact that most clients expect to be able to use credit or debit cards when paying for things.
Today’s clients, whether no matter what their age, find it very convenient to pay via credit or debit card, or directly from their HSA or FSA — or from Zelle, Venmo or other like services. 

When therapist do phone, video and other types of virtual or remote sessions, credit card and electronic payments are essential because they enable the client to pay you before or after the session.

More payment options that are convenient means more access to care for a larger number of people — and result in more clients in your practice.

Whether a therapist accepts payment by electronic means — credit card, debit card, e-check, wire transfer, Zelle, Venmo, etc.— depends on both the therapist and clients’ preferences and needs.

Many therapists find that their number of paid weekly client hours increase when they accept credit cards, debit cards, and other types of electronic payments.

Clients often like to get rewards — points or miles or cash back — when they pay for therapy–and they tell us so!

If you don’t accept credit cards or electronic payments but accept checks or a bank transfer of funds, clients who want the rewards can use a payment option like Plastiq where the client pays the credit card processing fee.

With services like Plastiq, a client can pay with a credit card — and even split the charge between two different cards — and the therapist receives a bank transfer right away or is sent a paper check within a week, just as if the client had paid with a credit card.

Another benefit to the therapist with Plastiq is that the client pays the credit card processing fee, the therapist doesn’t. Many therapists love that because it means they receive all the money paid for the session.

For therapists, card and electronic payments can mean freeing up more time, energy, and effort — and quicker access to funds because of the following:

• Instant payment, so less hassle getting paid
• Less time scanning checks into your bank app
• Less time spent every week going to the bank to cash or deposit checks and cash
• No waiting for checks to clear.
• 1 or 2 days, at most, to have the funds deposited in your account
• Autopay features available for payment or invoicing
• Having a card on file for missed appointments or late cancellation

One way to increase income from your practice and not have to pay any transaction fees is to have your clients pay you using Zelle or Venmo or another such payment option.

One therapist I coached added Zelle to his practice in addition to credit cards as a payment option and increased his take home earnings $100 per month because he didn’t have to pay that amount in credit card fees. That was a very easy way to bring in $1200 more that year.

Another therapist in one of my practice development groups added Venmo as a payment option when a client suggested it. When using Venmo, the client pays through the app at the end of the session — just a couple of clicks — then there's a ding on the smartphone, the therapist receives it, opens the app, clicks on the amount of the balance. then clicks on the deposit button. Voila! Two days later it’s in her account. If she wants it instantly then she clicks on the instant deposit button and pays a small fee, then it’s deposited in her account shortly after that. 

Here are some descriptions of options for getting paid spelled out:

• Client hands you cash. You record it, use it, or deposit it at the bank.
• Client hands or sends you a check. You record it and deposit it by phone or tablet app or at the bank.
• Client gives you their credit card information after each session or you have it on file orhands you a credit card, debit card, HSA or FSA card. You enter the amount, swipe the card or enter it manually or automatically. Credit card company deposits the money in your bank account a day or two later.
• Client uses Plastiq app and sends/gives you a Plastiq check or immediate bank transfer. Plastiq charges the client’s credit card, the client pays the processing fee, client receives the credit card rewards/points/miles on their card.
• Client pays you in office by Venmo. You receive the amount immediately, click on transfer balance, a day or two later the money is in your bank account. No transaction charge. If you use instant transfer then there is a small charge. Note: If you use Venmo in your practice make sure your privacy setting is on “Private” or everyone in your network and your client’s network will know how much they paid you, what for, and when.
• Client has a credit card or debit card on file with you via your Electronic Health Record Provider or Stripe, you enter the session info and price, the amount is automatically charged to the client’s credit card — if it is not expired — and the money is put in your bank account in within a few days to a week.
• Client pays you in advance for a number of sessions by either credit card, debit card, personal or bank bill pay check or cash. For the time it takes to receive it, see above examples.
• Client receives a therapist sent invoice — through email, text or app — for credit card, debit card or electronic check payment right before or after the therapy session; client clicks on the invoice and pays the amount. A day or two later the amount is in your practice bank account. Offered by Square, PayPal, etc.
• Client receives end of the month billing. Therapist sends invoice after the month’s sessions — by mail, email, or app — and the client sends or make a payment by a physical check, e-check, money order, credit card, debit card, etc. For the time it takes to receive it see above examples.

>Credit Card processing companies that therapists report using are: Square, PayPal, Stripe, Ivy Pay or their bank. These companies also process debit cards and bank funds. These processors charge/keep a small percentage of the dollar amount of the transaction, usually around 3%. Some therapists use a credit card terminal to swipe or insert cards — this is purchased from the card processor by the therapist — others use an app on their phone or tablet. I use the Square Terminal in my office and have it on my desk — whether I’m seeing clients in person or virtually; it’s easy to enter credit card numbers in or swipe if in person; it’s easy to read, and processes very rapidly. Very professional, convenient, and easy to use for both the client and myself.

Venmo and Zelle transfer funds from the client’s bank account and deposits the funds into the therapist’s practice bank account. The funds go directly into the therapy practice bank account and unless you have a Venmo business account, these types of platforms do not charge/keep any amount from the transaction. However, for instant transfers, Venmo does charge a small amount, equivalent to a credit card processing fee.

Plastiq, as described, charges the client’s credit card and deposits the full amount, no charge to the therapist, into the therapist’s bank account or sends a check within a week. The credit card processing charge is paid by the client in addition to the amount the therapist is paid.

HSA (Health Savings Account) and FSA (Flexible Savings Account) Cards are debit cards and are processed the same way. Clients who have HSA and FSA cards like to use those because they aren’t taxed on that income since it can only be used for qualified healthcare expenses — therapy is one. HSA and FSA cards help clients with high-deductible health insurance plans cover their out-of-pocket costs. Another thing to note about HSA cards is that contributions, up to the yearly IRS limit, can come from the client, the employer, a relative or anyone else who wants to add to the HSA.

So now you’ve had a presentation of a number of the options available to therapists for getting paid fast, and in easy, convenient, and cost-effective ways. By no means does this article include every option available to therapists as there are many more not mentioned here.

Should you decide to add some new payment options to your practice it will, I’m sure, give you added time, money, and clients. See what differences these new options bring to your practice.

Lynne Azpeitia, LMFT, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping them develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visitwww.Gifted-Adults.com or www.LAPracticeDevelopment.com.