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In this installment of “Let’s Get Technical,” our panel of experts review three payment processing platforms: Square, Stripe, and Ivy Pay.

December 2020

Illustration of a phone displaying text Pay

With the expansion of telehealth, practitioners need tools that let their patients pay them from anywhere. Many psychologists can turn to their practice management systems for integrated payment options, but for those without a cohesive solution, a standalone payment platform could be the best approach.

Billing for psychological services, however, is not as simple as invoicing for home repairs or online purchases. There are important HIPAA and other privacy issues to keep in mind, and processing fees to consider.

Our panel of psychologists rate and review three popular payment processing platforms to help you find one that balances ease of use and security with system integration and cost.


Square

square-up-logo

Review Ratings

5
★★★★★

5
★★★★★

Stripe

stripe-logo

Review Ratings

3
★★★☆☆

2
★★☆☆☆

Ivy Pay

ivy-pay-logo

Review Ratings

3
★★★☆☆

3
★★★☆☆

Square

Square credit processing service logo Square is a credit processing service that offers a range of products and services to assist in building and marketing a business. Square strives to offer a simple startup process and provide a fast and easy way to accept credit card payments at any time and from anywhere.

For businesses that are subject to HIPAA, Square’s services are compliant and include a Business Associate Agreement (PDF2 289KB) (BAA) at no charge. The BAA also applies to any third party that Square contracts with for its services. Square, like many other payment processors, offers auto-generated email or text receipt for services. Psychologists will want to turn this optional feature off to be consistent with HIPAA Security Rule requirements.

Square has no monthly fees, only the price per transaction which ranges from 2.9% to 3.5% plus 15-30¢ flat fee (invoice transactions: 2.9% + 30¢, Card-not-present transactions: 3.5% + 15¢, Card on File transactions: 3.5% + 15¢).

Overall Review Ratings

5

★★★★★

—Mary O'Leary Wiley, PhD, ABPP

5

★★★★★

—JoAnna Romero Cartaya, PhD

Panelist Ratings and Comments

Mary O'Leary Wiley, PhD, ABPP I would highly recommend Square to other psychologists, especially those who do not have credit or debit card payment systems integrated into their practice management software. Square is easy to use, gets very good ratings, and allows practitioners to sign a HIPAA-compliant agreement.

The company seems very serious about confidentiality and security, and the software is easy to use on smartphones or on a computer. Automatic deposits save time and energy for the psychologist. It is especially appropriate for payments for telehealth sessions since checks or other forms of payment are more difficult to collect.

I see no clinical contraindications for any specific type of client. Square does what it promises and does it well.”
— Mary O'Leary Wiley, PhD, ABPP

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Privacy/Security

4 ★★★★☆

Square provides an extensive privacy policy that details how the provider’s and patient’s personal and financial information is collected, encrypted, stored, and shared. Square allows psychologists and other providers to meet the requirements of HIPAA through an easily obtained BAA. The only higher level of security would be a payment system that is part of an integrated HIPAA-compliant billing and record system.

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Available Features

5 ★★★★★

For accepting copays and balances due from clients, Square is elegantly simple with all the features necessary for payment by a credit card (or debit card, including Health Savings Account and Flexible Spending Account cards). Square does not process insurance claims or payments but does offer more complex services including payroll functions and tax filings, and it can be used to issue statements or invoices.

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Ease of Use

5 ★★★★★

Square is easy to use for direct and online payments. You can enter whatever amount your client tells you to process into Square using a smartphone, and it is quickly processed. Payment is directly deposited into your bank account, typically within a day or two.

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Functionality

5 ★★★★★

Square requires little bandwidth while using the smartphone app or the website. I enjoy using Square, and my clients have never had any concerns about it.

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Customer Support

4 ★★★★☆

My experience with customer service was minimal but assistance is provided through online chat and email. There are educational resources available online, including a searchable community question and answer information library.

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Value for money

5 ★★★★★

Square provides excellent value for the money spent. There are no start-up fees or monthly charges. For a $150.00 client charge, Square withheld $4.56 in fees (3.04%). Given that there is no overhead for using it, for a point of service payment system, this is very reasonable.

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Recommendations for use

I would recommend using Square primarily for collecting payments from clients. It allows easy and quick transactions and automatically deposits the payments into your bank account, saving time to deposit checks or cash payments.

Although Square can be used for online scheduling and by multiple service providers at a business location, it is not a practice management system. It also does not bill insurance companies or have integrated medical billing software.


JoAnna Romero Cartaya, PhD I enjoy using Square and would recommend it to colleagues. It is a large payment processing business with a wide range of products and services for running a business.

Square’s terms of use and privacy policies provide clear information regarding online card processing security measures, HIPAA compliance, and an easily accessible BAA. Fees are transparent (although in some cases higher than other card processing services) and may require additional purchases of card readers or a touchless device.

Clients can easily review charges posted to their user account and payments are quickly transferred. Customer service is responsive and there is a wide community resource library.

Because it is highly customizable to fit a practice’s branding and marketing, Square can be used in a variety of settings with different practice sizes and levels of employees, as well as assist in accounting or payroll options.
—JoAnna Romero Cartaya, PhD

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Privacy/Security

5 ★★★★★

Square’s services allow for HIPAA compliance and easy access to their BAA. Square employs strong security features such as end-to-end encryption; cryptographic protocols and message formats for transferring data; and 24/7 server monitoring. In addition, no card numbers, magnetic stripe data, or security codes are stored on Square’s client devices.

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Available Features

5 ★★★★★

Square provides basic fee collection and credit card processing, but also offers many different add-on services, including the ability to use it on a business/organization website, payroll, accounting services, client self-scheduling, website design, and marketing services.

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Ease of Use

5 ★★★★★

I found Square to be simple to use and quick to get up and running on an iPad, desktop, and mobile phone. Invoices and additional features are customizable and can easily be designed around your own branding. The touchless options and chip readers were also straightforward for both provider and client.

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Functionality

5 ★★★★★

Square performs well and quickly processes payments through phone, card on file, or using a card reader. It is not recommended to try collecting and processing payments while offline, so having the option to switch to using a phone with mobile data is handy.

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Customer Support

5 ★★★★★

Customer service was courteous and helpful online, and quick to respond if calling, though it was difficult to find a phone number on their website. Square also provides multiple resources, how-to guides, and blog articles.

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Value for money

5 ★★★★★

While overall fees for using Square credit card processing run between 2–4% of a transaction, the customer support and range of services and add-ons make it a good value. Included in their fees are fraud monitoring and high levels of security and privacy measures, as well as payment dispute assistance.

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Recommendations for use

Square is highly customizable to fit a practice’s branding and marketing as well as assist in accounting or payroll options. In addition, during the pandemic Square offers multiple methods of taking payments whether in person or remote. Square also makes it easy for clinicians to create an informed consent document outlining payment processing practices and a form for clients that may choose to have a card on file. For providers establishing an online presence or who want to learn a little more about marketing, the online forums and community of business owners is a good resource.

Stripe

Stripe online payment processing platform logo Stripe is an online payment processing platform that has plugins and integrations for hundreds of business software applications including e-commerce platforms, accounting and invoicing systems, and customer relationship management (CRM) software. The software offers a variety of features that support better understanding and tracking of the financial aspects of a business.

Stripe is compliant with the Payment Card Industry (PCI) standards, but it is not HIPAA-compliant on its own. As a result, you cannot store patient name or credit card information on the Stripe app or platform; however, some practice management systems have integrated Stripe onto their HIPAA-compliant platforms.

Psychologists who opt to use Stripe should be aware of the software’s auto-generated email receipt feature and the need to deactivate it to be consistent with HIPAA Security Rule requirements.

There are no monthly fees, only the price per transaction of 2.9% + 30¢.

Overall Review Ratings

3

★★★☆☆

—Charmain F. Jackman, PhD

2

★★☆☆☆

—Kevin D. Arnold, PhD, ABPP

Panelist Ratings and Comments

Charmain F. Jackman, PhD Providers with small independent practices may find Stripe useful and convenient. Customer service is responsive and accessible, and Stripe provides reports that allow providers to look at trends in their business.

The lack of HIPAA compliance is a missed opportunity, but smooth integration with practice management platforms that are compliant is a significant benefit. Larger practices, however, may already have a practice management software with an integrated payment system, and there is unlikely any incentive to change to using Stripe.
—Charmain F. Jackman, PhD

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Privacy/Security

4 ★★★★☆

Security is a major focus for Stripe, and the app requires a password and two-digit verification code to enter the site. Credit card information is de-identified and only the last four digits are visible.

While Stripe is not HIPAA-compliant on its own, some practice management platforms have integrated Stripe into their HIPAA-compliant platforms, which is convenient for providers to have most aspects of their business in one place.

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Available Features

4 ★★★★☆

Stripe has been around since 2011 and has a lot of features that support better understanding and tracking of the financial aspects of your business. Stripe provides the capacity to integrate on your website, and you can use the platform to sell products, digital courses, subscriptions, etc.

HIPAA compliance is a major missed opportunity, but their capacity to integrate with other HIPAA-compliant software is a significant advantage.

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Ease of Use

4 ★★★★☆

There are a lot of features on the Stripe website, which can make it challenging to navigate. However, it is easy to find payments. There are a number of reports and analytics that can be performed. The patient user experience is minimal and similar to other credit card transactions.

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Functionality

4 ★★★★☆

Providers can swipe cards or enter information manually with Stripe. The app and website function well, but the app is limited in what it can do. The web-based design is more relevant for psychologists who want to tap into the financial side of their practice and set goals and view trends in their business.

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Customer Support

4 ★★★★☆

Stripe offers 24-hour customer service, and you can chat or have a telephone conversation with a representative. When you request support, they let you know the expected wait time. You can also email your question, but the response time is longer.

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Value for money

3 ★★★☆☆

Stripe is on the pricier side at 2.9% + $0.30 per transaction. The value is in the security and the financial reports that come with it.

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Recommendations for use

For providers who expect to have a busy practice, it would be worth your time to look into a practice management platform that has Stripe integrated into the platform, as you will be able to benefit from organization-negotiated lower rates. The transaction fees definitely add up, but the convenience of being able to charge your clients at the time of the session is crucial, especially when using telehealth.

Kevin D. Arnold, PhD, ABPP I would not recommend Stripe for psychologists. The features and costs do not seem well-suited to behavioral health overall, especially when thinking of offices providing 160 to 500 billed units per month. Even for large groups, alternatives to Stripe exist in the healthcare finance market that are less expensive and better tailored. For example, finding a payment processing system that provides an automated payment posting option would allow psychologists to avoid the costs of keying payments into billing systems. Stripe seems much better suited to online commerce.
— Kevin D. Arnold, PhD, ABPP

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Privacy/Security

3 ★★★☆☆

The lack of BAA and HIPAA privacy policy is unfortunate. Stripe provides a number of privacy and security policy reviews on its website, and the ability to contact the security department via direct email is a welcome feature.

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Available Features

3 ★★★☆☆

Psychologists who use Stripe to process credit cards either in the office (through the use of a credit card processing terminal) or online likely will be satisfied. It has additional features, such as setting up autopayments or invoice billing, however, these features appeared complicated to setup and use. A key positive feature is app options such as GooglePay, something many psychologists likely could integrate into their EHR-based portal sent invoices.

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Ease of Use

3 ★★★☆☆

Stripe’s terminal-based and online credit card process were very easy to use, however, navigating the processes for autopayments, invoicing, and bank account electronic funds transfer were very complicated to understand. Stripe’s delay in delivery of funds was also much longer than most. Patients familiar with online payment processing, or with the use of apps like ApplePay, will find Stripe just as easy to use.

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Functionality

4 ★★★★☆

Stripe’s functionality is about the same as other similar systems. Given its capacity to accept payments from apps, Stripe’s functionality is probably superior for payment processing when compared to many bank-based systems.

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Customer Support

4 ★★★★☆

Stripe offers chat, phone, and email support with accurate wait times. Customer support was responsive and usually capable of providing some, or most, of the needed help; but sometimes the content of the web-based written guidance was overly complicated and technical.

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Value for money

2 ★★☆☆☆

When compared to bank-based payment processing, the fees for Stripe seemed high (2.9%+$.30) per card processed charge. The ACH delivery of payment also seems excessively long and that has its own cost associated.

Ivy Pay

Ivy Pay logo Ivy Pay is a payment system created specifically for therapists featuring instant payment, secure credit card storage, and progress notes. It is marketed primarily for solo practitioners and is entirely app-based (Android and Apple platforms) for the provider.

On the patient side, an SMS message is sent to the client providing them with a link to a secure web page to enter their credit card information. Ivy Pay is designed to be HIPAA secure and they offer a BAA.

There are no monthly fees, only the per charge fee of 2.75% per transaction.

Overall Review Ratings

3

★★★☆☆

—Charmain F. Jackman, PhD

3

★★★☆☆

—JoAnna Romero Cartaya, PhD

Panelist Ratings and Comments

Charmain F. Jackman, PhD Ivy Pay is great software for therapists with small practices who do not already use a practice management software. This would have been great during the period when I was still doing paper progress notes and did not have an integrated practice management system. So, for those therapists, I think it is a solid product that allows you to take payments and document progress, an added feature that most payment systems do not have.

However, if you already have a practice management system with an integrated payment process, I do not think that it would be worth it to add Ivy to the mix. What you would save in $0.30 transaction fees will not likely be worth the headache of having all your practice management tools on different platforms.
—Charmain F. Jackman, PhD

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Privacy/Security

5 ★★★★★

Ivy Pay’s main selling point is that it is HIPAA-compliant and that it was created specifically for therapists. Client information is stored, and their privacy policy explains how the data is stored. Security is a high priority for Ivy Pay. To enter the app, therapists enter a pin, which times out in under a minute of inactivity. Patients need to enter a password and a 2-digit verification code each time they access the site.

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Available Features

3 ★★★☆☆

At the end of the day, Ivy Pay is only a payment system—one that allows you to store protected health information directly on the app because of its HIPPA-compliant design for therapists. You will not be able to generate superbills for patients as there is no place to put diagnoses or to generate invoices, but the app does track weekly and monthly payment activity, and you can obtain a year-to-date financial statement.

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Ease of Use

5 ★★★★★

Ivy Pay is easy to use and to navigate. It is a simple interface with just a few features, so it is not confusing at all. Patients access it through a link that is sent from the therapist, so they do not need to download an app or visit a website.

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Functionality

3 ★★★☆☆

Ivy Pay is only app-based, and one limitation is that providers cannot access the data from a web-based interface. Not being able to print superbills or other invoices for patients limits how well it can be used.

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Customer Support

3 ★★★☆☆

I did not need support, but I reached out to get a sense of their response time. Customer support is limited. There is no phone number to call directly, but you can send an email or request a call back. I did not receive a response to my email. They do provide responses to frequently asked questions.

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Value for money

4 ★★★★☆

Ivy Pay is specifically designed for therapists and is HIPAA-compliant. There are no upfront costs, only the per charge fee of 2.75% per transaction. This is more reasonable than most payment systems that typically charge a flat-rate fee plus a transaction fee.

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Recommendations for use

I recommend Ivy Pay for therapists with small practices who do not already use a practice management software. It is a solid product that allows you to take payments and document progress.

JoAnna Romero Cartaya, PhD Ivy Pay is easy to use as a credit card collection service tailored to individual mental health providers without a contract or subscription fees. Its credit card processing fee is low in comparison to other similar services and provides a completely touchless payment process.

Ivy Pay is only for providers who are in solo practices as it does not appear it can be used for multiple accounts and the app will only work on one mobile phone—no desktop version and no options for customization.

Ivy Pay works fairly well as a payment processing app but has some features that I didn’t feel are congruent with a payment app (i.e., ability to create clinical notes, deep breathing exercise). As an independent provider with a cash practice, given my unreliable customer service experience and difficulty in getting questions answered, I would be less inclined to use this service or recommend it to others, even with the lower price point.
—JoAnna Romero Cartaya, PhD

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Privacy/Security

3 ★★★☆☆

Ivy Pay is a HIPAA-compliant app that uses encryption, two-factor authentication, and adheres to Payment Card Industry Data Security Standards. Setting up the security features of the app was easy and straight forward. Downloading an unsigned BAA was easily accessible. Receiving the signed BAA, however, was challenging.

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Available Features

3 ★★★☆☆

Ivy Pay creates a mobile invoice for easily processing credit cards and tracking payment by cash or check. Ivy Pay also includes features that are unexpected for a payment processing app such as the ability to create clinical notes and a breathing exercise for clients that automatically appears.

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Ease of Use

4 ★★★★☆

Ivy Pay is very easy to navigate and quick to set up. Funds are typically deposited within 24 hours. My clients did find it challenging to obtain a receipt. Use requires a mobile number (no landlines) for every client listed—and mobile numbers cannot be duplicated.

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Functionality

2 ★★☆☆☆

Generally, the app functions fairly well for processing payments, but there were a few concerning issues for clients paying with cash or check (unnecessary text messages sent as a result of not putting a credit card on file; no way for the client to review the terms of service), and for the provider (signed BAA request in the app was not responded to; if the client has not paid by the time of the next session Ivy Pay will not let you create another charge for the client).

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Customer Support

2 ★★☆☆☆

Customer service was challenging to navigate and unreliable when it came to scheduled phone consultations. There is no direct phone number or email provided to get in contact with customer service—all is done through the app with the feature of “call back” or “email me” with a text box for questions. There is no other support or resources available. No educational material is provided.

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Value for money

3 ★★★☆☆

There are no contract or monthly fees for using Ivy Pay, and its credit card processing fee is low in comparison to other similar services. The additional components of Ivy Pay for me did not add value to the app and were sometimes confusing.

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Recommendations for use

I would recommend solo or independent contractors who have cash-only practices use the app for a credit payment rather than an accounting tool or to attach notes to the session—given some of the issues with the functioning of the app. To start using it with a client, I would begin the setup while in person or over telehealth with the client and go from there.


Psychologist panel review ratings key

Categories rated from 1 to 5, with 5 being the most positive score.

Privacy/Security

If applicable, do the creators acknowledge that providers need to be HIPAA-compliant? Is it HIPAA-compliant? Do they offer a BAA? Are there other legal/regulatory issues to consider? Is there a privacy policy? Is data collected, stored, shared? Is data de-identified? Is there a security policy? Data encryption?

1-HIPAA relevant and ignored, no privacy policy etc.; 5-Highest levels of privacy and security

Available Features

Does the software have all the features your practice needs? What are the key features? What is lacking?

1-Missing many key features; 5-Has all the features our practice needs and more

Ease of Use

Is it easy to navigate? Is it customizable?

1-Very difficult; 5-Very easy

Functionality

Does it perform well? Is it web-based? Is there an app?

1-Very poor; 5-Very well

Customer Support

Is customer support responsive when needed? Do they provide support through the following contact options: Phone, email, online, educational resources, video tutorials?

1-Very unresponsive; 5-Very responsive

Value for Money

Does this software provide good value for the money spent?

1-Poor value for money; 5-Highly valuable

Overall Rating

Would you recommend this software to other psychologists? Why or why not? Summarize your thoughts on the software.

1-Strongly do not recommend; 5-Strongly recommend

Applications reviewed October 2020


This column discusses various software and applications available to psychologists for their professional use. The views expressed in this column are the views of the authors and do not reflect the views of the American Psychological Association or any of its divisions or subunits. All authors have no financial interests in the apps or software discussed. APA does not recommend or endorse any practitioners, products, procedures, opinions or other information that may be mentioned in this column; those who use these applications or products do so at their own risk. Please direct updates and feedback about apps to Communications Office Staff.

Date created: December 2020

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