Which payment processing platform performs best?

Available Features

Square has all the features that my practice needs. My client tells me how much to process and I input the data into Square using my smartphone. Square takes a small processing fee from payments prior to depositing into my bank account.

For larger practices, there are credit card readers, payment terminals and registers that can be purchased. There are also readers that allow a card to be swiped ($10 for reader that plugs into smartphone), and readers that are contactless and use credit card chips ($49). I have seen these used at restaurants but would not find them necessary as a solo practitioner.

Ease of Use

Note that using Square for scheduling, texting and other services such as email reminders becomes slightly more difficult.

Recommendations for use

I believe it would be easiest for solo practitioners to use, although it could be used for small group practices with centralized banking practices. The only patients that Square would be inappropriate for are those who do not feel comfortable with online payments or who do not have a smart phone.

Collecting copays or deductibles for telehealth sessions would be especially simple, compared to mailing in checks. It would be quite easy to avoid having to deal with collections if Square was used on a regular basis.

Privacy/Security

This service collects data on users including location and websites that the user had viewed prior to using their services. Clients who may be sensitive to information tracking may need to be informed how their therapist using this service may impact their own personal information.

Square also includes organizational security features, for example two-factor authentication and strong password controls are required for administrative access to the system. Security systems and processes are regularly tested by qualified internal and external teams, and Square also includes a detailed response plan in case of an emergency.

Available Features

Each Square account includes: Account takeover protection, End-to-end encrypted payments, active fraud prevention, Dispute management, and Data-security (PCI) compliance coverage.

Square also has an option to create contracts for payment—such as the ability to create a contract for putting a card on file, payment agreements, contracts for services and completion of services, which I found helpful. Other options such as asking clients to join a mailing list or provide feedback on services/environment are also available.

During COVID, how clients pay is important whether using a card on file, completing the transaction before or during the appointment, or by billing for services later (such as a no-show appointment). For those who do have an open office, Square offers card readers that are touchless and their services can be used on multiple devices including desktop computers, mobile phones, tablets as well as the ability to use Apple or GooglePay.

Square’s additional features can be overwhelming or exciting depending on one’s thoughts about marketing. Square offers support for designs and consultation through their support services, including walking through what features of Square may be most useful depending on the type of business using—Mental health practices are easily identified and set up when starting in Square.

Ease of Use

I found navigating Square’s website enjoyable and took away different ideas on things that may be helpful to further market a private practice—in addition they have resources and support for their services as well as a section on business during COVID-19 and focus on inclusion and the current state of standing out against systemic racism.

Customer Support

Square has prominently placed images and resources for COVID-19 and makes it clear that it is an option for touchless payment services and devices. In addition, they have a mission statement speaking out against systemic racism—and supporting Black and minority business, which includes posting resources with additional website links.

Privacy/Security

Stripe allows patients to send their own payment information to Stripe so that the psychologist is not sending the credit card information on behalf of the patient, nor is it necessary for psychologists to store credit card or banking information (and assume the risks for encryption and security of the financial information). Allowing patients to pay Stripe directly removes a number of liability concerns.

Stripe does reveal that it shares data with third parties (“We share personal data with third party business partners when this is necessary to provide our services to our users.”), and careful consideration of the expansiveness of the sharing might be worth asking about, since the Stripe website doesn’t provide details per se of the third parties with whom they share such things as patient names.

Available Features

Psychologists may wish to consider that, like most other similar products, Stripe is not a part of their billing system. The implication includes potential redundancies in invoicing (Stripe) and running patient statements (Billing System).

Since Stripe is not designed primarily as a healthcare product, it does not compile payment data and then export it to a psychologist for automatic payment posting in a billing system. This creates a need to key-in the payments, a process that can cause increased time in posting payments along with possible data entry errors.

The role of many of the features of Stripe in e-commerce likely are valuable to online retailers or other corporations desiring to sell things and establish invoicing, payment options, and processes that are well-beyond the need for most psychologists or group practices. Navigating the set-up and application of those features seemed confusing and hard to understand, likely because they lacked intuitive utility for practitioners.

Customer Service

If psychologists are very tech savvy, there are complete reference guides and a technical support chat option, though some of the content in the written tutorials was overly complicated and technical.

The videos are mostly easy to digest and offer many of the typical “how-to” types of information similar to YouTube.

The reviews from customers seemed particularly helpful, and Stripe should be commended for allowing critical reviews to be published (e.g., refreshing transparent).

Available Features

Ivy Pay allows you to store protected health information directly on the app.

Patients enter their credit information, so therapists do not need to access to card information, and you do not need a credit card reader.

In addition to credit card payments, therapists are also able to type a progress note right into the system.

On the patient side, users are only able to see receipts and payments.

Privacy/Security

Ivy Pay is downloadable in the Apple Store or Google Play. All data is entered via a mobile phone, and the platform easily and quickly walks through the steps of setting up passwords, a PIN, and security questions. This experience was also similar on the client’s end. No data is stored on the user’s phone.

The terms of service policy for Ivy Pay is found in a link on the terms of service for Talk Ivy—as they are both owned by Ivy Labs, Inc., but are separate services that are not related to one another. I had to request the terms of service that a client would receive as I could not locate it on their website.

I found it confusing that by using Ivy Pay—that in some way users are agreeing to Talk Ivy’s terms although not using that service or accessing that service. The terms of service also do not fully describe the content of Ivy Pay as for example, Ivy Pay includes a section to write clinical notes within the app—no additional information is given regarding the note feature or how records are requested or sent for example. I would think that providers would need to develop an informed consent, perhaps as Ivy Pay would send the records, if requested, rather than the provider.

Ivy Pay requires a PIN and clients are required to go through a two-factor sign to access the link provided in a text message. The client does not install the app; rather their interactions are via a web browser on their phone from a link sent in a text. The client will be taken through the two-factor authentication every time they want to view their receipt despite making an account and will need to download the receipt on the webpage to view offline if they wish to print it.

Per their privacy policy—the site uses both session cookies and persistent cookies when accessing Ivy and the information gathered may be used to address spam, malware, and identity theft.

Available Features

A provider generates an invoice with session fee, date, time with client initials, and mobile phone number. Ivy Pay will then text the client a welcome link to set up an account and place a card on file and process the payment. On the therapist end—once the account is set up the provider can set up a charge (invoice) and charge the card on file.

Ivy Pay accepts all major credit cards as well as HSA/HFA cards—same fee for all. The client enters their card information whether with the therapist in session or outside of the session—there is no chip or card swipe necessary and the provider doesn’t have to enter in any card information. This is especially handy for completely touchless payment.

Ivy Pay provides the option to create a clinical/progress note once an invoice is created, which will automatically save every ten seconds. However, no template can be created for any of the notes.

• I was surprised to see this as it was not described in any of their policies nor discussed on the website and is strange given Ivy Pay is marketed as a payment processing service only.
• There is an icon stating that these notes are HIPAA-secured encrypted notes and there is a toggle to go into “privacy mode” which makes the note unviewable on a mobile phone until the provider re-enters their pin.
• I also do not see an option to print the notes or how to send them out or information of how these notes are stored, maintained, or accessed if a provider is no longer using Ivy Pay. In discussing with customer service rep—providers can request notes to be sent by contacting customer service who then will process and send the notes. No current release forms are available on their site regarding the process of how their service will send the notes out if requested.

Once it’s set up, the app will prompt the user in a “time to relax” exercise and a short deep breathing exercise occurs. This feature was also a surprise as there was no mention of this feature on their website or within the app or on the website—this breathing exercise will keep running until the user closes the browser, which may not be appropriate for every client or if the payer of the session is not the client (i.e. in cases of the provider providing care to a minor rather than the parent). There is no current way to disable this feature.

Functionality

The app generates multiple text messages to the therapist at the onset of setting up accounts or if any changes are made, so in the beginning it would be many text messages depending on how many clients a therapist sees per day.

Contacting customer service and requesting a signed BAA was hit or miss within the app itself. I did not receive a signed BAA was until I emailed customer support directly.

Customer Support

Customer support did not show up to two scheduled and confirmed phone appointments. Email responses regarding the two missed phone appointments included mistakes and appeared to be cut and pasted from other responses.

The customer service agent also provided inconsistent explanations and did not acknowledge that they had no-showed twice. At the second no-show, an email response came 24 hours later. All questions sent from within the app through the “email me” feature never received a response.