> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Set up card payments
> Choosing a processor for a dental group, card-present versus card-not-present economics, treatment-plan deposits, membership billing, surcharging legality, PCI scope, and saving cards on file compliantly.
Card payments account for a large share of patient collections in dentistry. Out-of-pocket spending is the largest source of U.S. dental expenditures,1 and annual maximums limit many dental-plan benefits. Configure the **settlement destination**, **card descriptor**, and **pricing model** using the legal entity structure, merchant agreement, bank documents, and expected volume.
## Prerequisites
* The PC's operating account open
* Your practice brand decided, for the descriptor
* Your expected card volume and mix
## Why this is a bigger decision in dental
In a medical group, the payer sends most of the money and patient cost-sharing is the remainder. In a dental group the proportions flip toward the patient: plans stop paying at the annual maximum, downgrades and frequency limits shift cost to the patient by design, and uninsured patients are a core segment rather than an edge case. Three card flows carry that weight:
* **Point-of-care collection** of estimated patient share at checkout
* **Treatment-plan deposits** for cases such as implants, full-arch work, and orthodontics, sometimes followed by installments on a stored card
* **Membership-plan billing** through recurring monthly or annual charges; see [Launch a membership plan](/guides/payments/launch-a-membership-plan)
Your processor has to do all three well, per legal entity.
## Choose a processor
| Option | Fits | Watch |
| ------------------------------ | --------------------------------------------------------------------- | -------------------------------------------------------------------------------------- |
| **Standalone processor** | Groups wanting rate control and portability | Requires integration work |
| **PMS-embedded payments** | Small single-entity practices | Blended pricing, lock-in, weak multi-entity support |
| **Bank-integrated processing** | Multi-entity groups wanting settlement to follow the entity structure | Availability varies |
| **Platform-bundled** | Speed to launch | See [Bundled payroll and processing](/concepts/banking/bundled-payroll-and-processing) |
**Test the multi-entity case before signing.** Can each location settle to **its own PC's** account? A processor that settles everything to one configured account will settle your second PC's patient payments into whichever account was set up first, which is a commingling problem, not a configuration preference.
## Pricing: interchange-plus vs blended
| | Blended / flat rate | Interchange-plus |
| ----------------------- | ---------------------------------- | ---------------------------------------------- |
| **Looks like** | "3.5% + 30¢" | "Interchange + 0.30% + 10¢" |
| **Transparency** | None, you can't see the components | Full, interchange is published by the networks |
| **Cost at low volume** | Simple, often fine | Marginally better |
| **Cost at real volume** | Usually worse | Usually better |
| **Benchmarkable** | No | Yes |
At meaningful volume, ask for **interchange-plus**. The published interchange rates are the same for every merchant; what you're negotiating is the markup, and you can only negotiate what you can see. A dental group's card volume gets to "meaningful" faster than its insured revenue suggests, because so much of collections is patient-paid.
## Card-present vs card-not-present
| | Card present | Card not present |
| ------------------- | -------------------------------- | --------------------------------------------- |
| Where | In office, dipped or tapped | Phone, online, saved card, membership renewal |
| Rate | Lower | Higher |
| Fraud liability | Generally the issuer's, with EMV | **Generally yours** |
| Chargeback exposure | Lower | Higher |
Encourage in-office payment at check-out where you can. It costs less and disputes less. Payment-plan installments and membership renewals are unavoidably card-not-present, which is why their written authorizations matter (below).
## Steps
Use a descriptor patients will recognize, such as "Bluebird Dental," rather than an unfamiliar legal entity name. A DSO structure often uses different legal names and brands, so confirm the actual statement display with a test transaction.
Set the descriptor to the brand, include a phone number if your processor supports it, and check what actually appears on a test transaction rather than what the configuration screen says.
Route settlement according to the merchant agreement, billing provider, entity records, bank documents, state law, and agreement stack. Keep the entity and location ledgers separate. See [Structure accounts across your entities](/guides/banking/structure-accounts-across-entities).
Passing the processing fee to patients is permitted in some states and restricted in others, and card network rules impose their own requirements including advance disclosure, signage, receipt disclosure, and caps.
**Verify both state law and network rules before implementing**, and note that debit card surcharging is generally treated differently from credit. Also weigh the patient-relations cost: a surcharge on a dental bill lands differently than one on a retail purchase, especially on a four-figure treatment plan the patient is already stretching to afford.
PCI DSS scope depends on how card data flows. To keep it minimal:
* Use **point-to-point encrypted terminals** so card data never touches your systems
* Use **hosted payment pages** or iframes for online payments, so card data goes to the processor directly
* **Tokenize** cards on file so the practice stores the token rather than the card number
* **Never** write card numbers on paper forms or store them in the PMS
Complete the appropriate self-assessment questionnaire annually.
Card data written on an intake form and filed in a chart is both a PCI problem and, in that context, arguably a privacy one. Train the front desk explicitly: never write down a card number.
Requires:
* **Written authorization** from the patient, specifying what may be charged and when
* **Tokenization**, using the processor's token rather than storing the card number
* **Notification before charging**, according to the agreement, policy, and applicable law
* A clear way for the patient to revoke
Card on file plus autopay is what makes large-case payment plans and membership billing work. It is also, done badly, a chargeback generator. The difference is the written authorization and the pre-charge notification. For an ortho or implant payment plan, the authorization should name the total, the installment amount, and the schedule.
Send an automatic email or text receipt, including for recurring charges. Include a recognizable descriptor and contact information for questions.
Card deposits arrive **net of fees**, in batches that don't align to individual payments.
Record **gross revenue and fee expense separately**. Netting them understates both revenue and expense, and it makes your effective processing rate invisible. See [Reconcile payments daily](/guides/payments/reconcile-daily-payments).
## Payer virtual credit cards
If a dental payer sends single-use card numbers instead of EFT, you are paying 2–3% on money that should arrive free. Complete their EFT enrollment and ask in writing to opt out of the card program. See [Paper checks and virtual credit cards](/concepts/payments/paper-checks-and-vcc).
## Verify it worked
* [ ] Descriptor tested on a real transaction and shows the practice brand
* [ ] Settlement points at the correct **PC's** account, per entity
* [ ] Interchange-plus pricing at meaningful volume
* [ ] Surcharging decision verified against state law and network rules
* [ ] PCI scope minimized; SAQ completed
* [ ] Card-on-file authorization form in use, with totals and schedules for payment plans
* [ ] Cards tokenized, never stored
* [ ] Receipts sending automatically, including recurring charges
* [ ] Gross revenue and fees recorded separately
* [ ] Dispute rate monitored against processor thresholds
## Common failure modes
| Failure | Consequence |
| ---------------------------------------------- | ------------------------------------------------- |
| Descriptor shows the legal entity name | Chargebacks |
| All entities settling to one account | Commingling |
| Blended pricing at high volume | Overpaying, invisibly |
| Surcharging without checking state law | Regulatory exposure |
| Card numbers written on paper | PCI and privacy exposure |
| Card on file without written authorization | Chargebacks you will lose |
| Payment plan with no stated total and schedule | Disputed installments |
| Netting fees against revenue | Understated revenue and invisible processing cost |
| Not monitoring dispute ratio | Reserves or account closure |
## Sources
1. ADA Health Policy Institute, [Dental care market](https://www.ada.org/resources/research/health-policy-institute/dental-care-market). Out-of-pocket spending was the largest source of U.S. dental expenditures in 2024.