Cash-pay and mixed practices take payment in many forms: debit and credit cards, health savings account cards, flexible spending account cards, checks, and cash. Each is slightly different in the books, and handling them consistently saves headaches.
For most practices, an HSA or FSA card is processed like any other card, and the deposit arrives net of fees. Your books should record the gross amount as revenue and the fee as an expense, rather than recording only the net deposit. That keeps revenue accurate and shows the true cost of accepting cards. Some patients will ask for itemized receipts to submit for reimbursement, so make sure your system can produce them.
Look at your processor statement and divide total fees by total card volume. If the percentage has crept up, ask why. Rates can change with card type, how a payment is entered, and your processing agreement. Review the statement a couple of times a year, as we suggested in our bookkeeping myths post.
A chargeback happens when a patient disputes a payment with their card issuer. They are costly, because you can lose the payment and pay a fee. Clear pricing at the start, signed agreements for plans, and good records of care all help. For prepaid packages, keep your refund and cancellation policy in writing and confirm it with the patient. The bookkeeping of those plans is covered in prepaid care packages.
When you refund a patient or lose a dispute, record it against the original revenue, not as a random expense. Tag chargebacks so you can see how many there are and whether a pattern exists.
Match each processor deposit to the batch of payments behind it. Differences point to fees, refunds, or errors. This is the same discipline that makes your monthly close faster, as in the month-end close checklist.
Record gross revenue and fees separately, review your fee percentage, document policies to reduce chargebacks, and reconcile every deposit. Payments are routine until they are not, and clean records make the exceptions easy to handle.
911 Bookkeepers works with chiropractic and cash-pay medical practices across the Baton Rouge metro and surrounding parishes, making sure payment methods, fees, and refunds are recorded cleanly.
Book a free 30-minute financial checkup and find out exactly where your business stands.