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Whether you’re cash-pay only or in-network everywhere, patients hand you a card every day, copays, deductibles, cosmetic work, memberships. The POS decision is less about the reader on the counter and more about four things: what it costs at your volume, whether it talks to your EHR/PM ledger, whether HSA/FSA cards work, and how well it handles card-on-file and recurring plans.

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The contenders

A reasonable default: start on Square (in-person-heavy) or Stripe (online-heavy) under transparent flat pricing; renegotiate into interchange-plus with a traditional processor when monthly card volume makes the savings real; switch to EHR-native processing when posting payments by hand starts costing staff hours.

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Set it up like a healthcare business

However you choose, the setup mistakes are the same ones: Open the account under the entity, not yourself. Legal name and EIN of the practice (or the PC, in an MSO/PC structure, patient revenue belongs to the PC). Processing under your SSN ties 1099-Ks and processing history to you personally and complicates a future sale. Set the business category (MCC) honestly. The MCC does two jobs: it keeps the processor’s risk team from freezing a “miscategorized” medical account, and it’s what lets patients’ HSA/FSA debit cards approve, those cards only work at healthcare-coded merchants. If a patient’s HSA card declines anyway, they can pay normally and submit the receipt to their plan for reimbursement. Settle to a dedicated account. Point deposits at the practice operating account so card revenue is identifiable on the bank statement, it makes reconciliation and month-end close dramatically easier (account structure). Keep receipts and descriptors HIPAA-clean. Statement descriptor = the practice’s public name (unrecognized charges become disputes); no diagnosis or treatment details on receipts or invoice line items. Get card-on-file authorizations in writing. Stored cards with signed authorization are the backbone of payment plans and no-show fees, and the first thing a chargeback review asks for.

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Memberships, packages, and recurring plans

If you run a membership or prepaid package model, the POS needs real recurring billing (not staff re-keying cards monthly). Two compliance tripwires to design around, with your attorney: several states regulate prepaid healthcare plans as insurance if they promise future services for a fixed fee (structure as discount-plus-per-visit where that’s a concern), and auto-renewal laws, California’s especially, require clear disclosure, affirmative consent, and easy cancellation. More on the model itself: hybrid & membership practices.

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Surcharging and cash discounts

Passing card fees to patients is legal in most states but tightly regulated: credit surcharges are capped (roughly your actual cost, max ~3-4%), must be disclosed before payment, and can never apply to debit cards, HSA/FSA cards are debit cards. Many practices skip the whole mess with a cash discount instead. Check your state’s current rule before enabling either.