Surcharging Explained: Rules, Risks & Best Practices

Implementing Credit Card Surcharging in ChiroSpring

How to evaluate, enable, and communicate credit card surcharging in ChiroSpring while maintaining compliance, transparency, and a smooth patient checkout experience. It is designed to help staff understand when surcharging applies, how it appears in the system, and what to tell patients.

1. Define what surcharging is and when it applies 0:49

• Surcharging means adding a fee to a credit card payment to offset processing costs.

• The surcharge can be up to 3% or the actual cost of acceptance, whichever is lower.

  Do not apply surcharging to:

  • Debit cards
  • HSA cards
  • EBT cards
  • Gift cards
  • Cash or checks
• Use this definition to train staff so they can explain the program clearly to patients.

2. Confirm the business case for surcharging 2:15

• Review current credit card processing fees as one of the business’s largest expenses.

• Estimate how much can be recovered by shifting credit card fees to the cardholder.

  Use the savings to support business goals such as:

  • Hiring staff
  • Purchasing equipment
  • Improving patient care
  • Increasing retained revenue
• Compare the cost of surcharging against the cost of continuing to absorb processing fees.

3. Verify compliance requirements before activation 7:34

• Register for surcharging with the processing bank.

• Post required signage at the point of entry and point of sale, both in-person and online.

  Provide disclosures that explain:

  • The surcharge rate
  • How the fee is applied
  • How patients can avoid the fee
• Ensure the surcharge is shown as a separate line item on receipts and checkout screens.
• Confirm the surcharge rate never exceeds the allowed cap.

4. Check state-specific restrictions and special rules 12:13

• Do not surcharge in jurisdictions where it is prohibited, including:
  • Connecticut
  • Massachusetts

  • Puerto Rico

    Apply special handling where required:

  • Maine and New York may require dual pricing displays
  • Oklahoma has a 2% surcharge cap
  • Colorado and New Jersey have specific disclosure requirements
• Use system controls to automatically detect and apply the correct rule set when possible.

5. Understand the customer experience and staff communication plan 14:07

• Make sure staff can explain surcharging in a simple, transparent way.

  Train frontline team members to say:

  • The fee applies only to credit card payments
  • Patients can avoid the fee by using another payment method
• Reinforce that transparency reduces confusion and improves acceptance.
• Prepare talking points and FAQs for common patient questions.

6. Avoid common compliance mistakes 15:31

• Do not rename the fee to avoid compliance rules; it is still considered a surcharge.
• Do not assume your location automatically exempts you from the rules.
• Never surcharge debit cards.
• Do not mix up surcharging with cash discounting.
• Do not apply surcharging differently based on whether a transaction is B2B or B2C unless the rules specifically allow it.

7. Configure the checkout workflow in ChiroSpring 26:37

• Ensure the process is fast and seamless at checkout.

  Avoid manual steps such as:

  • Asking whether the card is credit or debit
  • Toggling buttons manually
  • Using calculators or separate receipts to determine the fee
• Confirm the workflow is built into the normal payment process.
• Make sure the system automatically identifies the card type and applies the correct surcharge only when appropriate.

8. Confirm supported payment methods and flexibility 27:28

• Verify surcharging works across supported payment methods, including:
  • Tap to pay
  • Swipes
  • Dips
  • Virtual entry
  • Statement payments
• Confirm the system applies the surcharge only when the payment is a credit card.
• Ensure the workflow remains consistent across in-office and remote payment scenarios.

9. Review how surcharging appears in checkout and receipts 28:59

• At checkout, the system should display the surcharge amount automatically.
• For terminal-based payments, the patient should be prompted to accept or decline the surcharge.

• If the patient declines, the transaction should be canceled so they can choose another payment method.

  Receipts should show:

  • Base amount
  • Surcharge amount
  • Final total
• Confirm the surcharge is visible on the receipt for compliance and transparency.

10. Understand how surcharges appear in reporting and refunds 30:09

• Review payment history to understand how surcharge transactions are stored.
• Confirm the base transaction amount remains visible without inflating the original sale amount.
• When processing refunds, verify the system includes the surcharge amount where applicable.
• Use the payment history report to view surcharge amounts if a patient asks for details.

11. Handle virtual credit card payments correctly 31:37

• Identify virtual credit cards used by insurance payers as credit card transactions.

• If surcharging is enabled, virtual credit card payments may not cover the full amount after the surcharge is applied.

  Contact insurance payers and request an alternative payment method such as:

  • Check
  • Direct deposit
• Avoid accepting virtual credit cards if they create reconciliation issues under the surcharge model.

12. Evaluate savings and decide whether to launch 32:47

• Estimate savings based on monthly card volume and current processing rates.

• Compare the expected savings to current monthly processing fees.

  Decide whether the program is a good fit for the practice based on:

  • Patient mix
  • Payment behavior
  • Comfort level with the policy
• Prepare staff with answers to common objections before launch.

13. Communicate the policy to patients clearly 33:44

• Post signage so patients know the policy before paying.

• Prepare a short explanation for staff to use when asked why the fee exists.

  Reinforce that patients can avoid the surcharge by paying with:

  • Debit card
  • Cash
  • Check
  • HSA card, when applicable
• Keep the explanation simple, transparent, and consistent across the team.

14. Set up patient-facing disclosures for memberships and online payments 39:53

• If memberships or recurring payments are sold online, add a disclosure on the website.
• If memberships are sold in-office, ensure signage is visible at the point of sale.
• Confirm patients can see the surcharge policy before they enter payment details.
• Update website footers or payment pages if needed to reflect the surcharge policy.

15. Know how to enroll, get help, or turn the program off 34:33

• Complete the surcharge signup form to begin setup.
• If not already using Kaira Spring Pay, enroll in that service as well.
• If questions arise, route compliance-related questions to the appropriate support team.
• If the practice later decides to stop surcharging, request that the program be turned off.

Notes

• Do not surcharge debit cards, HSA cards, EBT cards, gift cards, cash, or checks.
• Do not exceed the legal cap; in most cases this is 3%, but some states have different limits.
• Do not use surcharging in prohibited jurisdictions such as Connecticut, Massachusetts, and Puerto Rico.
• Do not rename the fee to avoid compliance rules; regulators may still treat it as a surcharge.
• Do not mix surcharging with cash discounting unless you fully understand the legal and operational differences.
• Do not rely on staff judgment to identify card type; use system automation whenever possible.
• Do not skip signage or receipt disclosures; these are required for compliance and transparency.
• This SOP is operational guidance and does not replace legal advice.

Tips

• Use automated card-type detection to avoid manual errors at checkout.
• Keep a short FAQ script at the front desk for common patient questions.
• Standardize signage and website disclosures so every location uses the same language.
• Review monthly payment reports to estimate savings and confirm surcharge activity.
• Train staff to offer the patient a choice: pay the surcharge with credit card or avoid it with another method.
• If you process many virtual credit card payments from insurers, proactively request check or ACH payment instead.
• Revisit state rules periodically, since surcharge regulations can change.