Interchange rates are the foundational costs of credit card processing. If you think of payment processing like a retail business, Interchange is the wholesale price. It is the baseline fee set by card networks (Visa, Mastercard, Discover, and American Express) that must be paid to the bank that issued the customer's card.
In your practice, you deal with fixed and variable costs - from malpractice insurance to the equipment in your adjustment rooms. In the world of payments, Interchange is the primary "wholesale" cost of doing business.
What is Interchange?
Think of Interchange as the baseline cost of processing a payment. It is a non-negotiable fee set by the major card networks (Visa, Mastercard, Discover, and Amex). These fees are paid by the merchant (you) to the bank that issued your patient’s card to cover the costs of fraud protection and the risk of lending.
The Anatomy of Your Fees
Just as a patient’s treatment plan is broken down into various adjustments and therapies, your processing fee is composed of three distinct parts:
Interchange (The Wholesale Cost): The fixed amount mandated by the card brands.
Assessments: Small fees paid directly to the networks (Visa/Mastercard) for using their infrastructure.
Processor Markup: The service fee paid to your payment processing bank, (Nuvei) for managing your account.
Why Do My Fees Change?
In the same way that a complex spinal adjustment requires more time and resources than a simple consultation, different transactions carry different "risks" and costs.
Factor | Lower Cost (Better Margin) | Higher Cost (Higher Overhead) |
Payment Method | Patient swipes, taps or dips their card in-office. | A "Card on File" or keyed-in payment for a missed appointment. |
Card Type | A standard debit card with no rewards. | A "Premier" Rewards or Corporate card used for a large payment. |
Data Quality | Full Address Verification (AVS) is used for cards. | Missing security data during a phone-in payment. |
Understanding the Bottom Line
Interchange rates are updated twice a year (typically April and October). While you cannot negotiate these rates, you can control your costs by prioritizing "Card Present" (chip) transactions and ensuring your staff collects the billing address for any payments processed using a card on file.
Since you can't realistically dictate which card your patients use, these rate changes are an expected business cost. Nevertheless, your recurring revenue model offers a long-term advantage, actually making you more profitable. Automating the payment process eliminates the "friction" of discussing money at the front desk, which, in turn, boosts patient retention.
Disclaimer: This article provides a general overview of interchange rates. Specific fees vary based on your processing volume, industry, and the specific cards your customers use.