Synopsis

(1) Some third- party administrators and insurance companies pay dentists using virtual credit card payments instead of issuing checks or electronic deposits.

(2) Dental Providers have the right to get paid by the method that best suits their needs.

(3) US Code of Federal Regulations 45 CFR 162.925 gives dental providers the right to be paid by Healthcare EFT Standard reimbursements.

(4) DO NOT accept Virtual Card Payments

What is Virtual Credit Card (VCC)?

A VCC is a claim payment from an insurance company (with an EOB) that has an image of a “credit card” along with a credit card number, expiration date, for the exact dollar amount of the claim being paid.  

Why are Virtual Card Payments BAD?

3 Reasons to Avoid VCC payments

#1: YOU PAY UNNECESSARY MERCHANT FEES:

Just like every other credit card payment, your merchant service provider will take a percentage of the amount processed. (usually 2% to 4%).

#2: THEY ARE CONFUSING:

When you accept a virtual card payment, your merchant account records it as “Visa” (or some other credit card)

When you record the virtual card payment in your software; do you post it as an “insurance” payment or as a “credit card” payment”? Maybe something else?

Unless you make changes in your software or your record keeping, it will become difficult to tell the difference between “insurance credit card payments” and “patient credit card payments”.

#3: THEY ARE TEMPTING:

In many cases, a virtual card payment can be used like any credit card to make online purchases. This opens the possibility of employee theft; and virtual card fraud can go undetected for a long time

Dentist’s should Opt-Out of Accepting Virtual Credit Card Payments

A “Virtual Credit Card” payment is not much different than a “Visa Gift Card”

Dentists can opt out of accepting virtual card payments.

Contact the carrier or plan administrator and request that payments sent by check, or EFT.

The carrier or plan administrator may give you the run around; be persistent and insistent in your denial to accept virtual card payments.

Read the fine print; it will have instructions on how to opt out.

Dealing with insurance companies is can be a PITA. The CAQH has provided a letter template that you can send to insurers. You can get it here: Sample_Provider_EFT_Request_Letter_to_Health_Plan.pd

The ADA also has information: Dentists can opt out of credit card reimbursement from third-party payers


States with Laws Regarding Virtual Cards

Georgia: https://www.ada.org/en/publications/ada-news/2018-archive/june/georgia-law-lets-providers-choose-reimbursement-method

Connecticut: https://www.ada.org/en/publications/ada-news/2018-archive/june/connecticut-law-lets-dentists-refuse-virtual-credit-cards

Alabama: http://216.104.34.14/~alabamamedicine/wp-content/uploads/2016/09/Act2016320.pdf

Others Links

U.S. Code of Federal Regulations. CFR 45§162.925. Additional requirements for health plans. Gov Regs. https://www.govregs.com/regulations/expand/title45_chapterA-i1_part162_subpartI_section162.925

Requesting EFT payments from health plans and status of implementation of operating rules. Council for Affordable Quality Healthcare (CAQH). December 2013. https://www.caqh.org/sites/default/files/core/template/letters/Sample_Provider_EFT_Request_Letter_to_Health_Plan.pdf

Need help? Contact Bill for assistance.
William Hiltz BSc MBA CET

Bill Hiltz is the CEO of
Hiltz & Associates
and the creator of
Dental FraudBusters.