Patient payments can happen at several points in the medical revenue cycle: before the visit, at check-in, or after the claim is processed. Any remaining balance can be paid online or through a payment plan.
Medical software often participates in that entire process. A platform handling scheduling, eligibility, billing, claims, and patient balances already has much of the context behind each payment. The payments relationship should work with that context and return more of the value those transactions create to the software company.
For established medical ISVs, that makes payments both a product and business decision, even when processing has worked for years.
Why does patient responsibility matter more to medical software now?
Patients are carrying great financial responsibility for their care. In 2025, KFF reported that 88% of covered workers were enrolled in a plan with a general annual deductible for single coverage, and 34% were in plans with a deductible of $2,000 or more. Among workers whose plans had a deductible, the average single-coverage deductible was $1,886.
That changes what a medical practice needs from its software.
Collecting from the patient can begin before the patient enters the building and continue well after the visit. MGMA treats both copayments collected at the time of service and patient-due balances collected at the time of service as practice operations benchmarks.
For the software platform, payments therefore sit inside a larger collection workflow. Getting the transaction approved is one piece of the job.
What does the patient payment workflow look like?
There are at least three distinct collection moments a medical platform may need to support.
Before the visit
The financial conversation can begin at scheduling.
For uninsured and self-pay patients, this can also involve a federal requirement. CMS generally requires providers to give these patients a good faith estimate when care is scheduled at least three business days in advance (or when an estimate is requested).
For insured patients, the workflow may involve eligibility information, expected cost sharing, prior balances, or other information available to the practice before the appointment. The payment experience is already connected to scheduling and patient access.
At the visit
During check-in, the practice may know a copay or another amount that can be collected at the time of service.
That payment needs to make its way back into the patient’s account without creating another reconciliation job for staff. In an October 2025 MGMA poll, practices that reported improving patient balance collections frequently pointed to stronger time-of-service collection, clearer estimates, and tighter front-end processes.
The front desk shouldn’t have to choose between moving the patient through the visit and improving financial workflow.
After the claim
The patient’s final balance may differ from the amount estimated before the visit. Now the platform may need to support a card-on-file charge, online payment, payment plan, refund, or another balance-resolution workflow.
The platform can tie the payment to the right patient, encounter, and balance – so staff aren’t reconciling it elsewhere later.
Why should a medical ISV look at the provider behind that experience?
Every transaction creates processing volume. Across a large practice base, those transactions become a recurring part of the software’s economics.
The software company may also depend on its payments provider for capabilities that users experience as part of the platform itself. Those can include card-on-file functionality, recurring payments, refunds, reporting, online collection, and in-person payment options.
If the platform has grown substantially since the original payments agreement was signed, it’s worth examining the relationship again.
The processing may still work perfectly well while the commercial or operating model no longer fits the company behind it.
What changes under Managed Payment Facilitation?
Managed Payment Facilitation allows ISVs to earn from payment volume while the payments partner remains the registered PayFac. The practices processing through the program operate as sub-merchants under the provider’s PayFac structure.
Under a Managed PayFac model, NUMBER holds that role and handles the payments infrastructure behind it, including merchant underwriting, risk management, and the regulatory responsibilities associated with the PayFac program. The medical ISV can focus on the software experience while participating commercially in the payment activity its product supports.
For a platform already processing payments, though, a better economic model is only useful if the existing patient collection workflow survives the change.
What should a medical ISV protect when it switches payment providers?
This is where medical platforms have a different problem from companies adding payments for the first time.
Practices already have a way of working. Staff know how they collect at check-in. Patients may already have cards stored. Payment plans may already be running. Online collection may already feed into balances and reporting.
A switch should start with that existing workflow.
The first question for a prospective provider should be: what will our practices have to do differently?
That includes the visible workflow and the systems behind it:
- What changes at check-in?
- How are existing cards on file handled?
- What happens to active payment plans?
- Does the practice need another portal or login?
- How are payments reconciled back to patient balances?
- Who answers the practice when a payment fails or something looks wrong?
The answers determine how much of the switch reaches the people using the software every day.
After all, provider changes can affect collections. In the same 2025 MGMA survey, medical groups reporting worse patient balance performance cited factors including staffing disruption, vendor changes, and system conversions that interrupted collection consistency.
For a medical ISV, preserving the collection workflow is part of protecting the practice relationship.
Engineering needs to see the payment surface before it scopes the work
The same principle applies behind the interface.
Medical platforms may already use payment functionality for stored cards, payment plans, refunds, online collection, in-person transactions, and reporting.So engineering needs to compare the current payment surface with the new one before anyone estimates the project.
NUMBER’s developer documentation exposes several integration paths, including REST APIs, mobile SDKs, PayForm, Virtual Terminal, and desktop integration options. The same documentation covers functionality including card-on-file plans, recurring payments, transaction processing, credits, and reporting.
That produces a much better estimate than treating “payments integration” as one line item.
Who should support the practice after payments go live?
To the medical practice, the payment experience belongs to the software.
When the terminal won’t connect, a payment cannot be located, or a transaction needs to be investigated, the practice is unlikely to spend much time thinking about the organizational boundary between the ISV and processor.
It needs an answer.
A medical ISV should know where its responsibility ends, where the payments partner takes over, how issues are escalated, and what the practice experiences while the problem is being resolved.
If every payments issue still becomes an internal product-support ticket the ISV must chase through another company, some of the operational burden stays exactly where it was.
The economics of a new agreement count, and so does the amount of payments work the software company still must carry.
What should payments support across the medical revenue cycle?
By the time a balance is ready to collect, the platform may already know what happened at the visit, what insurance paid and what the patient still owes.
Payments should carry that context through to collection. What’s paid at check-in should post correctly. What remains after adjudication should be easy to resolve. And when something goes wrong, staff should know where to turn.
As payment volume grows across the practice base, the software company has a commercial stake in that growth.
That’s a more useful standard than asking if the processor can run a card.
Where NUMBER fits
NUMBER is a registered PayFac of KeyBank and provides Managed Payment Facilitation for software companies, including healthcare platforms.
If your medical platform already processes payments, bring us the workflow you have today. We can show you how NUMBER would support it and where your platform can capture more value from existing payments..
Frequently asked questions
When should medical software collect patient payments?
There is no single collection point that applies to every balance. Depending on the patient’s coverage and the information available to the practice, payment may occur before care, at the time of service, or after claim adjudication. Medical software should be able to support the appropriate payment workflow at each stage.
Does a medical software company need to become a PayFac to earn payment revenue?
No. Under a Managed Payment Facilitation arrangement, the payments partner remains the registered PayFac while the software company can participate in the economics of transactions generated through its platform.
Does changing payment providers require rebuilding the medical payment workflow?
It depends on the existing integration and the new provider’s technical model. The ISV should compare current payment functions, APIs, stored-payment workflows, reporting, and practice-facing processes before estimating the migration. Reviewing the provider’s integration documentation before scoping the project gives engineering a more concrete basis for that comparison.
Sources:
- KFF. 2025 Employer Health Benefits Survey
- Centers for Medicare & Medicaid Services. What Is a Good Faith Estimate?
- Medical Group Management Association. 2025 DataDive Benchmarks and Filters Guide
- Medical Group Management Association. Patient Balance Collection: What’s Moving the Numbers and How to Get Ahead, October 22, 2025.
- Mastercard. About Payment Facilitators
