By Nick McLaughlin, Founder and CEO of Breez Health
For years, one of the most overlooked challenges in hospital financial assistance has been a strangely ordinary one: the work often depends on tools never designed to carry it.
A shared spreadsheet. A crowded inbox. A filing cabinet down the hall. A folder on someone’s desktop that only one person knows how to navigate.
These systems are familiar and inexpensive, held together by people who understand every workaround and exception. Because the process technically works, it’s easy to mistake survival for stability.
But financial assistance is no longer a quiet back-office function. It sits at the center of patient experience, revenue cycle performance and regulatory scrutiny. Hospitals need to know who was approved, when eligibility begins and ends, what documentation supports the determination and whether the same standard was applied consistently across patients.
When that information lives across spreadsheets, paper files, inboxes and disconnected systems, the burden shifts to staff. They become the search function. They become the audit trail. They become the only thing standing between a routine question and hours of manual reconstruction.
The problem isn’t that the information doesn’t exist. It’s that finding it, trusting it and reporting on it takes far more effort than it should.
The Hidden Cost of “Where Did We Put That?”
A financial assistance determination doesn’t end when an application is approved.
In most hospitals, that approval has to be applied backward to prior balances and carried forward for future care, often for months at a time. A patient may return for imaging, a follow-up visit, an emergency department encounter or a new episode of care, and the same basic question has to be answered again: is this patient currently covered, and under what terms?
That should be a quick lookup. Too often, it isn’t.
The approval letter may be in a document management system. The eligibility window may be buried in patient accounting notes. Supporting documentation may live in an inbox. A spreadsheet may show the status, but not the history behind it. Repeated across hundreds of applications, “where did we put that?” becomes more than an annoyance. It becomes a hidden operating cost.
It also makes the program’s history harder to see. Whether a patient applied before, what they reported, what was verified and how their situation changed over time can all matter when making a current determination. In a fragmented system, that context is easy to lose. It only stays usable when the program has one consistent record to draw from.
Audit Readiness: Rebuilding the Story After the Fact
Financial assistance determinations are never as clean as they look on paper.
There’s what a patient’s household income and size actually are. There’s what the patient reports. And there’s what the documentation shows. Those three things rarely line up perfectly. Hospitals make decisions inside that gray area every day, using the information they have, the policy they follow and the judgment the process requires.
That’s where the audit risk begins, when that gray area gets handled differently from one application to the next. Household size may be interpreted inconsistently. Documentation standards may shift depending on who’s reviewing the file. A policy update may reach one workflow before it reaches another. Together, these issues create a pattern that’s difficult to defend once someone starts asking why similar cases produced different results.
Staff then have to spend hours reconstructing what happened on an account, reconciling conflicting answers across systems, and a supporting a process that’s hard to defend with confidence when someone outside the finance department starts asking questions.
What Changes When There’s One Record Instead of Five
There’s a meaningful difference between a process that works because people remember where everything is, and a process that works because the system itself keeps track. The first is fragile. It depends on tenure, institutional memory and a handful of people who happen to know the workarounds. The second holds up regardless of who’s covering the desk that day.
A centralized system of record doesn’t remove the judgment that financial assistance decisions require. It does make that judgment easier to apply consistently, and easier to show, after the fact, that it was applied consistently. Eligibility status, application history, documentation and determination logic all live in one place, so the answer to “what happened on this account” doesn’t depend on who you ask or which tab they happen to have open.
The Real Fix Isn’t More Effort
Every hospital I’ve worked with has smart, dedicated people running their financial assistance programs. The problem has rarely been effort. It’s been infrastructure.
Some hospitals do have much of this covered through sophisticated EHR infrastructure, but many do not. Especially those working with systems where financial assistance was never a primary design consideration. The fix usually isn’t asking staff to work harder or remember more. It’s giving the program a single record to run on, instead of asking people to be the system themselves.
The work of financial assistance will always require judgment. It shouldn’t also require a search party.
Editor’s note: Nick McLaughlin is the founder and CEO of Breez Health, which builds financial assistance solutions for hospitals, including FairSight, a system of record for managing eligibility, determinations and reporting.
