Many health care institutions use electronic health records (EHR) to track financial assistance for patients, but how they do it varies greatly. On the financial side, many of these EHRs handle billing, insurance claims, and financial assistance tracking. Other EHRs are highly customizable for different specialties, integrate with third-party tools, and offer analytics to improve care and efficiency. While some advocates still rely on spreadsheets and manual notes to keep track of financial matters, there’s no universal way to do it, making financial navigation more complicated than it needs to be.  

One of these software systems, Epic, includes robust features that help cancer care centers manage billing, scheduling, and financial assistance. To support the effective use of systems like Epic in addressing these challenges, the Association of Cancer Care Centers’ (ACCC’s) Financial Advocacy Network hosted a coffee chat on January 27, 2025, where cancer program members shared strategies for leveraging Epic to enhance financial assistance efforts. 

What Is an Epic Work Queue? 

Work queues in Epic are a popular way to monitor copay assistance, free drug programs, and patient balances, “We currently do have a work queue for our [patients who are eligible to receive] free drugs, and then we also have a separate work queue for our patients [eligible for] copay assistance,” mentioned Linda Hayward, a patient financial advocate from the University of Maryland Upper Chesapeake Health-Kaufman Cancer Center. In Epic, a work queue is a to-do list that helps health care staff manage and organize tasks related to patient care, billing, scheduling, and more. Work queues automatically group accounts, orders, claims, or other records that need attention based on predefined criteria. 

For example, in financial assistance tracking, a work queue might collect all patients with pending copay assistance applications or unpaid balances to be flagged for review. Shannon White, manager of Radiation Oncology at Genesis Healthcare System in Zanesville, OH explains, “For the copay assistance program, we have a work queue and what triggers it is when a patient treatment plan includes a drug that is eligible for a copay assistance program, and they have a payer that is not Medicare [or] Medicaid. So, it [does not] trigger until the doctor or the clinical team adds the treatment plan into Epic.” 

Some cancer programs separate these into different queues to make things easier to manage; they use triggers, or actions that initiate the work queue, to collect and organize specific data from patient accounts, insurance details, or unpaid balances. In billing, work queues can highlight claims that require corrections or additional documentation before submission. Others rely on billing indicators or custom tags that classify patients receiving financial help and prevent them from getting billed while assistance is being processed.  

Common Limitations When Using Epic 

Even though Epic has adaptable features, many cancer care programs struggle to use it efficiently for financial navigation. The system works differently depending on contracts, versions, and IT setups, so while some institutions have access to robust financial assistance tools, others are stuck with frustrating workarounds. “It would be great if all Epic [support] across all the health systems could be on the same page,” stated Jordan Karwedsky, financial advocator at Green Bay Oncology. Tracking financial assistance payments and grant balances is another major pain point. 

Some cancer centers use third-party tools that integrate with Epic to identify patients eligible for financial assistance and automatically track claims. To address integration challenges, ACCC offers an EHR Integration Roadmap and a valuable resource library to assist cancer programs and multidisciplinary teams in navigating and streamlining EHR integration with external entities, such as reference labs and third-party platforms. 

Challenges With Accurate Data in Epic 

Getting accurate cost estimates in Epic, especially for oncology, isn’t easy. Some cancer centers struggle with infusion drug pricing, and Epic’s estimator often defaults to brand-name drug costs, making patients think they will have increased out-of-pocket expenses. Connecting the estimator with prior authorizations and financial assistance tracking helps, but not everyone has that setup. 

A big issue is that some of Epic’s best features require IT support to activate, and financial navigators often hear that certain functions aren’t possible, even when other cancer programs are using them successfully. Another roadblock financial advocates face is the lack of communication between a cancer program’s IT department and Epic’s support team. “Having a strong internal IT team that is familiar with work queues has helped us customize, design and configure ours to give us the information we want to see.” revealed Shannon White. Financial navigators often don’t have direct Epic support, leading to delays and rejected requests. Plus, separating insurance claims from financial assistance slows things down. Adding a financial navigator to a cancer program’s team would make the whole process run more smoothly. 

Creating Financial Navigation Teams  

With all these challenges, it’s no surprise that financial navigators are making the case for dedicated teams within cancer centers. Financial navigation teams keep an eye on insurance denials and appeals, measuring how often they can overturn denials and recover lost revenue. Having financial advocates in the cancer care setting plays a critical role in securing financial assistance for patients, which can also benefit the cancer centers themselves. ACCC provides tools and resources to guide cancer programs in financial advocacy, such as the Financial Navigation Assessment tool, to help cancer programs evaluate their current financial advocacy programs, identify areas for improvement, and advocate for hiring a financial navigator if they do not currently have one. ACCC also offers a guided workflow that explores tools and techniques to improve a cancer program’s financial advocacy.  

In the meantime, some institutions are exploring the formation of an Epic-focused financial navigation workgroup to address these issues. Many financial navigators are committed to sharing workflow screenshots, demos, and lessons learned to help others optimize their Epic setups. As these conversations continue, collaboration and knowledge-sharing will be key in improving financial assistance tracking in Epic and ensuring patients get the financial support they need.  

Read more about how ACCC’s Financial Advocacy Network supports financial navigation services.