We've been using our HSA for years now and have never had to show a receipt to the IRS. In fact, while the first year I was really diligent about keeping receipts, I honestly don't keep them anymore. It just hasn't ever been asked for. No payments have ever been disputed (nor should they have been because everything was part of the allowed coverage). I honestly wouldn't over-stress about keeping up with a million receipts. Unless you think it might be a questionable charge, you should be fine. Our funds are available through a HSA debit card, so we just use the debit card to pay our medical bills and that's pretty much the end of it. I've never had to submit anything directly to the HSA account that way. Do you not have a debit card for your account?