Making the Business Case for 340B Referral Capture

For healthcare facilities eligible for 340B drug pricing discounts, the program can be a lifesaver. 340B reimbursement funds critical health programs for vulnerable populations that demonstrably improve patient outcomes. As health systems struggle to recover financially from the pandemic, 340B can also be an important revenue stream for covered entities (CE) which typically serve less advantaged communities. Yet despite the many benefits of full 340B participation, some covered entities limit themselves to capturing obviously eligible prescription claims and forgo referral capture because of compliance concerns. That’s unfortunate, because referral capture can pay real dividends for covered entities if they just make the business case for it.

The key to compliant referral capture is documentation

According to HRSA guidance, when there is clear documentation demonstrating that a covered entity owns patient care, the CE can claim prescriptions for 340B savings even when they are written by an outside referral provider. That may seem cut and dried, but the catch is that every covered entity must define ownership of patient care in their written policies and procedures when it comes to referral. At a minimum, HRSA requires that the referral be documented in the EHR, including proof of patient encounters with both the referring and referral providers. Read more >