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We understand that referrals are often the grayest area of your 340B program. That’s why we’ve been building technology and teams specifically focused on referral capture for more than a decade. As we engage with clients, we pay close attention to what works for them and what doesn’t, and we like to share our experience to help healthcare providers make informed decisions.
When it comes to referral capture, we have found that a deep appreciation for the complexity of workflows, configurations, resourcing and tailored policies and procedures are critical to success. This ensures clients can experience not only an optimized 340B program but one without worry of audit and compliance risks.
Below is a list of questions we suggest asking of any referral partner you’re considering:
- How many team members do you have to support key functions like implementation, client support, product and technology, security, analytics, auditing and compliance?
- Which security certifications do you hold? SOC2 Type II and/or HITRUST? Can you please provide evidence of this?
- Tell me about your technology and product build. Is this in-house or subcontracted? If subcontracted, have there been any changes in who the work is subcontracted with? Is this work conducted in the US or outside of the US?
- What configurations do you support for capturing referral prescriptions? For instance, how are referrals evaluated and how are specialist documents evaluated for compliance?
- How many HRSA audits have your clients successfully passed that included referral claims?
- What type of audit support do you provide? Can you please share evidence?
- How many clients can you provide as references, and can I have their contact information?
- Which Third-Party Administrators (TPAs) do you work with?
- What is your average time to revenue?
- What is your average implementation time? What does this process typically look like?
- How do you store and protect the EMR/patient data that we’re sending to you?
- Do you have internal support for Policy and Procedure creation and/or optimization? Do you have any templates or expert team members who can provide guidance?
- What type of monitoring/alerts to you have available if something were to happen to the EMR data feeds we’re sending you? For example, if a file we send errors out, what happens?
- What are some ways you would suggest optimizing my current program?
Selecting the right referral partner is a critical decision for optimizing your 340B program. By asking the right questions and evaluating key areas such as team support, technology and compliance history, you can gain a clear understanding of a partner’s capabilities and fit for your organization. A strong referral capture system not only enhances program performance but also mitigates risk. With the right partner, you can move forward confidently knowing your 340B program is set up for long-term success
Melissa Palchak Opraseuth is senior vice president of 340B Operations at R1. She can be reached at mpalchak@r1rcm.com.
Join us at our November 12th webinar to hear insights from current 340B litigation and impacts to HRSA compliance. Click below to learn more and register.
**This event is for covered entities only.
