340B Revenue Recovery and Optimization
Referral prescriptions that were never captured. Providers missing from the eligible list. Clinics operating for two quarters before anyone registered them. None of it looks like a problem on a dashboard, and all of it shows up as savings that quietly never arrived.
At a glance
- Largest category
- Referral-based dispensing
- Assessment first
- Always
- Output
- Sized opportunity
- Compliance-first
- Non-negotiable
Optimization means capturing what the statute already allows
We want to be precise about language here, because it matters. Optimization does not mean stretching eligibility, expanding the patient definition beyond what it supports, or finding creative interpretations. That work destroys programs, and it puts clients in front of a Congressional committee rather than a compliance committee.
It means finding the dispenses that were already eligible under your existing, defensible policy — and were simply never captured. In most programs that gap is significant, and it is almost entirely mechanical: mapping, registration timing, referral documentation and reconciliation.
Assessment before recovery. Always.
Compliance check
We confirm the patient definition and policy foundation is sound. If it is not, we stop and recommend remediation first.
Opportunity assessment
A defined-scope diagnostic that quantifies the gap by category against your real data. You get a number and a breakdown before you decide whether to pursue anything.
Recovery build
Workflow, documentation and system changes that capture the eligible volume going forward, with your team owning the operational steps.
Verification
Capture rate re-measured after implementation, so the improvement is demonstrated rather than assumed.
Revenue recovery — common questions
Is capturing referral-based dispensing actually compliant?
It can be, and it is widely practiced. Eligibility depends on the relationship between your entity and the patient, the documentation linking the referral to the encounter, and whether your entity retains responsibility for care. It is entirely dependent on documentation quality, which is why we test the documentation before capturing anything.
Can you recover retroactively?
Generally no. 340B pricing applies at purchase, so a dispense that was not accumulated at the time typically cannot be recovered after the fact. The exception is contract pharmacy reconciliation discrepancies, where an unresolved item may still be resolvable. Most recovery value is prospective.
How do you charge for this work?
The opportunity assessment is a defined-scope diagnostic with a fixed fee. Recovery implementation is scoped against what the assessment finds. Where a contingency structure is appropriate we will discuss it — but we quantify first, so you are never buying an unknown.
Will this conflict with our TPA relationship?
We are not replacing your TPA and we do not sell competing software. In practice, findings usually result in configuration changes that your TPA implements.
Find out what the gap is worth before you decide to close it.
The opportunity assessment gives you a number and a breakdown. What you do with it is entirely your call.