Epoetin Alfa for Dialysis Outpatients: Analysis of Administered versus Medicare-Reimbursed Units

Abstract

This study audited the efficiency and accuracy of patient billing and reimbursement systems for epoetin alfa (Epo). The outpatient records of 604 chronic dialysis patients at eight academic health centers, from selected quarters during 1989 to 1993, were reviewed. The number of units administered or dispensed for home use was compared with Health Care Finance Administration (HCFA) reimbursement records. Overall, 18% (range 2% to 45% per institution) of the Epo administered or dispensed at the study sites was not represented in the HCFA reimbursement records. Institutions may be losing some entitled reimbursement for Epo and should evaluate their reporting/billing practices. The extent to which reimbursement for Epo, our test drug, reflects billing/reimbursement inefficiencies for other drugs deserves further evaluation.