<![CDATA[ABSTRACT The Indonesian Case-Based Groups (INA-CBGs) payment system aims to enhance the cost-efficiency of healthcare services; however, implementation has revealed issues with "pending claims." These pending claims can lead to discrepancies between INA-CBG rates and actual hospital costs, particularly in cases with specific severity levels. This study aimed to analyze the relationship between INA-CBG severity levels and the cost discrepancies associated with pending inpatient claims at Dr. H. A. Rotinsulu Lung Hospital, Bandung. A quantitative research design was employed, utilizing a correlational approach with a cross-sectional study design. The study utilized total sampling, comprising 387 medical record files. The variables analyzed were INA-CBG severity levels and claim cost discrepancies. Data analysis was performed using the Chi-Square test. The results indicated that the majority of cases (55.82%) fell under severity level III. Claim discrepancies were predominantly characterized by a deficit, totaling -IDR 642,916,279. The Chi-Square test yielded a p-value of 0.000 (p0.05). The study concludes that there is a significant relationship between INA-CBG severity levels and the cost discrepancies of pending inpatient claims. While severity level is a crucial factor in determining BPJS claim rates, improving the accuracy of medical record documentation and diagnostic coding is essential to minimize pending claims and cost discrepancies, thereby reducing financial losses for the hospital. Keywords: Cost Difference, INA-CBGs, Pending Claims, Severity level. ABSTRAK Sistem pembayaran berbasis Indonesian Case Based Groups (INA-CBGs) bertujuan meningkatkan efisiensi pembiayaan pelayanan kesehatan, dalam pelaksanaanya ditemukan permasalahan berupa pending klaim yang berpotensi menimbulkan selisih tarif antara tarif INA-CBGs dan biaya riil rumah sakit, terutama pada kasus dengan severity leveltertentu. Penelitian ini bertujuan untuk menganalisis hubungan antara severity level INA-CBGs dengan selisih biaya pending klaim rawat inap di RS Paru dr. H. A. Rotinsulu Bandung. Jenis penelitian ini adalah kuantitatif dengan desain korelasional melalui pendekatan cross sectional. Sampel dalam penelitian ini menggunakan total sampling sebanyak 387 berkas rekam medis. Variabel penelitian meliputi severity level INA-CBGs dan selisih biaya klaim. Analisis data dilakukan menggunakan uji Chi Square. Hasil penelitian menunjukkan bahwa mayoritas kasus berada pada severity level III sebesar 55,82%. Selisih klaim didominasi oleh kondisi defisit dengan total -Rp 642.916.279. Hasil uji Chi Square menunjukkan nilai p-value 0,000 (p0,05). Kesimpulan pada penelitian ini terdapat hubungan yang signifikan antara severity level INA-CBGs dengan selisih biaya pending klaim rawat inap. Severity level merupakan aspek penting dalam penentuan tarif klaim BPJS tetapi diperlukan peningkatan akurasi dokumentasi rekam medis dan ketepatan pengkodean diagnosis untuk meminimalkan pending klaim dan selisih biaya sehingga mengurangi kerugian finansial rumah sakit. Kata Kunci: INA-CBGs, Pending Klaim, Selisih Biaya, Severity level.]]>
