Article Per Year (5 Year)
p-Index From 2020 - 2025
0.61
P-Index
This Author published in this journals
All Journal Jurnal Ilmu Informasi Perpustakaan dan Kearsipan Jurnal Penelitian Pembelajaran Matematika Sekolah J-REMI : Jurnal Rekam Medik dan Informasi Kesehatan
Tuzzahra, Raudya
Unknown Affiliation
Health Professions Library & Information Science Mathematics Public Health

Published : 3 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 1 Documents
Search
Journal : J-REMI : Jurnal Rekam Medik dan Informasi Kesehatan

 1 
Penyebab Pengembalian Berkas Klaim BPJS Kesehatan Pasien Rawat Inap Ditinjau Dari Syarat-Syarat Pengajuan Klaim di RSUD Majenang Tuzzahra, Raudya; Hakim, Agya Osadawedya; Romodon, Dion; Gunawan, Gunawan
J-REMI : Jurnal Rekam Medik dan Informasi Kesehatan Vol 6 No 1 (2024): December
Publisher : Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/j-remi.v6i1.5469

Abstract

Issues related to BPJS Health insurance claims often pose challenges for healthcare facilities. The primary reasons for claim rejections typically involve administrative errors, such as incomplete documentation or incorrect diagnostic codes. This study aims to identify the factors contributing to the high rate of inpatient claim rejections at RSUD Majenang. Employing a qualitative approach with a case study design, this research analyzes data collected from in-depth interviews with hospital verification officers and coding officers. The findings reveal that inaccurate diagnostic coding and incomplete supporting documentation are the primary causes of claim rejections. Inaccurate diagnostic coding is attributed to several factors, including errors in diagnosis recording, discrepancies in perceptions between hospital verifiers and BPJS Health, and potential indications of diagnostic code misuse. Additionally, a lack of interdepartmental coordination and inadequate understanding of claim guidelines contribute to the problem. The findings of this study have significant implications for efforts to improve the quality of healthcare services and the efficiency of claim management in hospitals. To streamline BPJS Health claims, it is necessary to enhance the competency of staff, strengthen interdepartmental coordination, improve the quality of medical documentation, and conduct periodic evaluations of claim procedures.
Co-Authors Dion Romodon Elva Rahmah Gunawan Gunawan Hakim, Agya Osadawedya hanifah hanifah Syafdi Maizora