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All Journal Journal of Health Promotion and Behavior Infokes : Jurnal Ilmiah Rekam Medis dan Informasi Kesehatan PELS (Procedia of Engineering and Life Science) OVUM : Journal Of Midwifery and Health Sciences Jurnal Pelayanan dan Pengabdian Masyarakat Indonesia Proceeding of International Conference Health, Science And Technology (ICOHETECH) Prosiding Seminar Informasi Kesehatan Nasional Madani: Jurnal Pengabdian Masyarakat dan Kewirausahaan Journal of Economics and Public Health International Journal of Health and Medicine
Nur Rahmawati, Eni
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Religion Arts Humanities Biochemistry, Genetics & Molecular Biology Chemistry Computer Science & IT Control & Systems Engineering Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Electrical & Electronics Engineering Engineering Health Professions Industrial & Manufacturing Engineering Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health Veterinary Other

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Journal : PELS (Procedia of Engineering and Life Science)

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Stroke Code Accuracy Correlates with Social Security Administration Claim Approval: Ketepatan Kode Stroke Berkorelasi dengan Persetujuan Klaim Badan Penyelenggara Jaminan Sosial Rahmawati, Eni Nur; Febrianti, Salamah Nindaf
Procedia of Engineering and Life Science Vol. 9 (2025): Proceedings of the 2025 Annual Meeting of APTIRMIKI
Publisher : Universitas Muhammadiyah Sidoarjo

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Abstract

The accuracy of diagnosis coding has a significant impact on the BPJS claims process. This study aims to investigate the relationship between the accuracy of stroke diagnosis codes and the approval of claims by the Social Security Administration for inpatient care. This type of research is analytical research with a cross-sectional approach. The statistical test used in this study is Fisher's Exact Test. The population was 506 medical records, and a sample of 83 medical records was selected using a simple random sampling technique. The research instruments were observation and interview guidelines, checklists, ICD-10, and SPSS version 26. Data processing included data compilation, editing, coding, classification, tabulation, and data presentation. The results of the analysis of existing coding procedures were documented in Standard Operating Procedures (SOP). The accuracy of stroke diagnosis codes was 70 (84%) of medical records, while the inaccuracy of stroke diagnosis codes was 13 (16%) of medical records. The percentage of BPJS claims approval was 52 (63%) medical records, while those who did not approved were 31 (37%) medical records. The Fisher Exact Test calculation results showed a p-value <0.014 significance level (0.014 <0.05) in SPSS. Conclusion: There is a relationship between stroke diagnosis code accuracy and BPJS claim approval. It is recommended to revise the SOP in point 3, requiring coding staff to reconfirm with physicians if they encounter any issues in the coding process and the management procedures that support the diagnosis. The head of medical records should recommend that coding staff attend coding training.
Co-Authors Bhisma Murti Didik Gunawan Tamtomo Dimas Rizky Maulana Dwi Anand Sinar Putra, Imanuel Fatwa, Sagita Wasilatul Fauziah, Fadhilah Jihan Nur Febrianti, Fera Febrianti, Salamah Nindaf Hasanah, Pangestuti ‘Ainun Imanuel Dwi Anand Sinar Putra Lilik Anggar Sri Rahayuningsih Nopita Cahyaningrum Nugraheni, Sri Wahyuningsih Nurdiyansyah, Andi Karisma Nurhayati Nurhayati Nurhayati Rizky Maulana, Dimas Sari, Sella Yulia SRI LESTARI Utami, Yeni Tri Yatim, Nurulshyha Md