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Ani Ismayani Justika
Universitas Duta Bangsa Surakarta
Health Professions

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Reduced hospital revenue due to error code diagnosis in the implementation of INA-CBGs Warsi Maryati; Novita Yuliani; Anton Susanto; Aris Octavian Wannay; Ani Ismayani Justika
International Journal of Public Health Science (IJPHS) Vol 10, No 2: June 2021
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v10i2.20690

Abstract

In the case-mix system, diagnostic codes are used as the basis for classifying health service rates. The difference in tariffs between hospitals and the accuracy of the diagnosis code causes a gap where there are hospitals that benefit and are disadvantaged by the Indonesian case-based groups (INA-CBGs) tariff policy. This study assesses the gap factor between hospital rates and INA-CBGs rates, which include hospital characteristics and the accuracy of the diagnosis code. Samples were taken of 100 medical record documents of inpatients at two hospitals in Surakarta, Central Java, Indonesia in 2020 by stratified random sampling. Data were collected by observation and analyzed by Chi-Square test. There were errors in the primary diagnosis code 11 (32.35%), secondary diagnosis code 19 (55.88%), combination diagnosis code 4 (11.76%). Changes in the INA-CBG code that caused the inaccuracy of the claim rate were 26 (59.09%) case-mix main groups (CMG) codes, 44 (100%) CBG-specific codes, 31 (70.45%) severity level codes. Public-private hospitals with class B experienced a decrease in income of IDR 46,081,900 (-17.50%), while special government hospitals with class A experienced an additional income of IDR 99,733,869 (38.31%). An accurate diagnostic code can increase the odds by 42.128 times the accuracy of the INA-CBGs rate (b=42.128; 95% CI=11.127 to 159.497; p<0.001).
KARAKTERISTIK RUMAH SAKIT DAN KEAKURATAN KODE DIAGNOSIS MEMPENGARUHI HASIL KLAIM INA-CBGs Warsi Maryati; Novita Yuliani; Ani Ismayani Justika
Jurnal LINK Vol 16, No 2 (2020): NOVEMBER 2020
Publisher : Pusat Penelitian dan Pengabdian kepada Masyarakat, Poltekkes Kemenkes Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (415.524 KB) | DOI: 10.31983/link.v16i2.6426

Abstract

Setiap rumah sakit memiliki standar tarif pelayanan kesehatan. Perbedaan tarif  rumah sakit dan tarif INA-CBGs serta keakuratan kode diagnosis menyebabkan adanya kesenjangan pendapatan yang diperoleh rumah sakit. Studi ini  menilai faktor yang menyebabkan kesenjangan antara tarif rumah sakit dan tarif INA-CBGs, diantaranya karakteristik rumah sakit dan keakuratan kode diagnosis. Sampel diambil secara stratified random sampling sebanyak 100 di dua rumah sakit  tahun 2020. Pengumpulan data dilakukan dengan observasi dan kemudian dianalisis dengan uji Chi-Square. Analisis jalur dilakukan dengan pendekatan Structural Equation Modeling (SEM) menggunakan STATA 13 untuk menemukan model yang paling tepat untuk menggambarkan faktor penyebab kesenjangan tarif. Hasil menunjukkan bahwa 34% kode diagnosis tidak akurat dan 44% tarif INA-CBGs lebih rendah dari tarif rumah sakit. Rumah sakit milik Pemerintah memiliki log odds 1,037 lebih baik dalam menentukan ketepatan tarif INA-CBGs daripada rumah sakit swasta, namun secara statistik tidak signifikan (b=1,037; CI95%= -0,115 hingga 2,189; p=0,078). Kode diagnosis yang akurat memiliki log odds 3,885 lebih baik dalam menentukan ketepatan tarif INA-CBGs daripada kode diagnosis yang tidak akurat (b=3,885; CI95% =2,488 hingga 5,282; p0,001).
Co-Authors Anton Susanto Aris Octavian Wannay Maryati, Warsi Yuliani, Novita