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All Journal Jurnal Rekam Medis dan Informasi Kesehatan
Aulia Ughti Ratriana
Puskesmas 2 Pekuncen, Kecamatan Ajibarang Kabupaten Banyumas
Health Professions

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Tinjauan Penyelesaian Dispute Klaim Rawat Inap Pasien Coronavirus Disease 2019 (COVID-19) di RSUD Ajibarang Tahun 2020 Eliyah Eliyah; Aulia Ughti Ratriana
Jurnal Rekam Medis dan Informasi Kesehatan Vol 5, No 1 (2022): Maret 2022
Publisher : Poltekkes Kemenkes Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (909.472 KB) | DOI: 10.31983/jrmik.v5i1.8394

Abstract

Dispute claim are disagreement between BPJS Kesehatan and health facilities over claims caused by coding or medical. The dispute becomes a workload for the claim submission officers and affects the hospital revenue. We found that there 66 files in dispute category at RSUD Ajibarang in April-July 2020 with a percentage of 50,8%. The purpose of this study is to analyze the causes of disputed claims for inpatient treatment based on inputs and processes, to find the solution overview. This research uses a qualitative descriptive method with case study approach and the research subjects are 4 people. The research on human resources and facilities showed relatively good conditions. Regarding the technological factor, SIMRS development is needed, the planning factor requires the creation of a special SOP to handle the COVID-19 claim dispute issue and the claim process implementation factor is seen from the flow that is in accordance with existing regulations, an introduction to the procedure for inputting COVID-19 claims is needed on INA-CBG's application. So, it can be concluded that it is necessary to prepare SOP related to disaster cases in collecting claims in the INA-CBG's application and providing human resources who have special competencies for medical recorders.
Co-Authors Eliyah Eliyah