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All Journal Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda (JIPIKI)
Zahra, Awlia Varasemitha
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Health Professions Public Health

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Analisis Penyebab Pengembalian Klaim BPJS Pasien Rawat Inap Ditinjau Dari Proses Pengkodean Di RSUD Majenang Zahra, Awlia Varasemitha; Hakim, Agya Osadawedya; Fauzi, Harry; Gunawan, Gunawan
Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda (JIPIKI) Vol. 9 No. 2 (2024): Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda Edisi Agustus
Publisher : Akademi Perekam dan Informasi Kesehatan Imelda

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52943/jipiki.v9i2.1651

Abstract

Pending Claim is a refund because there is no agreement between BPJS Health and FKRTL regarding coding rules and medical determination (claim dispute). The correct diagnosis and action code will determine the smooth process of submitting claims for medical services to BPJS Health and reduce the number of claim returns. This study aims to determine the causes of inpatient claim returns in terms of the coding process at Majenang Hospital. The research method used is a qualitative method with an observational descriptive design. Data was obtained from pending claims from July to September 2023. Data collection methods were observation and interviews. Majenang Hospital research results showed that 371 claims were returned and 187 claims were returned due to coding confirmation. Factors inhibiting the accuracy of a diagnosis or action code are the use of combined codes, errors in determining the main diagnosis, differences in perception, and discrepancies in supporting results with the diagnosis. Efforts that can be made to minimize the number of claim returns include reviewing diagnosis or action codes, communicating between DPJP, the casemix team and BPJS verifiers, coding training and having an SPO.
Co-Authors Gunawan Gunawan Hakim, Agya Osadawedya Harry Fauzi, Harry