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Implementation of The Legal Obligation to Complete Inpatient Medical Records for Cancer Patients at Prof. Dr. I.G.N.G. Ngoerah Denpasar General Hospital Sutrisnawati, Gusti Ayu Eka
Journal of Social Research Vol. 4 No. 7 (2025): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v4i7.2623

Abstract

The type of research uses the empirical legal research method quantitatively descriptive analytical, because it observes and examines reality in filling out the medical resume of inpatients at Prof. Dr.I.G.N.G.Ngoerah Denpasar Hospital. The approach used is factual, legislative, and conceptual approaches. This data comes from primary, secondary, and tertiary data along with primary, secondary, and tertiary legal materials. Data collection methods include observation, document studies, interviews and checklists. The results of this study show that: 1). Incompleteness in filling out inpatient electronic medical records at Prof. Dr. I. G. N. G. Ngoerah Denpasar Hospital has the potential to cause losses for patients and become the basis for a lawsuit. The lawsuit can be based on the non-conformity of electronic medical records with applicable legal standards and violations of patient rights, access to medical data by unauthorized parties, as well as non-compliance with regulations that can result in administrative and criminal sanctions for healthcare facilities, electronic medical resumes have legal implications because medical resumes are legal documents that can be used as evidence in medical dispute cases. Regulation of the Minister of Health Number 24 of 2022 regulates medical records, and incomplete filling can be considered a violation if there is negligence in filling it. The effectiveness of law enforcement in this case is influenced by the factors stated by Soerjono Soekanto, including clear regulations, competent law enforcement, adequate support facilities, public awareness, and a supportive work culture. 2). The factors causing the incompleteness of filling out inpatient electronic medical resumes are in the Gynecological Oncology Division (19%) and Surgical Oncology (18%). The factors causing the incompleteness of filling out an electronic medical resume are seen in terms of legal factors and non-legal factors.
Analysis Of The Suitability Of INA-CGBS Claim Coding at BPJS Kesehatan Wasin at RSUP prof. dr. I.G.N.G.NGOERAH Denpasar Sutrisnawati, Gusti Ayu Eka; Manuaba, Fajar; Purwani, Sagung Putri M.E
Jurnal Health Sains Vol. 4 No. 12 (2023): Journal Health Sains
Publisher : Syntax Corporation Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46799/jhs.v4i12.1162

Abstract

RSUP Prof.Dr.I.G.N.G.Ngoerah Denpasar is an advanced service facility which is part of supporting the running of national insurance programs processed by the BPJS agency. The BPJS Health wasin audit aims to ensure that companies or participants have fulfilled their obligations regarding health insurance provided by BPJS Health, where reimbursement for advanced health services costs uses the INA-CGBs E-Claim application. INA-CBG E-Claim is an application specifically designed to assist hospitals in the national health insurance claim process. INA-CBG's is the amount of claim payment by BPJS to health facilities where the INA-CBG's rate uses a coding system with ICD-10 for diagnosis and ICD 9CM for procedures or actions. The aim of this research is to obtain the suitability of INA-CBGs claim coding on BPJS Health wasin at Prof. Dr. IGNGNgoerah Denpasar Hospital. Empirical legal research used in this research, with a quantitative approach. which exists in fact. The results of this research are that the impact of losses from discrepancies in the coding of clinical data affects the financing of health services, so there is a need for a BPJS Health data processing process regarding re-confirmation regarding the advantages and disadvantages of claims that will be paid. In August 2023, there was confirmation that there were 638 inpatient data processing data, 2339 outpatient data. Then action was taken by the hospital to provide training to coding officers and continue to regularly monitor and check the hospital's internal verification.