Indonesian Journal of Global Health research
Vol 6 No 5 (2024): Indonesian Journal of Global Health Research

Quality of Medical Record Documentation Affects Accuracy of Diagnosis Codes in Ina-CBGs Claims in Hospitals

Yuliani, Novita (Unknown)
Noor, Hesty Latifa (Unknown)
Maryati, Warsi (Unknown)



Article Info

Publish Date
09 Oct 2024

Abstract

Indonesia in financing its health services has implemented a casemix system in the National Health Insurance (JKN) program organized by the Social Security Administering Agency (BPJS). The Indonesian Case Based Groups (INA-CBGs) tariff is determined based on the diagnosis code, so its inaccuracy can lead to a decrease in claim results. The quality of clinical documentation as the basis for determining the diagnosis code in INA-CBGs claims. The purpose of this study was to empirically prove whether there is a relationship between the quality of medical record documentation and the accuracy of diagnosis codes in INA-CBGs claims.The researcher used a cross-sectional design, to analyze the completeness of medical information and the accuracy of diagnosis codes in 100 INA-CBGs pending claim documents. Sampling was carried out using a simple random technique at two private hospitals in Central Java, Indonesia. The data obtained were analyzed using the Chi-Square test. Claim documents with complete medical information were 55 (55%) and incomplete were 45 (45%). Completeness of medical information can increase the accuracy of the diagnosis code by 10.286 times better than incomplete medical information (b = 10.286; 95%CI = 3.813 to 27.743; p <0.001) and statistically both have a significant relationship. Completeness of medical information is an important thing that determines accurate diagnosis codes, so it will indirectly impact hospital income from INA-CBGs claims. Hospitals need to make efforts to improve the quality of medical record documentation, one of which can be achieved by utilizing electronic medical records.

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Journal Info

Abbrev

IJGHR

Publisher

Subject

Education Health Professions Languange, Linguistic, Communication & Media Nursing Public Health

Description

Indonesian Journal of Global Health Research (IJGHR) menyediakan forum untuk berbagi publikasi penelitian ilmiah, perawatan kesehatan yang tepat waktu dan terkini serta mempromosikan pengembangan keperawatan, kesehatan masyarakat, masyarakat, lingkungan, dan kesehatan kerja. Jurnal ini menerbitkan ...