Analisis Akurasi Koding Pada Pengembalian Klaim BPJS Rawat Inap  Di RSUP Fatmawati Tahun 2016

Indawati, Laela

doi:10.33560/jmiki.v7i2.230

Cited by 13 publications

(13 citation statements)

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“…Hal ini sesuai dengan penelitian Kusumawati dan Pujiyanto,(2018) menyatakan bahwa ketidaktelitian petugas coder dan grouper dalam melakukan proses input ke National Casemix Center (NCC menjadi salah satu penyebab pengembalian berkas ke rumah sakit.Ketidakuratan kode disebabkan koder kurang teliti dalam penentuan kode penyakit (Indawati, 2019).Dampak ketidaktelitian pelaksanaan klaim mengakibatkan pending claim. Kesalahan teknis administrasi klaim menjadi penyebab pengembalian berkas klaim (Sulaimana dkk., 2017).…”

Section: Identifikasi Ketelitianunclassified

Faktor Penyebab Pending Claim Ranap JKN Dengan Fishbone Diagram Di Rsup DR Kariadi

Sahir

Wijayanti

2022

JurnalMIKI

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Pembiayaan kesehatan di rumah sakit diperoleh dari pembayaran klaim oleh BPJS Kesehatan. BPJS Kesehatan melakukan purifikasi dan verifikasi berkas klaim. Berkas klaim yang dinyatakan tidak lengkap oleh BPJS Kesehatan, menyebabkan pending claim yang berdampak keterlambatan pembayaran klaim. Berdasarkan studi pendahuluan di RSUP Dr Kariadi ditemukan permasalahan penyelenggaraan klaim JKN yakni pending claim 3,67%. Penelitian dilakukan bertujuan menganalisis faktor penyebab pending claim rawat inap JKN di RSUP Dr Kariadi dengan fishbone diagram. Jenis penelitian adalah kualitatif. Pengumpulan data menggunakan observasi, wawancara, dokumentasi, brainstorming. Hasil penelitian menunjukkan bahwa faktor-faktor penyebab pending claim, meliputi : faktor man terkait ketidaktelitian petugas menyebabkan ketidakakuratan koding 1,26%, kesalahan input data klaim 0,01%, ketidaklengkapan informasi pendukung diagnosis dan tindakan pada resume medis 0,31%. Faktor material menyebabkan berkas tidak lengkap 0,10%. Faktor machine berasal dari gangguan sistem aplikasi Jasa Raharja 0,21%, serta faktor method karena perbedaan persepsi antara koder dan verifikator BPJS Kesehatan terhadap kaidah koding dan regulasi klaim 0,83%. Akar penyebab masalah adalah kurangnya waktu penyelesaian klaim, gangguan sistem Jasa Raharja, kurangnya filter dalam memenuhi kelengkapan syarat berkas klaim. Upaya perbaikan yaitu koordinasi antar instansi terkait penyelesaian perbedaan persepsi coder RS dan verifikator BPJS Kesehatan serta gangguan sistem Jasa Raharja, percepatan RME pada seluruh berkas klaim yang dipersyaratkan untuk mencegah pengembalian berkas klaim tidak lengkap.

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Section: Identifikasi Ketelitianunclassified

Faktor Penyebab Pending Claim Ranap JKN Dengan Fishbone Diagram Di Rsup DR Kariadi

Sahir

Wijayanti

2022

JurnalMIKI

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“…Kasus bedah pasien rawat inap di RSKD Duren Sawit memiliki kode diagnosis utama, sekunder dan kode tindakan, peneliti hanya meneliti kode diagnosis utama dan sekunder yang masih memiliki ketidaktepatan kode diagnosis dikarenakan pada kode tindakan sudah sesuai dan tidak memiliki kode yang kurang tepat (Laela Indawati, 2019).…”

Section: Pendahuluanunclassified

Tinjauan Ketepatan Kode Diagnosis Pada Kasus Bedah Pasien Rawat Inap di RSKD Duren Sawit

Rahayu¹,

Indawati²,

Widjaja³

et al. 2022

cerdika

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Based on Kenmenkes RI in 2014, it explains about coding which has the meaning as an activity of providing main diagnosis codes and secondary diagnoses in accordance with ICD-10 and providing procedure codes in accordance with ICD-9CM. Coding inaccuracies can affect the financing of health services, this study was conducted to see the accuracy of the main and secondary diagnosis codes of surgical cases of inpatients at Duren Sawit Hospital using descriptive research methods with a quantitative approach, namely writing aims to describe the results obtained on the accuracy of diagnosis codification. Informants in this study were inpatient coders at RSKD Duren Sawit, data collection in this study using interviews and observation methods. The results of this study indicate that the coding SPO uses the latest procedures based on an electronic system, the educational background of the coder at RSKD Duren Sawit has an important role in the quality of the correct code. The competence of the coder at RSKD Duren Sawit still has to undergo deeper learning, in the results of coding research on surgical cases of inpatients, it was found that the average dignosis code that had accuracy was 58 (63.74%) and 33 (36.26%) were inappropriate, and it was also found that the results of the accuracy of the secondary diagnosis were 84 (92.30%) and 7 (7.70%) were inappropriate. Based on the 4 characters, the inaccuracy occurred in the main diagnosis of the majority in the 4th character as many as 31 (34.7%). There are factors that become obstacles to the identification of 5M, namely the man factor, the lack of accuracy of doctors in inputting diagnoses and the lack of accuracy of officers in re-examining incorrect diagnosis codes and having to undergo learning related to coding more deeply for diagnosis coding officers who are not from academic graduates of medical records.

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“…Kelengkapan informasi penunjang sangat mempengaruhi ketepatan pemberian koding penyakit dimana pada saat melakukan pengkodean perlu adanya informasi pendukung untuk memperkuat dalam menetapkan kode penyakit. Dalam hal ini dapat membantu perekam medis untuk melakukan pengkodean penyakit apabila terjadi informasi yang kurang jelas atau tidak lengkap (Indawati, 2016;Nisak, 2021).…”

Section: Hasil Dan Pembahasanunclassified

Correlation of Supporting Information Completeness Factors With the Accuracy of Disease Coding at 'Aisyiyah Siti Fatimah Hospital of Sidoarjo

Mellania

Rossarini²,

Nisak

et al. 2022

jp stikesnu

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Based on the data obtained from the observation on the inpatient medical record file of the Hospital 'Aisyiyah Siti Fatimah Tulangan Sidoarjo that the initial data shows that there are still medical record files with inaccurate diagnosis codes that do not match as much as (33%). The purpose of this study is to determine the relationship between the completeness of supporting information factors that affect the accuracy of disease coding in inpatient medical record files at the 'Aisyiyah Siti Fatimah Hospital, Tulangan Sidoarjo. This research method uses quantitative research with correlational research which has the aim of determining whether or not there is a relationship between two or more measurable variables. Data collection was carried out in August-October using a check list sheet by observing the inpatient medical record data. The population in this study were all inpatient medical record files in August-October 2021 and the sample in this study was 231 inpatient medical record files at the Hospital 'Aisyiyah Siti Fatimah Tulangan Sidoarjo with random sampling which was presented in the frequency table and cross tabulation, then tested using the Chi Square Test.The results of the Chi Square test of this study indicate that the supporting information completeness factor variable has a relationship with the accuracy of disease coding because the p value <0.05, which means Ho is rejected. The results show that the p value of the completeness of supporting information factor = 0.022.In this study, it is recommended to improve the quality of coding by increasing the completeness of the file, and can produce an accurate data by conducting coding training and evaluating coding audits to support the accuracy of disease coding.

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Analisis Akurasi Koding Pada Pengembalian Klaim BPJS Rawat Inap Di RSUP Fatmawati Tahun 2016

Cited by 13 publications

References 0 publications

Faktor Penyebab Pending Claim Ranap JKN Dengan Fishbone Diagram Di Rsup DR Kariadi

Faktor Penyebab Pending Claim Ranap JKN Dengan Fishbone Diagram Di Rsup DR Kariadi

Tinjauan Ketepatan Kode Diagnosis Pada Kasus Bedah Pasien Rawat Inap di RSKD Duren Sawit

Correlation of Supporting Information Completeness Factors With the Accuracy of Disease Coding at 'Aisyiyah Siti Fatimah Hospital of Sidoarjo

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