Analisis Faktor Ketidaktepatan Kode Diagnosis Pada Klaim Bpjs di Rumah Sakit : Literature Review

Priyatmaja Putri, Yustyzia (2022) Analisis Faktor Ketidaktepatan Kode Diagnosis Pada Klaim Bpjs di Rumah Sakit : Literature Review. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

The inaccuracy of the diagnosis code is one of the causes of the BPJS claim failure. The right diagnosis code will help in the smooth process of BPJS Health claims. In fact, in some hospitals there is still an inaccuracy in the diagnosis code, which is still quite high, especially for BPJS patients. This has an impact on the BPJS claim process. The purpose of this study was to analyze the inaccuracy factor in the diagnosis code on BPJS Health claims at hospitals in Indonesia by using the literature review method based on the elements consisting of: Man, Facilities, and Method. The results of the review of 21 articles found, there were inaccuracies in the diagnosis code caused by the aspect of human resources, available infrastructure to support diagnosis coding, policies, procedures and available workflows. The results of the review show that there are several factors causing the inaccuracy of the diagnosis code, one of which is the man factor, namely the indiscipline of officers related to filling out the diagnosis, coding, and entry officers. The facilities factor is caused by the incompleteness of the results to support the diagnosis. The method factor is caused by the standard operating procedure that is not optimal in its manufacture and implementation. Efforts that can be made to overcome the inaccuracy of the diagnosis code include increasing the competence of coding officers by participating in training or workshops on coding and disease classification. Reviewing the coding procedure policies, making agreements regarding standard abbreviations, and applying rewards and punishments to officers' performance.

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