Analisis Faktor Penyebab Ketidaktepatan Kode Diagnosis Pada Klaim BPJS Pasien Rawat Inap di RSUD Blambangan Banyuwangi Tahun 2023

Islami, Annisa Nur (2024) Analisis Faktor Penyebab Ketidaktepatan Kode Diagnosis Pada Klaim BPJS Pasien Rawat Inap di RSUD Blambangan Banyuwangi Tahun 2023. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Diagnostic code inaccuracies in the National Health Incurance claims of hospitalized patients at Blambangan Banyuwangi Regional Hospital were a problem in the submission of the National Health Incurance claims. The study aimed to analyze the cause of diagnostic code inaccuracy in the Social Security Agency on Health claims of hospital patients at Blambangan Banyuwangi Regional Hospital based on the theory of behavior "ABC" (Antecedent BehaviorConcequences), which will then determine the priority cause of problems with the Reinke method and give recommendations for problem correction using the brainstorming method. This type of research was qualitative, with methods of data collection through interviews with 4 respondents, observations, and documentation. The results of the research obtained by the researchers concerning the diagnostic code inaccuracies on the National Health Incurance claims, the priority cause of problems using the Reinke method, obtaining the 3 top problems sequence with the highest total score of 29, meaning no codification-related training has been held, the second order obtained with a total of scores of 21, meaning there have been no coding SOP related coding procedures, and the third sequence obtained with an overall score of 18, meaning no routine meetings of the hospital and National Health Incurance related code differences have been conducted. Taking into account these factors, it is recommended to conduct internal and external training on codification, propose a draft coding SOP related to the coding procedures that have been created, and the need for regular meetings between claims officers and National Health Incurance verificators.

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