ANALISIS FAKTOR PENYEBAB KETIDAKTEPATAN KODEFIKASI PENYAKIT DAN TINDAKAN PASIEN BEDAH BPJS KESEHATAN RAWAT INAP DI UPT RSUD RAA SOEWONDO PATI

Setyowati, Dwi Nur (2024) ANALISIS FAKTOR PENYEBAB KETIDAKTEPATAN KODEFIKASI PENYAKIT DAN TINDAKAN PASIEN BEDAH BPJS KESEHATAN RAWAT INAP DI UPT RSUD RAA SOEWONDO PATI. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Coding is the classification of similar diseases into one number group according to ICD 10 for diseases and ICD 9 CM for procedures. The results of the preliminary study showed that data on the inaccuracy of inpatient coding was 22% and outpatients were 5% from 60 samples whereas in coding claims the accuracy must be 100 percent. The impact of inaccurate coding can cause revision files to pile up in the internal verifier section which results in delays in sending claim files to BPJS. The delay in sending claims in December 2023 is 14 days from the specified date. This research aims to analyze the factors that cause inaccurate coding of diseases and procedures for surgical patients BPJS health inpatient is based on predisposing, enabling, and reinforcing aspects and determine the priority causes of the problem using USG and develop efforts to fix the problem using brainstorming. This type of research uses qualitative data collection techniques using written questions, interviews, observation, and documentation. The research subjects were 4 inpatient coders, 1 internal verifier, 1 verification coordinator, and 1 head of medical record. The research results showed that the cause of inaccurate coding was the predisposing factor that coders did not understand the punctuation marks in the ICD, omitcode command according to PMK 26 of 2021 guidelines, and lack of understanding of the requirements for making a diagnosis according to the instructions in the BA mutual agreement, From the enabling factor of facilities, there is no air conditioning in the inpatient's coder's room and coders rarely take part in claims coding training. From the reinforcing factor, there is no SOP for coding diseases and procedures for inpatients and no reward and punishment system for inpatient coders. The priority problem that must be resolved is the absence of SOP for coding of diseases and procedures inpatients.

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