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All Journal Health Science Journal of Indonesia Proceedings of the International Conference on Applied Science and Health
Cicih Opitasari
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Dentistry Education Health Professions Medicine & Pharmacology Nursing Public Health

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The Completeness and accuracy of clinical coding for diagnosis and medical procedure on the INA-CBGs claim amounts at a hospital in South Jakarta Cicih Opitasari; Atik Nurwahyuni
Health Science Journal of Indonesia Vol 9 No 1 (2018)
Publisher : Sekretariat Badan Penelitian dan Pengembangan Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22435/hsji.v9i1.464

Abstract

Abstrak Latar belakang: Kelengkapan resume dan ketidaktepatan koding masih menjadi penyebab terbesar pengembalian berkas klaim dari BPJS. Penelitian ini bertujuan untuk melakukan analisis kelengkapan dan ketepatan koding diagnosis dan prosedur terhadap besaran klaim di satu rumah sakit (RS) Pemerintah di Jakarta Selatan. Metode: Penelitian observasional yang dilakukan dengan penelusuran rekam medis (RM) bulan November 2017 dan wawancara mendalam terhadap 7 informan yang terdiri dari manajemen, koder, dokter penanggung jawab pasien (DPJP) dan verifikator RS. Ketepatan koding didapatkan dengan membandingkan pengkodean oleh koder RS dan koder standar. Analisis data dilakukan dengan analisis konten. Hasil: Dari 105 sampel rekam medis didapatkan angka ketidaklengkapan resume terbanyak pada pemeriksaan penunjang (12,2%), ketidaksesuaian pengisian pada diagnosis sekunder mencapai 68,6% dan ketidaktepatan koding paling tinggi pada diagnosis utama (21,9%). Rerata klaim INA-CBGs yang dihasilkan koder RS lebih rendah dari koder standar dengan selisih klaim sebesar 4%. Hal tersebut disebabkan adanya ketidakpatuhan dokter dan tidak semua dokter mendapatkan pelatihan pengkodean. Proses pencatatan RM masih banyak didelegasikan kepada residen. Pemeriksaan resume oleh verifikator dan pengkodean oleh koder masih kurang pemahaman tentang diagnosis dalam konsep INA-CBGs. Kesimpulan: Ketidaklengkapan resume dan ketidaktepatan koding di RS menyebabkan klaim INA-CBGs yang diterima lebih rendah rata-rata 4% sehingga dapat mengurangi pendapatan RS. (Health Science Journal of Indonesia 2018;9(1):14-8) Kata kunci: Ketidaktepatan koding, diagnosis dan prosedur, klaim rendah Abstract Background: Coding inaccuracy and inadequate physician documentation are still the major problem of BPJS claims that resulting potential loss of hospital finance. This study aims to analyze the completeness and accuracy of diagnosis and procedure coding on the INA-CBGs claim amounts at one government hospital in South Jakarta. Methods: This observational study was conducted through medical record review during the period of November 2017 and in-depth interview involved 7 informants consist of hospital management, coders, responsible physicians and hospital verifiers. Re-coding was carried out by standar coder and the results were compared with hospital coders outcome. Content analysis was used to analyze the data. Results: The review of 105 medical record found incomplete documentation for supporting medical examination variable (12.2%), inconsistency documentation of secondary diagnoses were the highest, at 68.6% and the most frequent for inaccurate coding was primary diagnoses at 21.9%. The claims generated by hospital coders are lower than standard coder by an average 4%. The indepth interview revealed low physicians compliance on the documentation standard procedure and lack of coding training for physician. The process of the documentation practice was still delegated to the resident physicians. The discharge summary review by verifier and coding by the coders was still lack of understanding of the diagnosis in the INA-CBGs concept. Conclusion: Incomplete discharge summary and inaccurate coding of diagnosis and procedure generate loss of hospital revenue by an average 4%. (Health Science Journal of Indonesia 2018;9(1):14-8) Keywords: Inaccuracy of clinical coding, diagnosis and procedure, lower claim
Evaluation of claim submission and returning for BPJS inpatient services: a case study of hospital X in 2017 Cicih Opitasari; Nurhayati Nurhayati
Health Science Journal of Indonesia Vol 10 No 1 (2019)
Publisher : Sekretariat Badan Penelitian dan Pengembangan Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22435/hsji.v10i1.1845

Abstract

Latar belakang: Keterlambatan dan ketidaklengkapan pengajuan klaim menyebabkan keterlambatan pembayaran klaim yang akan berdampak pada arus kas rumah sakit (RS). Artikel ini bertujuan untuk menilai pengajuan dan pengembalian klaim pada pelayanan rawat inap pasien BPJS. Metode: Penelitian potong lintang dengan desain studi kasus. Sumber data menggunakan data pengajuan dan pengembalian klaim rawat inap pasien BPJS periode Januari-Juni 2017. Data dianalisis secara deskriptif. Hasil: Frekuensi pengajuan klaim rawat inap terbanyak 17 kali dan terendah 13 kali dalam sebulan, yang berarti RS mengajukan klaim ke BPJS hampir setiap 2-3 hari sekali.Dari 11,945 berkas klaim, sebanyak 3,013 (25,2%) berkas klaim dikembalikan ke RS oleh BPJS. Nilai klaim yang diajukan untuk 11,945 berkas adalah Rp. 146,967,494,700, sedangkan nilai klaim dari berkas yang dikembalikan sebesar Rp. 45,150,888,100-. Alasan berkas dikembaliakn antara lain masalah administrasi, ketidaklengkapan resume medis, pemeriksaan penunjang, konfirmasi koding, tidak layak, pinjam status, dan TXT yang tidak terbaca. Penyebab paling banyak berkas dikembalikan adalah konfirmasi koding (42,4%) dan ketidaklengkapan resume medis (30,3%). Kesimpulan: Tampaknya RS tidak pernah mengalami keterlambatan dalam pengajuan klaim, namun berkas klaim yang dikembalikan BPJS masih banyak, yang utamanya disebabkan oleh permasalahan koding dan ketidaklengkapan resume medis. Kata kunci: Penilaian, klaim, pengajuan, pengembalian. Abstract Background: Incomplete and late claim submission may result in the delay of claim payment. The impact of late payment will certainly disrupt the cash flow of the hospital. This study aims to evaluate the claim submission and returning for BPJS inpatient services. Methods: This was cross sectional study with a case study design approach. The source of data used was submission and returned claim data from hospital financing department during the period of January to June 2017. The data were analyzed descriptively. Results: The highest frequency for inpatients claim submission was 17 times and the lowest was 13 times. The hospital submit the claim file almost every 2-3 days. Of the 11.945 inpatient claims, as many as 3.013 claim files were returned by BPJS. The total claim amounts of 11,945 files was Rp. 146.967.494.700,- and, the total amount of returned claim was Rp. 45.150.888.100,-. The reasons of claim returned including administrative completeness, incomplete summary discharge , confirmation of coding, inappropriate files, unreadable TXT in BPJS application and supporting examination. The most common causes of claim files returned was confirmation of coding (42.4%) and incompleteness of discharge summary (30.3%). Conclusion: The hospital was never late in submitting claim documents but the claim returned by BPJS were still high. The most common causes of claim returned to the hospital was coding confirmation and incompleteness of discharge summary. Keywords: Evaluation, claim, submission, returning
MODE OF DELIVERY, HOSPITAL OWNERSHIP AND PREDICTORS MATERNITY LENGTH OF STAY IN TWO HOSPITALS IN JAKARTA Cicih Opitasari
Proceedings of the International Conference on Applied Science and Health No. 1 (2017)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background: Length of stay (LOS) is one of the most common indicator used for hospital performance assessment. The longer LOS for mothers giving birth can increase the risk of nosocomial infections and cause some psychological problems. Aims: This study aims to analyze the determinants of maternal length of stay which can be used to evaluate the hospital efficiency and quality care improvement. Methods: The cross-sectional study was conducted in two hospitals in Jakarta. We used the medical records of women who underwent delivery during the period of January 1 to December 31, 2011. Multivariate linear regression analysis with stepwise method was used to predict length of stay. Results: The study found 2727 patients met the inclusion criteria and were included in the analysis. The overall mean length of hospital stay was 3 days and the mean of mother’s age was 29,9 years old. Among all of the covariates, mode of delivery had largest impact on LOS, with cesarean section increasing LOS by 1.2 days on average (Coef=1,21; P=0,000), followed by hospital ownership with private hospital reducing LOS 0,79 days on average (Coef = 0,79; P=0,000). Conclusion: Mode of delivery and hospital ownership were the strong predictors for maternal length of stay in two hospitals in Jakarta. 
Co-Authors Atik Nurwahyuni Nurhayati Nurhayati