FACTORS AFFECTING REFUND OF BPJS CLAIMS IN INPATIENT CASES AT RSUP X
DOI:
https://doi.org/10.58222/sdgs.v1i1.1006Keywords:
Adminitration; Diagnosis Code; Klaim File; Kode Diagnosa; ReturnAbstract
Problem: Incomplete administration of claims files and inaccurate diagnosis codes are inhibiting factors in verifying claims files. From the results of initial observations of 10 samples of claim files for inpatient cases submitted to BPJS, it is known that 7(70%) were approved and 3(30%) were returned due to no confirmation of the Anatomic Pathology results, no X-ray results and incorrect diagnosis codes. resulting in delays in the claim payment process which causes material losses for the Hospital.
Objective: To find out the factors that influence the return of BPJS claims for inpatient cases.
Method: This type of research is observational with a descriptive design. The population and sample in this study were 130 claim files for the fourth quarter of 2022 which were returned to the hospital upon first submission. The data used is secondary data obtained by observation using an observation sheet, then the data is processed and analyzed univariately using a frequency distribution.
Results: Incomplete administration of claims files was 59(45%) and inaccurate diagnosis codes were 71(55%). It is recommended that hospitals make efforts to increase the accuracy of diagnosis codes through training, supervision and regular evaluation to minimize the occurrence of returned claims.
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