Review of Inaccuracy of Action Codes in the Event of Pending Claims for Outpatient Medical Rehabilitation Diagnosis at Lubuk Basung Regional Hospital in 2023: Tinjauan Ketidaktepatan Kode Tindakan Dalam Kejadian Pending Klaim Pasien Rawat Jalan Diagnosa Rehabilitasi Medik Di RSUD Lubuk Basung Tahun 2023

Rahmadhani; Nadilla

doi:10.37160/jremikes.v2i2.330

Authors

Rahmadhani Stikes Dharma Landbouw
Nadilla Prodi D3 Rekam Medis dan Informasi Kesehatan STIKES Dharma Landbouw Padang

DOI:

https://doi.org/10.37160/jremikes.v2i2.330

Keywords:

Accuracy, pending, Coding, Claims, BPJS

Abstract

Code accuracy is the conformity of the diagnosis code determined by the coding officer with the patient's medical record in accordance with ICD regulations. Inaccuracy in assigning diagnosis codes will affect data and information in the health service process. The aim of this research is to determine the accuracy of medical action codes in the event of pending claims in patients undergoing medical rehabilitation diagnostic procedures at Lubuk Basung Regional Hospital in 2023. This type of research is quantitative with descriptive methods. This research was conducted at Lubuk Basung Regional Hospital from 22 June to 4 August 2023, with a population of all medical records from medical rehabilitation procedures from January to March 2023 with a sample of 81 medical records using a simple random sampling method. This research was conducted by observation using univariate analysis techniques. The results showed that of the 81 outpatient medical records for medical rehabilitation procedures, 28 (34.6%) were pending and 53 (65.4%) were not pending, while 28 (34.6%) had inappropriate medical action codes. and 53 (65.4%) were correct. Conclusions regarding the accuracy of medical action codes can cause claims to be pending due to inaccuracies in assigning medical action codes, one of which is influenced by writing codes that are not appropriate or the action code is not specific to ICD-9 CM. According to researchers, to reduce inaccuracies in medical action codes, coders should carefully write down the codes to be created in medical records in accordance with ICD-9 CM so that they can be identified easily by BPJS verifiers.

References

Faik Agiwahyuanto, Sylvia Anjani, dan S. C. S. (2021). Tinjauan Penyebab Pengembalian Berkas Klaim Bpjs Kesehatan Instalasi Rawat Jalan Kasus Fisioterapi. Jurnal Ilmiah Ilmu Kesehatan, 9(3), 551–569.

Juli Muroli, C., W. Rahardjo, T. B., & Germas Kodyat, A. (2020). Faktor-Faktor Yang Mempengaruhi Terjadinya Pending Klaim Rawat Inap Oleh BPJS Di RSAB Harapan Kita Jakarta Barat Tahun 2019. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 4(2), 191–197. https://doi.org/10.52643/marsi.v4i2.1040

Kemenkes RI. (2022). PMK Nomor 24 tentang Rekam Medis. Pemerintah RI, 33(1).

Kemenkumham. (2014). Peraturan BPJS Nomor 4 Tahun 2014 tentang Tata Cara Pembayaran Peserta Perorangan Badan Penyelenggara Jaminan Sosial Kesehatan.

Kementrian Kesehatan RI. (2009). UU no. 44 Tahun 2009 Tentang RS. Undang-Undang Republik Indonesia, 1, 41. https://peraturan.go.id/common/dokumen/ln/2009/uu0442009.pdf

Kementrian Kesehatan RI. (2014). Petunjuk Teknis Sistem INA-CBG. Journal of Craniofacial Surgery, 19(4), 1089–1091.

Maulida, E. S., & Djunawan, A. (2022). Analisis Penyebab Pending Claim Berkas BPJS Kesehatan Pelayanan Rawat Inap Rumah Sakit Universitas Airlangga. Media Kesehatan Masyarakat Indonesia, 21(6), 374–379. https://doi.org/10.14710/mkmi.21.6.374-379

Megawati, L., & Pratiwi, R. D. (2016). Faktor-Faktor Penyebab Pengembalian Berkas Persyaratan Klaim BPJS Pasien Rawat Inap di RS PKU Muhammadiyah Yogyakarta. Jurnal Kesehatan Vokasional, 1(1), 36. https://doi.org/10.22146/jkesvo.27476

Nurhadianah, N. (2022). Analisis Pending dan Dispute Klaim Kementerian Kesehatan Pasien Rawat Inap Covid 19. Dohara Publisher Open Access Journal, 01(07), 228–235.

Oktamianiza. (2016). Ketepatan pengkodean penulis diagnosa utama penyakit pada rekam medis Pasien rRawat Inap JKN (Jaminan Kesehatan Nasional) Di RSI Siti Rahmah Padang Tahun 2016. MENARA Ilmu vol x Jilid 1 no 72 November 2016, X(72),159-167. Oktamianiza, SKM, M. K, X(72), 159–167.

Oktamianiza. (2021). Manajemen Berkas dan Isi Rekam Medis Pada Sarana Pelayanan Kesehatan (pp. 4-7,13,221).

Sari, I. K., Morika, H. D., & Nur, S. A. (2020). analisi validasi resume medis dan kode diagnosis klaim bpjs tawat inap di RSUP DR. M. DJAMIL padang. Syedza Saintika, 57–58.

Trisna, W. V. (2018). Keakuratan Kode Tindakan pada Dokumen Rekam Medis Menggunakan ICD-9 CM Sebelum dan Sesudah Dilakukan Pelatihan Pengkodean di RSUD Petala Bumi Provinsi Riau. Inohim, 6(1), 6–13. https://inohim.esaunggul.ac.id/index.php/INO/article/view/143

Valentina, & Halawa, M. N. S. (2018). Analisis Penyebab Unclaimed Berkas Pasien BPJS Rawat Jalan Di Rumah Sakit Umum Imelda Pekerja Indonesia (RSU IPI) Medan. Jurnal Ilmiah Perekam Dan Informasi Kesehatan …, 3(2), 480–485. http://jurnal.uimedan.ac.id/index.php/JIPIKI/article/view/336