COMPLETENESS CORRELATION OF MEDICAL RESUMES INPATIENTS TOWARD CONTINUITY CLAIMS BPJS at the QADR TANGERANG HOSPITAL

Tri Harti Maya Utami, Lily Widjaja

Abstract


Completeness of medical resumes are things that need to be considered, because it plays an important role in ensuring the continuity of medical services and is the main requirement in filing claims in hospitals, health centers and all healthcare providers (PPK) to the Security Agency of Health (BPJS), all components of the resume medical needs include medical and resumes must be timely so that the claims process runs smoothly. Incomplete medical resume can lead to rejection by the verification BPJS so the claim file must be returned to the hospital in order to be completed. Thus the process of filing a claim to BPJS become obstructed and the claims process can not run smoothly. This resulted in delays in the disbursement of BPJS that can affect cash flow thus hampering the operations Hospital Hospital services such as late payment for services provided, the purchase of facilities and infrastructures that support services in house Sakit.Untuk determine the relationship completeness of medical inpatients resume to smoothness claims to BPJS Hospital Tangerang. The Research Qadr hospital was quantitative research, conducted by observation, look for the relationships between independent variables and the dependent variable is the completeness of medical inpatients resume the smooth claims to BPJS.Pengambilan samples using systematic random sampling of population 528 medical patients resume BPJS Hospitalization in April 2016 and samples taken 50 resumes medical research, data analysis using Chi-square test. Of the four components of the overall amount of the recapitulation completeness complete an average of 43 (86%) and incomplete 7 (26%). Claims BPJS fluent 31 (62%) and non-current 19 (38%). Chi-square test results. obtained P-value 0.000 <0.05 then Ho is rejected or there is a relationship between the completeness of medical resumes with the smoothness of a claim to BPJS Qadr Hospital in Tangerang. OR = 540 (95% CI: 31.7 - 9175), means completeness resume full medical have the opportunity smoothness of claims amounting to 540 times compared to the completeness of the medical resumes incomplete, and in research iniditeltiti also code for accuracy of diagnosis as a variable comparator (counfounding) and obtained 0. the results of P-value 0.000 <0.05 then Ho is rejected, so it can be concluded that there is a relationship between the accuracy of diagnosis by the smooth code claims to BPJS Qadr Hospital in Tangerang. Values obtained 31 OR (95% CI: 5.5 to 177), meaning that accuracy appropriate diagnosis code has a chance to claim fluency by 31 times compared to the accuracy of diagnosis codes that are not appropriate. it can be concluded that both these factors affect each other klaim.Therefore, it is expected the doctor fills the resume completely and correctly in order to reach the level of completeness of the standard 100% and do coding by following the procedures for book-coding based on the theory that ICD-10 volume 2 in order to meet the performance standards coding accuracy> 84%, as well as medical records clerk needs to perform quantitative and qualitative analysis.

 

Keywords: Completeness of medical resumes, diagnosis code accuracy, fluency claims.


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References


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