The Influence of Outpatients Medical Information Completeness in The Emergency Departments and Policlinics on Returning BPJS Health Claim Status
Abstract
Background: Returning BPJS Health claim status required some outpatients data, therefor this study conducted to understand the medical information needed for the BPJS Health claim.
Objective: The objective of this paper was returning BPJS Health claim status required some outpatients data, therefor this study conducted to understand the medical information needed for the BPJS Health claim.
Methods: Retrospective analysis with quantitative approach. Variables were groups of cases in the form of confirmation from BPJS Health related to reviews on pending claim files, differentiated according to the type of case. As far as observations could be grouped into 8 confirmation groups as the theme of the cases taken 396 samples of pending claim files at XXX Hospitals Semarang Central Java Indonesia. Data collection was obtained from observations. Data analysis used quantitative analysis.
Results: 16.9% were confirmation related to Z code as diagnosis, 11.1% were confirmation of secondary codes, 17.2% were confirmation of potential outpatient and inpatient care, 7.6% were system confirmation, 11.6% were confirmation related to medical support, 11.1% were confirmation regarding number of visits, 5.3% were confirmation related to medical actions, and 19.2% were other confirmations, which contains about authentication, administrative documents, patient identity.
Conclusion: Completeness of medical information on outpatients from emergency departments and polyclinic of BPJS Health patients were confirmation related to Z code as diagnosis, confirmation of secondary codes, confirmation of potential outpatient and inpatient care, system confirmation, confirmation related to medical support, confirmation regarding number of visits, confirmation related to medical actions, and other confirmations.
References
Bunga S, Indar, Seweng A. Implementation of First Level Outpatient Reference of BPJS Health Insurance Participants at Community Health Centres in Maros Regency. Indian J Public Heal Res Dev. 2019;10(04):889–92.
Suhanda R, Rochmah TN, Chalidyanto D, Ernawaty. Analysis of primary health facility leader perceived risk on cooperation with health care and social security agency in east java: (Study on public health centers and non-public health centers in urban areas). Indian J Forensic Med Toxicol. 2019;13(4):678–82.
Dartanto T, Pramono W, Lumbanraja AU, Siregar CH, Bintara H, Sholihah NK, et al. Enrolment of informal sector workers in the National Health Insurance System in Indonesia: A qualitative study. Heliyon [Internet]. 2020;6(11):1–12. Available from: https://doi.org/10.1016/j.heliyon.2020.e05316
Ilyas AA, Indar, Syamsuar, Razak A, Sukri, Masni. Implementation of Social Security Organizing Agency (BPJS) Compliment Claim at Bahagia General Hospital Makassar. Int J Adv Sci Technol. 2020;29(7):14100–11.
Nurhayati, Fitrisari D. Business Process Automation of Document Filing Based Alfresco for Referral BPJS Patient (case study: BPJS Center of Dharmais Cancer Hospital). In: 2016 International Conference on Informatics and Computing, ICIC 2016. 2017. p. 406–10.
Widiyanti DA, Rahab R, Siswandari W. Finding The Key Words Medical Staff’s Compliance On The Completeness And Return Of Speed Of Inpatient Medical Record In Cilacap Hospital. In: International Conference on Rural Development and Enterpreneurship 2019 : Enhancing Small [Internet]. 2019. p. 245–51. Available from: https://scholar.google.nl/citations?user=tvQxUtkAAAAJ&hl=en
Oktoriani EN, Sutrisno J, Mayasari E, Sodik MA. Analysis of Medical Record Complete Flexibility to Complete Claims of Health BPJS RS Baptis Kota Batu. Anal Med Rec Complet Flex to Complet Claims Heal BPJS RS Baptis Kota Batu. 2018;3(1):46–53.
Sukiatun. Analysis Claim BPJS Review From Completeness of Medical Record Documents and Accuracy Diagnosis Codes in RSUD. dr. Iskak Tulungagung. J Qual Public Heal. 2018;1(1):1–12.
Windarti S, Maidin A, Saleh LM. Factors Causing the Delay of Submission of Health BPJS Claims in Hospital in Sidenreng Rappang District. Sci J Eng Pharm Sci. 2019;1(6):11–6.
Supriadi. Overview of the National Health Insurance Claims Process in Private Hospital X in Jakarta. In: KnE Social Sciences. 2018. p. 987.
Intiasari AD, Aji B, Masfiah S, Trisnantoro L, Hendrartini J. Factors Affecting Delaying Payment of National Health Insurance (BPJS Kesehatan) Premium Among Participants of The Informal Sector in Banyumas Regency. Ann Trop Med Public Heal. 2019;22(11B):1–7.
Istiqamah NF, Darmawansyah D, Syafar M, Mallongi A. Implementation of the national health insurance referral system at the public health center in the Pangkajene Kepulauan district in 2019. Open Access Maced J Med Sci. 2020;8(T2):27–31.
Yuliani, Nurwahyuni A. The Accuracy of Diagnosis, Procedures and Coding Completeness and Their Correlation With INA-CBG. In: Proceedings of International Conference on Applied Science and Health ICASH-PT014 [Internet]. 2019. p. 1109–23. Available from: https://publications.inschool.id/index.php/icash/article/view/472
Noveria Y, Soewondo P. Causes of Health Insurance Claim Revision in the Casemix Unit at Pekanbaru Hospital, Riau. In: The 5th International Conference on Public Health. 2019. p. 534–9.
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