Analysis of Pending Claims in Cases of Mistakes in Codification of Diagnosis in the INA-CBGs Claim Problem Solution Management Guide
Main Article Content
Abstract
Pending claims are a problem and a challenge for coders, along with the presence of Minister of Health Regulation No. 24 of 2022, which provides greater challenges for coders in clinical classification coding activities. The research contributed to finding out Pending Claim Analysis in Cases of Mistakes in Codification of Diagnosis in the INA-CBGs Claim Problem Solution Management Guide. This research was carried out from March to May 2023 at the Hospital Casemix Department in Bukittinggi. The implementation of this research started with collecting secondary data using observation, interviews, and documentation methods. Processing and analyzing data by collecting, tabulating, narrating, and analyzing descriptively with a retrospective approach based on relevant regulations. The non-random sampling technique used in sampling is Purposive Sampling. The research results showed that there were 5 cases of pending claims that experienced errors in the codification of the claimed diagnosis. Codification errors are caused by mismatches in management and resources, the emergence of mortality codes, and discrepancies in examination result values with the diagnosis criteria claimed in accordance with the BPJS Minutes Management Guide for Solutions to INA-CBGs Claim Problems.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with Jurnal Keperawatan Respati Yogyakarta agree to the following terms:
- Authors retain copyright and grant Jurnal Keperawatan Respati Yogyakarta right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC-BY that allows others to remix, adapt, build upon the work with an acknowledgment of the work's authorship and initial publication and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).